Diabetes and periodontitis

Interlinked Pathways: Exploring the Bidirectional Impacts of Periodontitis and Metabolic Syndrome

Metabolic syndrome (MBS) and periodontitis are distinct conditions with overlapping and unique risk factors. Periodontitis is a chronic destructive disease of the periodontium, driven by alterations in the host immune-inflammatory response to virulent periodontal pathogens. MBS is characterized by various abnormalities, including visceral abdominal obesity, dyslipidemia (low high-density lipoprotein (HDL) and high triglyceride (TG) levels), hypertension, and hyperglycemia. These factors collectively increase the risk of atherosclerotic cardiovascular disease (CVD) and diabetes. Several pro-inflammatory mediators are involved in the pathogenesis of periodontitis and MBS, and the deleterious bidirectional effects of these mediators exacerbate the severity and progression of both conditions. This comprehensive review focuses on the intricate relationship between MBS and periodontitis. Specifically, it explores the pathophysiological mechanisms of each disease component of MBS and its impact on periodontitis, and vice versa.

Association of endogenous sex hormone levels with tooth loss due to periodontitis in men and post-menopausal women: The multi-ethnic study of atherosclerosis

AIM

To investigate the association between endogenous sex hormone levels and history of tooth loss related to periodontitis in healthy middle-aged to older men and post-menopausal women.

METHODS

This cross-sectional study included 5649 participants aged 45-84 (mean age, 63 ± 10 years) from the Multi-Ethnic Study of Atherosclerosis cohort who had sex hormone levels measured and answered a questionnaire regarding perceived periodontal status at exam 1. Multivariable logistic regression was used to examine the association of sex hormones (exposure) with history of tooth loss (outcome), stratified by sex.

RESULTS

Among post-menopausal women, higher free testosterone (per 1SD) was associated with a greater prevalence of tooth loss [OR 1.49 (95% CI, 1.08-2.05)], whereas higher sex hormone binding globulin (SHBG) was associated with a lower prevalence of tooth loss [OR 0.74 (0.58-0.94)], after adjustment for cardiometabolic risk factors and reproductive factors. In men, higher free testosterone and lower SHBG were associated with a lower prevalent probability of tooth loss in unadjusted analysis, but these associations lost significance after covariate adjustment.

CONCLUSION

A higher androgenic sex hormone profile in post-menopausal women (i.e., increased free testosterone, lower SHBG) was associated with an increased prevalence of tooth loss, after adjusting cardiometabolic risk factors. No such association was found in men. These findings suggest that sex hormones may influence or serve as a marker for periodontal health.

Food preferences and periodontal status of adults assisted by a public health care system

This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher's discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18-39; 40-59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18-39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40-59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system.

Potential Effects of Non-Surgical Periodontal Therapy on Periodontal Parameters, Inflammatory Markers, and Kidney Function Indicators in Chronic Kidney Disease Patients with Chronic Periodontitis

Chronic kidney disease (CKD) and chronic periodontitis (CP) contribute to the increased level of inflammatory biomarkers in the blood. This study hypothesized that successful periodontal treatment would reduce the level of inflammatory biomarkers in CKD patients. This prospective study recruited two groups of CP patients: 33 pre-dialysis CKD patients and 33 non-CKD patients. All patients underwent non-surgical periodontal therapy (NSPT). Their blood samples and periodontal parameters were taken before and after six weeks of NSPT. The serum level of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and periodontal parameters were compared between groups. On the other hand, kidney function indicators such as serum urea and estimated glomerular filtration rate (eGFR) were only measured in CKD patients. Clinical periodontal parameters and inflammatory markers levels at baseline were significantly higher (p < 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p < 0.05) after six weeks of NSPT. CKD patients demonstrated a greater periodontitis severity and higher inflammatory burden than non-CKD patients. Additionally, CKD patients with CP showed a good response to NSPT. Therefore, CKD patients’ periodontal health needs to be screened for early dental interventions and monitored accordingly.

Association of hyperglycaemia and periodontitis: an updated systematic review and meta-analysis

Purpose

The aim of this updated systematic review and meta-analysis was the association between hyperglycemia and periodontitis.

Methods

We searched PubMed/MEDLINE, Web of Science, and Scopus until March 2021. The key search words were based on "periodontitis" and "hyperglycemia." We included cohort, case-control, and cross-sectional studies, restricted to publications in English. The quality assessment of included studies and data extraction were done by two independent reviewers. Meta-analysis was performed for cross-sectional studies using the random-effects model.

Results

The literature search yielded 340 studies, and finally, 19 and 11 studies were included in systematic review and meta-analysis, respectively. The total sample size of the eligible studies in the meta-analysis was 38,896 participants, of whom 33% were male with a mean age of 51.20 ± 14.0 years. According to a random-effect meta-analysis in cross-sectional studies, the pooled odds ratio (OR) for the association between hyperglycemia and periodontal indices was statistically significant (OR: 1.50, 95%CI: 1.11, 1.90). There was evidence of publication bias (coefficient: - 3.53, p-value = 0.014) which, after imputing missing studies, the pooled OR of the association between hyperglycemia and periodontitis change to 1.55 (95%CI: 1.20, 1.90).

