Endogenous and microbial biomarkers for periodontitis and type 2 diabetes mellitus

It has been well documented that there is a two-way relationship between diabetes mellitus and periodontitis. Diabetes mellitus represents an established risk factor for chronic periodontitis. Conversely, chronic periodontitis adversely modulates serum glucose levels in diabetic patients. Activated immune and inflammatory responses are noted during diabetes and periodontitis, under the modulation of similar biological mediators. These activated responses result in increased activity of certain immune-inflammatory mediators including adipokines and microRNAs in diabetic patients with periodontal disease. Notably, certain microbes in the oral cavity were identified to be involved in the occurrence of diabetes and periodontitis. In other words, these immune-inflammatory mediators and microbes may potentially serve as biomarkers for risk assessment and therapy selection in diabetes and periodontitis. In this review, we briefly provide an updated overview on different potential biomarkers, providing novel diagnostic and therapeutic insights on periodontal complications and diabetes mellitus.

Estimation of serum C-reactive protein activity in periodontal health and disease and response to treatment: a clinico-biochemical study

Background

Periodontitis is a chronic infectious disease affecting periodontium having multifactorial etiology, can cause significant systemic challengein addition to localized inflammation, tissue damage, and bone resorption. A serological marker of systemic inflammation known as C-reactive protein has been linked to an increased risk for a number of pathological conditions, including cardiovascular diseases.

Aim

To estimate levels of serum C-reactive protein in healthy individuals and subjects with periodontal diseases and to compare serum C-reactive protein levels in subjects having periodontal disease pre-operatively & post-operatively.

Materials and methods

The study was conducted on 60 subjects age ranging from 35 to 60 years. 30 individuals with healthy periodontium were in group 1 (control group) and the remaining 30 were diagnosed as adult periodontitis were in group 2 (experimental group). Periodontal examination done using gingival index, plaque index, periodontal pocket depth, and Russel's index. CRP levels were examined between group 1 and group 2 and in group 2 between baseline visit before treatment and 2 months after treatment.

Results

The findings of this study show a significant connection between periodontal disease and the inflammatory marker CRP in the body, as well as a tendency for a significant decrease in serumCRP levels following periodontitis therapy. At baseline, there was a positive correlation among C-reactive protein, probing pocket depth, and Russell's index.

Conclusion

As CRP is a key mediator for cardiovascular disease, an increase in C- reactive protein levels in periodontal diseases suggests a significant connection between periodontitis and cardiovascular diseases. Early periodontal treatment might decrease the severity of cardiovascular disease that already exists. This suggests that periodontal examination should be part of routine practicealong with cardiovascular examination.

Elucidation of common molecular diagnostic biomarkers between chronic periodontitis and Parkinson's disease via bioinformatics analyses

BACKGROUND AND OBJECTIVES

Parkinson's disease (PD) and chronic periodontitis (CP) are both inflammatory diseases; a correlation between the two diseases has been reported, but the underlying mechanisms of this association have not been investigated. We investigated the common molecular mechanisms between PD and CP and the role of immune cells in the pathogenesis of them using bioinformatics analyses to elucidate the association between the two diseases.

METHODS

We obtained gene expression data from the Gene Expression Omnibus (GEO) database: GSE10334, GSE16134, and GSE23586 for CP gingival samples and GSE20146 for PD brain samples. Subsequently, we conducted an enrichment analysis of the differentially expressed genes (DEGs) using the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses. Moreover, all DEGs were analysed for protein-transcription factor interactions and protein-immune cell co-expression. We constructed protein-transcription factor, protein-protein interaction (PPI), and protein-immune cell co-expression networks using the Cytoscape software. Moreover, we identified the hub genes and investigated them for potential diagnostic value.

RESULTS AND CONCLUSION

We identified 99 DEGs in the three CP datasets, 520 DEGs in the PD dataset and found five common DEGs in the CP and PD datasets, namely CXCR4, CXCL8, CD19, RPTN, and SLC16A9. These common DEGs identified in our study may have a potential impact on disease pathogenesis through the involvement of CXCR4-CXCL8-CD19 protein-complexes in dendritic cells. Therefore, CD19, LCP2, CXCR4, and LYN could be used as target molecules for the clinical diagnosis of both diseases.

Salivary Amylase and Mucin in Chronic Periodontitis: Pre- /Posttherapy

AIM

The study aims to investigate the potential of salivary amylase as a reliable biochemical marker for assessing periodontal disease progression, establishing a potential correlation between salivary amylase levels and periodontal disease severity.

MATERIALS AND METHODS

The study included 40 participants, aged 25-65, equally divided into a control and study group of 20 individuals each. Clinical parameters, such as oral hygiene index, gingival index, probing depth, and clinical attachment level were recorded. Saliva samples were collected and analyzed for amylase and mucin levels using a semi-auto analyzer and spectrophotometer, respectively. These clinical parameters and salivary biomarkers were evaluated before and after 45 days of phase I periodontal therapy. Statistical analysis, including independent samples t-test, paired samples t-test, and correlation analysis were performed to assess the treatment effectiveness and explore associations between clinical parameters and salivary biomarkers.