Conclusion

Results of the present study show that hyperglycemia was positively associated with periodontitis. However, more cohort and prospective longitudinal studies should be conducted to find the exact association. Overall, it seems the management of hyperglycemia could be considered as a preventive strategy for periodontitis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00861-9.

Self-correction of pathologic tooth migration after nonsurgical periodontal treatment in a metabolic syndrome patient with severe periodontitis and drug-influenced gingival enlargement

Drug-influenced gingival enlargement (DIGE) and reduced bone support caused by periodontitis are two of the etiologic factors for pathologic tooth migration (PTM). Comprehensive management, including surgical, orthodontic, and prosthodontic treatment, is usually required for recovery from severe DIGE and PTM. An 85-year-old Taiwanese male with a history of hypertension and uncontrolled diabetes mellitus (DM) visited our dental department for severe gingival enlargement and spontaneous bleeding. He was diagnosed as having advanced periodontitis and DIGE. Remarkable PTM occurred on the front sextants of his dentition. The patient's DM was gradually controlled, and his calcium channel blocker treatment was substituted with a new regimen for 7 months. One year after nonsurgical periodontal treatment and reinforcing the patient's oral care, both DIGE and PTM were spontaneously resolved without any surgical or orthodontic intervention. We advocate the value of early diagnosis, improving patient's oral hygiene, and meticulous nonsurgical treatment for both DIGE and PTM.

Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis

The objective of this article was to conduct a systematic review of the literature to contrast the existing evidence regarding the relationship between periodontal disease (PD) and diabetes mellitus (DM) with the possibly increased risk of SARS-CoV-2 infection, as well as to establish a hypothesis that explains the ways in which this interaction could take place. A literature search up from 1 January 2020 to 21 March 2021 was conducted in three electronic databases, namely, PubMed, Web of Science, and Scopus, in order to identify studies on periodontal disease alone or in conjunction with diabetes mellitus, reporting any relation with SARS-CoV-2 infection as a primary outcome. Only articles published in the English language were included. Due to the lack of studies, we decided to collect all the theoretical and clinical evidence suggesting a possible biological pathway evidencing the relationship among PD, DM, and SARS-CoV-2 infection. From a total of 29 articles, 12 were included for final review studies (five reviews, two hypotheses, one Special Issue, one perspective, one commentary, one case–control study, and one case report). In addition, this systematic review article hypothesizes the correlation between PD and type 2 diabetes mellitus (T2DM) by expression of angiotensin-converting enzyme 2 (ACE2) in periodontal tissue and the risk of SARS-CoV-2 infection. T2DM is a metabolic disorder characterized by high blood glucose levels resulting from altered insulin secretion or action. Likewise, periodontitis and T2DM are inflammatory disorders with a bidirectional association, and both diseases have a similar immunomodulatory cascade and cytokine profile. ACE2 is a crucial component of the renin–angiotensin system (RAS) and the key factor of entry in the cells by the new SARS-CoV-2. ACE2 is widely distributed in the lung and kidneys, and interestingly has a great distribution in the oral cavity, principally in the tongue and periodontal tissue. ACE2 in periodontal tissue plays a crucial role between health and disease. Moreover, the ACE2/Ang-(1-7)/MasR axis is downregulated in the dysbiotic and inflammatory periodontal environment. Nevertheless, the balance of ACE2 activity is modified in the context of concurrent diabetes, increasing the expression of ACE2 by the uncontrolled glycemia chronic in T2DM. Therefore, the uncontrolled hyperglycemia possibly increases the risk of developing periodontitis and triggering overexpression of ACE2 in periodontal tissue of T2DM patients, with these events potentially being essential to SARS-CoV-2 infection and the development of mild-to-severe form of COVID-19. In this sense, we would like to point out that the need for randomized controlled trials is imperative to support this association.

Evaluation of gingival and periodontal status in obese and non-obese type II diabetic patients - a cross sectional study

Objective

The aim of this study was to evaluate gingival and periodontal status in obese and non-obese type II Diabetic Patients.

Methods

The study population comprised of 75 subjects visiting the outpatient department of our institution, divided into three different groups, group 1 (obese diabetic), group 2 (non-obese diabetic), and group 3 (obese, non-diabetic). Diabetic status was assessed with HbA1c values and obesity status was assessed by body mass index (BMI) score greater than or equal to 30 kg/m². Gingival and periodontal status were assessed using the Gingival Index (GI) and Community Periodontal Index (CPI) respectively.

Results

The mean gingival index score in group 1, group 2, and group 3 were 1.58, 1.54, and 1.25, respectively. Gingival status was poor among obese and non-obese diabetic subjects (Groups 1 and 2) when compared with obese non-diabetic patients (Group 3). The periodontal status showed that periodontal pockets were increased in diabetic obese group (15.4%), followed by diabetic non obese (4.66%), and non-diabetic obese (2%) group respectively and loss of attachment was severe in diabetic obese group (60.7%), followed by diabetic non obese (45.9%) and non-diabetic obese (15.3%) respectively.

Conclusion

Gingival and periodontal status was poor in the obese diabetic group compared to non-obese diabetic and obese non diabetic group. Hence, the risk of gingivitis and periodontitis in obese diabetic patients should be addressed earlier to prevent further complications and achieve a good oral health status.

One-year evaluation of a new restorative glass ionomer cement for the restoration of non-carious cervical lesions in patients with systemic diseases: a randomized, clinical trial

OBJECTIVE

This randomized and clinical trial aimed to evaluate the performance of a new restorative Glass Ionomer Cement (GIC) for the restoration of non-carious cervical lesions (NCCLs) of patients with systemic diseases compared with a posterior resin composite after 12 months.

METHODOLOGY

134 restorations were placed at 30 patients presenting systemic diseases by a single clinician. NCCLs were allocated to two groups according to restorative system used: a conventional restorative GIC [Fuji Bulk (GC, Tokyo Japan) (FB)] and a posterior resin composite [G-ænial Posterior (GC, Tokyo Japan) (GP)] used with a universal adhesive using etch&rinse mode. All restorative procedures were conducted according to manufacturer's instructions. Restorations were scored regarding retention, marginal discoloration, marginal adaptation, secondary caries, surface texture, and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after 1 week (baseline), 6, and 12 months. Descriptive statistics were performed using chi-square tests. Cochran Q and Mc Nemar's tests were used to detect differences over time.

RESULTS

After 12 months, recall rate was 93% and the rates of cumulative retention failure for FB and GP were 4.9% and 1.6% respectively. Both groups presented similar alpha rates for marginal adaptation (FB 86.2%, GP 95.5%) and marginal discoloration (FB 93.8%, GP 97%) at 6-month recall, but FB restorations showed higher bravo scores than GP restorations for marginal adaptation and marginal discoloration after 12 months (p<0.05). Regarding surface texture, 2 FB restorations (3.1%) were scored as bravo after 6 months. All restorations were scored as alpha for secondary caries and postoperative sensitivity after 12 months.

CONCLUSION

Although the posterior resin composite demonstrated clinically higher alpha scores than the conventional GIC for marginal adaptation and discoloration, both materials successfully restored NCCLs at patients with systematic disease after a year.

CLINICAL RELEVANCE

Due to its acceptable clinical results, the tested conventional restorative GIC can be used for the restoration of NCCLs of patients with systemic diseases.

Periodontal parameters and oral hygiene in diabetic and nondiabetic adolescents in Zanjan

Background: Periodontal disease and diabetes mellitus are 2 most common encountered chronic diseases. The occurrence, appearance, and severity of the periodontium tissue conditions vary during adolescence. Also, there is controversy about the relationship between diabetes mellitus and increased periodontal disease breakdown during puberty. This study aimed to assess the periodontal parameters and oral hygiene in diabetic and nondiabetic adolescents in city of Zanjan. Methods: In this case and controls study, 140 diabetic (case) and 140 nondiabetic (control) adolescents were compared. The participants were matched by age, sex, and socioeconomic status using the group matching method. Clinical attachment loss, periodontal pocket depth, gingival index, periodontal index, and bleeding on probing were measured for the 6 Ramfjord index teeth. Data were analysed using descriptive statistics, chi-square test, t test, and one-way ANOVA using SPSS version 18. Results: The mean age of the diabetic and nondiabetic group was 16.7±1.6 and 17.1±0.30 years, respectively. Duration of diabetes was 2.15 ±0.86 years. Mean clinical attachment loss, periodontal pocket depth, gingival index, and bleeding on probing in the patient group were 7.4, 1.68, 12.9, and 97.7%, respectively. All these indices in diabetic adolescents were significantly greater than in nondiabetics. Only the PI was poor in both groups and no significant difference was noted in this respect between the 2 groups. Conclusion: Both diabetic and nondiabetic adolescents had equally poor oral hygiene. Gingivitis and periodontitis indices were significantly poorer in diabetic patients.

MMP-2 salivary activity in type 2 diabetes mellitus patients

BACKGROUND

Type 2 diabetes mellitus (T2DM) and periodontitis are chronic inflammatory diseases with a bidirectional relationship. The uncontrolled levels of glucose in T2DM patients change the pathophysiology and balance of inflammatory mediators. Matrix Metalloproteinase-2 (MMP-2) is a zinc-dependent endopeptidase that is responsible for tissue remodeling and degradation of the extracellular matrix in periodontal tissue. Therefore, the uncontrolled levels of glucose in T2DM could lead to an imbalance in MMP-2 activity in saliva, favoring the development of periodontitis.

METHODS

Ninety-seven T2DM patients from Hospital Dr. Donato Alarcon were included in the study. Following clinical examination, the patients were classified into four groups according to the presence and degree of periodontal disease and glycemic control. Blood and whole saliva samples (WSS) were collected from each patient. Blood samples were used for Hba1c and polymorphonuclear cells count determination, while WSS were used to determine MMP-2 activity, TIMP-1 and nitrite. MMP-2 activity was determined by zymography. TIMP-1 were determined by Western blotting, and nitric oxide (NO) levels were determined by the Griess method.

RESULTS

Of the 97 patients with T2DM, 66 had periodontitis of different severities: 18 patients had mild periodontitis, 15 had moderate and 33 had severe. Salivary MMP-2 activity, HbA1c and TIMP-1 were positively correlated with the severity of periodontitis. On the other hand, the increase in HbA1c was negatively correlated with MMP-2 activity and quantity of TIMP-1 but was positively correlated with nitrite levels.

CONCLUSIONS

T2DM with glycemic uncontrol conditions, distinct clinical alterations in periodontal tissue were identified, including a decrease in the gingival redness, increased the clinical attachment loss and imbalance of MMP-2/TIMP-1, as the possible causes of disorders promoting the progression of periodontitis. Accelerated periodontitis development with poor glycemic uncontrol likely results from the altered response of host defenses and decreased activity of polymorphonuclear cells. Taken together, these findings identify MMP-2 as a promising molecular market for periodontitis.

The Post-amyloid Era in Alzheimer's Disease: Trust Your Gut Feeling

The amyloid hypothesis, the assumption that beta-amyloid toxicity is the primary cause of neuronal and synaptic loss, has been the mainstream research concept in Alzheimer's disease for the past two decades. Currently, this model is quietly being replaced by a more holistic, “systemic disease” paradigm which, like the aging process, affects multiple body tissues and organs, including the gut microbiota. It is well-established that inflammation is a hallmark of cellular senescence; however, the infection-senescence link has been less explored. Microbiota-induced senescence is a gradually emerging concept promoted by the discovery of pathogens and their products in Alzheimer's disease brains associated with senescent neurons, glia, and endothelial cells. Infectious agents have previously been associated with Alzheimer's disease, but the cause vs. effect issue could not be resolved. A recent study may have settled this debate as it shows that gingipain, a Porphyromonas gingivalis toxin, can be detected not only in Alzheimer's disease but also in the brains of older individuals deceased prior to developing the illness. In this review, we take the position that gut and other microbes from the body periphery reach the brain by triggering intestinal and blood-brain barrier senescence and disruption. We also surmise that novel Alzheimer's disease findings, including neuronal somatic mosaicism, iron dyshomeostasis, aggressive glial phenotypes, and loss of aerobic glycolysis, can be explained by the infection-senescence model. In addition, we discuss potential cellular senescence targets and therapeutic strategies, including iron chelators, inflammasome inhibitors, senolytic antibiotics, mitophagy inducers, and epigenetic metabolic reprograming.

Correlation between diabetes mellitus and periodontitis in Taiwan: A nationwide cohort study

AIMS

The mechanism underlying the association of diabetes mellitus (DM) and periodontitis is not clear. This study aimed to investigate the correlation between DM and periodontitis.

METHODS

This study was a retrospective cohort study, which conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 39,384 new-onset DM patients who aged above 20 years old from 2005 to 2012. To avoid selection bias, we applied propensity score matching to obtain patients without DM, as the control group. Cox proportional hazard model was used to analyze the risk of periodontitis in patients with DM.

RESULTS

After controlling for related variables, Patients with DM had a higher risk for periodontitis compared with the patients without DM (adjusted hazard ratios [aHR] = 1.04, 95% confidence interval [CI]: 1.01-1.08). Patients with hypertension (HTN) had no higher risk for periodontitis (aHR = 0.96, 95% CI: 0.92-1.00). Patients with dyslipidemia and rheumatoid arthritis (RA) patients both had a higher risk for periodontitis (aHR = 1.26, 95% CI: 1.19-1.34; aHR = 1.41, 95% CI: 1.19-1.67).

CONCLUSIONS

There is a correlation between DM and periodontitis. Patients with DM may have a higher risk of incident periodontitis. Besides, age, HTN, dyslipidemia, and RA are also associated with incident periodontitis.

Proinflammatory (CD14+CD16++) monocytes in type 2 diabetes mellitus patients with/without chronic periodontitis

BACKGROUND

Until date, the proportion of nonclassic monocytes in type 2 diabetic mellitus patients with and without chronic periodontitis has not been evaluated based on glycemic control. The objective of this study was to compare the proportion of CD14+CD16++ monocytes in type 2 diabetic patients with and without chronic periodontitis.

MATERIALS AND METHODS

In this cross sectional study A total of sixty individuals with type 2 diabetes mellitus (n = 15/group) were recruited. Individuals were grouped based on glycosylated hemoglobin A (HbA 1c) values and the presence of chronic periodontitis; Group 1 (diabetes mellitus with good glycemic control), Group 2 (diabetes mellitus with poor glycemic control), Group 3 (diabetic mellitus with chronic periodontitis and good glycemic control), Group 4 (diabetic mellitus with chronic periodontitis and poor glycemic control). Fluorochrome-conjugated monoclonal antibodies against CD14, CD16, and human leukocyte antigen-antigen D related was used to analyze the proportion of nonclassic monocytes by flow cytometry. One-way ANOVA with Tukey's post-hoc test was used to assess the significant differences in monocyte subpopulations. The Pearson's correlation test was used to assess the relationship between hemoglobin A1c values and percentage of nonclassical monocytes. In both the above statistical tools, the value of P < 0.05 is considered as significant level.

RESULTS

Group 4 had the highest percentage of CD14+CD16++ monocytes 14.67% + 4.70%, followed by Group 3-9.73% + 0.60%, Group 2-9.32% + 2.03% and Group 1-5.92% + 0.63% (P < 0.001). Further, a statistically significant positive correlation between HbA (1c) levels and the proportion of CD14+CD16++ monocytes was observed.

CONCLUSION

In the present study, we observed type 2 diabetes mellitus patients with poor glycemic control and chronic periodontitis showed more than two-fold increase in the proportion of nonclassic monocytes compared to type 2 diabetes mellitus patients with good glycemic control.

Effects of Diabetes and Hypertension on Oral Mucosa and TGFβ1 Salivary Levels

The aim of this study was to investigate salivary levels of TGFβ1 and proliferation/ maturation of epithelial mucosa cells in diabetic and hypertensive patients.

DESIGN

in this cross-sectional study, whole stimulated saliva and oral mucosa exfoliative cytology specimens were collected from 39 patients that were healthy (control, n=10) or presented history of arterial hypertension (HAS, n=9), diabetes mellitus (DM, n=10) or both (DM+HAS, n=10). Salivary flow rate (SFR), TGFβ1 level in saliva, AgNORs and the epithelial maturation were evaluated. Non-parametric Kruskal-Wallis test, followed by Dunn's multiple comparison post-test and the Spearman test correlation analysis were used. SFR showed a significant decreased in DM and DM+HAS (0.47±0.11 and 0.64±0.43 mL/min) when compared to control (1.4±0.38 mL/min). DM+HAS presented the highest value of TGFβ1 concentration (24.72±5.89 pg/mL). It was observed a positive correlation between TGFβ1 and glycaemia (R=0.6371; p<0.001) and a negative correlation between TGFβ1 and saliva (R=-0.6162; p<0.001) and glycaemia and SFR (R=-0.5654; P=0.001). AgNORs number and status of maturation of mucosa cells were similar for all conditions. DM and DM+HAS presented the lowest SFR, which correlated with increased TGFβ1 levels. Despite the higher TGFβ1 secretion it was not observed changes in the morphology or proliferation of epithelial cells when diabetes or hypertension was present.

Relationship Between Periodontal Disease and Serum Factors in Patients Undergoing Hemodialysis

BACKGROUND

Chronic renal disease is a common condition with several recognized risk factors. Periodontal disease is a recently suggested risk factor for renal disease. We aimed to assess the relationship between periodontal disease and several serum factors in patients undergoing hemodialysis.

METHODS

This descriptive cross-sectional study was conducted on 57 patients undergoing hemodialysis. Periodontal examination was done by measuring the mean Pocket Depth (PD), Silness-Löe Plaque Index (PI), Ainamo and Bay Bleeding On Probing (BOP), Löe and Silness Gingival Index (GI) and Clinical Attachment Loss (CAL). Serum levels of albumin, calcium, phosphorus, hemoglobin, ferritin and creatinine were measured via a routine blood test. Cystatin C was separately measured. Data were analyzed using independent t-test, Pearson's correlation coefficient, chi square test and Mann Whitney test (alpha=0.05).

RESULTS

37 men and 20 women were evaluated. Of these, 26.3% had periodontitis and 73.7% had gingivitis. Serum level of albumin (P=0.02) and ferritin (P=0.043) in patients with periodontitis was significantly higher than that in patients with gingivitis. The serum level of creatinine (P=0.02), cystatin C (P=0.013), calcium (P=0.046) and phosphorus (P=0.037) had a significant correlation with severity of periodontitis and increase in CAL.

CONCLUSION

Increase in the serum levels of albumin and ferritin was related to the progression of gingivitis to periodontitis. Also, the serum levels of creatinine, cystatin C, calcium and phosphorus increased with an increase in CAL.

Effects of β-Glucans Ingestion on Alveolar Bone Loss, Intestinal Morphology, Systemic Inflammatory Profile, and Pancreatic β-Cell Function in Rats with Periodontitis and Diabetes

This study aimed to evaluate the effects of β-glucan ingestion (Saccharomyces cerevisiae) on the plasmatic levels of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10), alveolar bone loss, and pancreatic β-cell function (HOMA-BF) in diabetic rats with periodontal disease (PD). Besides, intestinal morphology was determined by the villus/crypt ratio. A total of 48 Wistar rats weighing 203 ± 18 g were used. Diabetes was induced by the intraperitoneal injection of streptozotocin (80 mg/kg) and periodontal inflammation, by ligature. The design was completely randomized in a factorial scheme 2 × 2 × 2 (diabetic or not, with or without periodontitis, and ingesting β-glucan or not). The animals received β-glucan by gavage for 28 days. Alveolar bone loss was determined by scanning electron microscopy (distance between the cementoenamel junction and alveolar bone crest) and histometric analysis (bone area between tooth roots). β-glucan reduced plasmatic levels of TNF-α in diabetic animals with PD and of IL-10 in animals with PD (p < 0.05). β-glucan reduced bone loss in animals with PD (p < 0.05). In diabetic animals, β-glucan improved β-cell function (p < 0.05). Diabetic animals had a higher villus/crypt ratio (p < 0.05). In conclusion, β-glucan ingestion reduced the systemic inflammatory profile, prevented alveolar bone loss, and improved β-cell function in diabetic animals with PD.

Periodontal disease and the metabolic syndrome

The metabolic syndrome (MetS) is a spectrum of conditions that increase the risk of cardiovascular disease and diabetes mellitus. The components of MetS include dysglycemia, visceral obesity, atherogenic dyslipidemia (elevated triglycerides and low levels of high-density lipoprotein) and hypertension. An association of periodontal disease and MetS has been suggested. This association is believed to be the result of systemic oxidative stress and an exuberant inflammatory response. When examined individually, the components of the MetS that are most closely related to the risk of periodontitis are dysglycemia and obesity, with lesser contributions by atherogenic dyslipidemia and hypertension. Data suggest that the odds of periodontitis increase with the number of MetS components present in an individual. The direction of the relationship between MetS and periodontal disease cannot currently be determined because the majority of studies are cross-sectional. The association between MetS and periodontitis, however, suggests that improved understanding of this association could promote interprofessional practice. Evidence suggests that periodontal therapy can reduce the levels of inflammatory mediators in serum. If this finding is confirmed, periodontal treatment could become part of therapy for MetS. Oral health providers who identify patients at risk for MetS could refer them to a medical provider, and physicians could refer patients to dentists to ensure that patients with MetS receive a dental evaluation and any necessary treatment. These clinical activities would improve both oral and general health outcomes.

The oral cavity microbiota: between health, oral disease, and cancers of the aerodigestive tract

Many studies show that the human microbiome plays a critical role in the chronic pathologies of obesity, inflammatory bowel diseases, and diabetes. More recently, the interaction between cancer and the microbiome has been highlighted. Most studies have focused on the gut microbiota because it represents the most extensive bacterial community, and the body of evidence correlating it with gut syndromes is increasing. However, in the strict sense, the gastrointestinal (GI) tract begins in the oral cavity, and special attention should be paid to the specific flora of this cavity. This study reviewed the current knowledge about the various microbial ecosystems of the upper part of the GI tract and discussed their potential link to carcinogenesis. The overall composition of the microbial communities, as well as the presence or absence of "key species", in relation to carcinogenesis is addressed. Alterations in the oral microbiota can potentially be used to predict the risk of cancer. Molecular advances and the further monitoring of the microbiota will increase our understanding of the role of the microbiota in carcinogenesis and open new perspectives for future therapeutic and prophylactic modalities.

Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients

BACKGROUND

This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects.

METHODS

517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were "periodontitis" and "oral hygiene behaviour", each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The "low performance index" (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0).

RESULTS

Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6).

CONCLUSIONS

The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women.

A novel chemically modified curcumin reduces inflammation-mediated connective tissue breakdown in a rat model of diabetes: periodontal and systemic effects

BACKGROUND AND OBJECTIVE

Periodontal disease is the most common chronic inflammatory disease known to mankind (and the major cause of tooth loss in the adult population) and has also been linked to various systemic diseases, particularly diabetes mellitus. Based on the literature linking periodontal disease with diabetes in a "bidirectional manner", the objectives of the current study were to determine: (i) the effect of a model of periodontitis, complicated by diabetes, on mechanisms of tissue breakdown including bone loss; and (ii) the response of the combination of this local and systemic phenotype to a novel pleiotropic matrix metalloproteinase inhibitor, chemically modified curcumin (CMC) 2.24.

MATERIAL AND METHODS

Diabetes was induced in adult male rats by intravenous injection of streptozotocin (nondiabetic rats served as controls), and Escherichia coli endotoxin (lipopolysaccharide) was repeatedly injected into the gingiva to induce periodontitis. CMC 2.24 was administered by oral gavage (30 mg/kg) daily; untreated diabetic rats received vehicle alone. After 3 wk of treatment, the rats were killed, and gingiva, jaws, tibia and skin were collected. The maxillary jaws and tibia were dissected and radiographed. The gingival tissues of each experimental group (n = 6 rats/group) were pooled, extracted, partially purified and, together with individual skin samples, analyzed for matrix metalloproteinase (MMP)-2 and MMP-9 by gelatin zymography; MMP-8 was analyzed in gingival and skin tissue extracts, and in serum, by western blotting. The levels of three bone-resorptive cytokines [interleukin (IL)-1β, IL-6 and tumor necrosis factor-α], were measured in gingival tissue extracts and serum by ELISA.

RESULTS

Systemic administration of CMC 2.24 to diabetic rats with endotoxin-induced periodontitis significantly inhibited alveolar bone loss and attenuated the severity of local and systemic inflammation. Moreover, this novel tri-ketonic phenylaminocarbonyl curcumin (CMC 2.24) appeared to reduce the pathologically excessive levels of inducible MMPs to near-normal levels, but appeared to have no significant effect on the constitutive MMPs required for physiologic connective tissue turnover. In addition to the beneficial effects on periodontal disease, induced both locally and systemically, CMC 2.24 also favorably affected extra-oral connective tissues, skin and skeletal bone.

CONCLUSION

This study supports our hypothesis that CMC 2.24 is a potential therapeutic pleiotropic MMP inhibitor, with both intracellular and extracellular effects, which reduces local and systemic inflammation and prevents hyperglycemia- and bacteria-induced connective tissue destruction.

Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

BACKGROUND

Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors.

MATERIALS AND METHODS

All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis.

RESULTS

One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis.

CONCLUSION

This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis.

The influence of type 2 diabetes mellitus on salivary matrix metalloproteinase-8 levels and periodontal parameters: A study in an Indian population

OBJECTIVE

Although many studies reported more severe periodontal disease and the existing proinflammatory conditions in patients with diabetes but only few have examined the effect of type 2 diabetes mellitus (DM) on salivary matrix metalloproteinase-8 (MMP-8) level and other periodontal parameters. This study aims to evaluate the effect of type 2 DM on salivary MMP-8 levels and periodontal parameters, which might be useful in monitoring periodontal disease in diabetes.

MATERIALS AND METHODS

A total of 90 subjects were selected for the study and were divided into three groups: Group I included 30 healthy subjects; Group II included 30 subjects without type 2 DM but with chronic periodontitis, and Group III included 30 subjects with type 2 DM and chronic periodontitis. Periodontal parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were taken. The salivary MMP-8 level was estimated by Quantikine Human total MMP-8 immunoassay kit using ELISA method.

RESULTS

The mean value of the salivary MMP-8 of Group III was highest followed by Group II and Group I, the least. The other periodontal parameters PI, GI, PPD, CAL, was comparatively highest for Group III.

CONCLUSION

This study suggests that diabetes is associated with an increased prevalence, extent, and severity of periodontitis. Furthermore, the increased levels of MMP-8 indicate the influence of diabetes on their salivary concentration.

β-Glucans (Saccharomyces cereviseae) Reduce Glucose Levels and Attenuate Alveolar Bone Loss in Diabetic Rats with Periodontal Disease

The objective of this study was to assess the effects of oral ingestion of β-glucans isolated from Saccharomyces cereviseae on the metabolic profile, expression of gingival inflammatory markers and amount of alveolar bone loss in diabetic rats with periodontal disease. Diabetes mellitus was induced in 48 Wistar rats by intraperitoneal injection of streptozotocin (80 mg/kg). After confirming the diabetes diagnosis, the animals were treated with β-glucans (by gavage) for 28 days. On the 14^th day of this period, periodontal disease was induced using a ligature protocol. β-glucans reduced the amount of alveolar bone loss in animals with periodontal disease in both the diabetic and non-diabetic groups (p < 0.05). β-glucans reduced blood glucose, cholesterol and triacylglycerol levels in diabetic animals, both with and without periodontal disease (p < 0.05). Furthermore, treatment with β-glucans reduced the expression of cyclooxygenase-2 and receptor activator of nuclear factor kappa-B ligand and increased osteoprotegerin expression in animals with diabetes and periodontal disease (p < 0.05). It was concluded that treatment with β-glucans has beneficial metabolic and periodontal effects in diabetic rats with periodontal disease.

Diabetes mellitus related bone metabolism and periodontal disease

Diabetes mellitus and periodontal disease are chronic diseases affecting a large number of populations worldwide. Changed bone metabolism is one of the important long-term complications associated with diabetes mellitus. Alveolar bone loss is one of the main outcomes of periodontitis, and diabetes is among the primary risk factors for periodontal disease. In this review, we summarise the adverse effects of diabetes on the periodontium in periodontitis subjects, focusing on alveolar bone loss. Bone remodelling begins with osteoclasts resorbing bone, followed by new bone formation by osteoblasts in the resorption lacunae. Therefore, we discuss the potential mechanism of diabetes-enhanced bone loss in relation to osteoblasts and osteoclasts.

Effects of dextrose and lipopolysaccharide on the corrosion behavior of a Ti-6Al-4V alloy with a smooth surface or treated with double-acid-etching

Diabetes and infections are associated with a high risk of implant failure. However, the effects of such conditions on the electrochemical stability of titanium materials remain unclear. This study evaluated the corrosion behavior of a Ti-6Al-4V alloy, with a smooth surface or conditioned by double-acid-etching, in simulated body fluid with different concentrations of dextrose and lipopolysaccharide. For the electrochemical assay, the open-circuit-potential, electrochemical impedance spectroscopy, and potentiodynamic test were used. The disc surfaces were characterized by scanning electron microscopy and atomic force microscopy. Their surface roughness and Vickers microhardness were also tested. The quantitative data were analyzed by Pearson's correlation and independent t-tests (α = 0.05). In the corrosion parameters, there was a strong lipopolysaccharide correlation with the Ipass (passivation current density), Cdl (double-layer capacitance), and Rp (polarization resistance) values (p<0.05) for the Ti-6Al-4V alloy with surface treatment by double-acid-etching. The combination of dextrose and lipopolysaccharide was correlated with the Icorr (corrosion current density) and Ipass (p<0.05). The acid-treated groups showed a significant increase in Cdl values and reduced Rp values (p<0.05, t-test). According to the topography, there was an increase in surface roughness (R2 = 0.726, p<0.0001 for the smooth surface; R2 = 0.405, p = 0.036 for the double-acid-etching-treated surface). The microhardness of the smooth Ti-6Al-4V alloy decreased (p<0.05) and that of the treated Ti-6Al-4V alloy increased (p<0.0001). Atomic force microscopy showed changes in the microstructure of the Ti-6Al-4V alloy by increasing the surface thickness mainly in the group associated with dextrose and lipopolysaccharide. The combination of dextrose and lipopolysaccharide affected the corrosion behavior of the Ti-6Al-4V alloy surface treated with double-acid-etching. However, no dose-response corrosion behavior could be observed. These results suggest a greater susceptibility to corrosion of titanium implants in diabetic patients with associated infections.

The sociodemographic characteristics, periodontal health status, and subgingival microbiota of patients with chronic periodontitis and type 2 diabetes mellitus: a case-control study in a Chinese population

BACKGROUND

In China, chronic periodontitis (CP) is common in patients with type 2 diabetes mellitus (T2DM). The purpose of this study is to identify the sociodemographic characteristics associated with such patients and to assess the periodontal health status and subgingival microbiota of patients with CP and T2DM (T2DMCP) in the Chinese population.

METHODS

A total of 150 patients with T2DMCP and 306 patients with CP without any systemic disease completed questionnaires, underwent clinical periodontal examinations and participated in diabetes-related parameter examinations. Subgingival plaques were obtained to determine the prevalence and amounts of selected oral bacterial species using polymerase chain reaction (PCR) and real-time PCR, respectively.

RESULTS

The income level and mean body mass index (BMI) of the patients with T2DMCP were significantly higher than those of the patients with CP. Additionally, the patients with T2DMCP were more likely to be urban residents, and they had significantly more severe periodontitis than did the patients with CP. In the patients with T2DMCP, the prevalence and amounts of Treponema denticola and Tannerella forsythia were significantly higher than those in the patients with CP. Finally, compared with the patients with CP, the patients with T2DMCP had a significantly lower prevalence and amount of Prevotella intermedia.

CONCLUSIONS

Compared with the patients with CP, the patients with T2DMCP were more likely to be urban residents and generally had higher incomes, higher mean BMI, and poorer periodontal health status. Higher levels of T. denticola and T. forsythia and lower levels of P. intermedia were identified in the subgingival plaque of the patients with T2DMCP.

Salivary proteins as predictors and controls for oral health

We will provide a translational view of using the recent technological advances in dental research for predicting, monitoring, and preventing the development of oral diseases by investigating the diagnostic and therapeutic role of salivary proteins. New analytical state-of-the-art technologies such as mass spectrometry and atomic force microscopy have revolutionized the field of oral biology. These novel technologies open avenues for a comprehensive characterization of the salivary proteins followed by the evaluation of the physiological functions which could make possible in a near future the development of a new series of synthetic protein for therapeutic propose able to prevent global oral diseases such as periodontal disease and dental caries, the two most prevalent oral diseases in the World.