RESULTS

The study group with chronic generalized periodontitis showed significantly higher salivary amylase (27022.5 ± 8598.9) and mucin levels (3258 ± 724.2) and worse clinical parameters than the control group at baseline. However, after phase I periodontal therapy, the study group exhibited reduced salivary biomarkers amylase (17924.0 ± 4703.6) and mucin (1828.45 ± 314.07) and improved clinical parameters, indicating the effectiveness of the treatment in enhancing periodontal health compared with the control group. Positive correlations were found between clinical parameters and salivary amylase/mucin levels both before and after therapy (p < 0.001).

CONCLUSION

Salivary amylase and mucin levels hold promise as valuable biomarkers for diagnosing active periodontal disease and evaluating treatment outcomes after phase I therapy.

CLINICAL SIGNIFICANCE

Salivary biomarker comparison offers a noninvasive diagnostic tool for periodontal disease, improving early detection and personalized treatment planning. Further research is required to validate its clinical value fully.

Association between Caspase-1, TNF-α Salivary Level and Their Diagnostic Potential to Discriminate Periodontitis from Healthy Control

PURPOSE

Periodontitis is associated with caspase and proinflammatory mediators, such as caspase-1 and tumor necrosis factor-alpha (TNF-α). The aim of this study was to evaluate the salivary levels of caspase-1 and TNF-α and determine their accuracy in differentiating periodontitis patients from individuals with a healthy periodontium.

MATERIALS AND METHODS

This case-control study enrolled 90 subjects, aged 30 to 55, attending the Department of Periodontics at Baghdad's outpatient clinic. Patients were initially screened to evaluate their eligibility for recruitment. After applying inclusion/exclusion criteria, subjects with a healthy periodontium were included in group 1 (controls), while subjects with periodontitis were included in group 2 (patients). The salivary levels of caspase-1 and TNF-α in participants' unstimulated saliva were measured using an enzyme-linked immunosorbent assay (ELISA). Then the periodontal status was determined using the following indices: full-mouth plaque, full-mouth bleeding on probing, probing pocket depth, clinical attachment level, and gingival recession.

RESULTS

TNF-α and caspase-1 salivary levels were higher in periodontitis patients than in healthy controls and were positively correlated with all clinical parameters. A positive significant correlation between TNF-α and caspase-1 salivary levels was noticed. For differentiating periodontal health and periodontitis, the area under the curve (AUC) values of TNF-α and caspase-1 were 0.978 and 0.998, while the proposed cut-off points were 128.163 pg/ml and 1.626 ng/ml, respectively.

CONCLUSION

The present findings supported a previous discovery that periodontitis patients have significantly higher levels of salivary TNF-α. In addition, there was a positive correlation between the salivary levels of TNF-α and caspase-1. Furthermore, caspase-1 and TNF-α showed high sensitivity and specificity in the diagnosis of periodontitis, as well as distinguishing periodontitis from periodontal health.

Melatonin levels in periodontitis vs. the healthy state: A systematic review and meta-analysis

The aim was to provide a comprehensive qualitative and quantitative assessment of any potential differences in melatonin levels in periodontitis vs. the healthy state. The keyword combination "melatonin" AND "periodontitis" was searched in Web of Science, PubMed, and Scopus. Qualitative analysis and quantitative analysis were performed on articles satisfying the inclusion criteria. Only 14 studies were included in the systematic review, out of which only 10 had quantitative data compatible with a meta-analysis. Ten studies demonstrated low melatonin in periodontitis, three studies demonstrated an initial reduction in melatonin levels followed by elevation with worsening of periodontitis, and one study showed an elevation in melatonin levels in the transition from a healthy state to periodontitis. Grading of recommendations assessment, development, and evaluation revealed that all the included studies had low to very low overall evidence. The meta-analysis revealed a significant reduction (p < .0001) in salivary melatonin levels in chronic periodontitis (3.26 ± 3.44 pg/ml) compared with healthy controls (5.27 ± 5.39 pg/ml), with a mean difference of 2.65 ± 7.84 and a confidence interval of 1.94-3.36. The significantly lower salivary melatonin levels in periodontitis must be inferred with caution given the low quality of the included studies.

Association between obesity and chronic periodontitis: A nationwide population-based cohort study in Taiwan

Previous studies have suggested that obesity might be associated with chronic periodontitis (CP); however, no clear conclusions have been reached so far. In this retrospective cohort study, we aimed to investigate the association between obesity and CP by using a large population-based dataset in Taiwan.A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2010 (LHID2010) derived from the National Health Insurance Research database in Taiwan, from 2000 to 2013. Obesity and non-obesity groups were matched with sex, age, urbanization level, socioeconomic status, and the related comorbidities by using the propensity score method at a 1:2 ratio.An obese cohort (n = 4140) and a non-obese cohort (n = 8280) were included in this study, with an average age of 41.7 ± 13.8 years and 42.0 ± 14.0 years, respectively. The risk of CP for the patients with obesity was 1.12-fold compared with those without obesity (hazard ratio, 1.12; 95% confidence interval, 1.01-1.25). In the subgroup analysis according to age and sex, the hazard ratio of CP were 1.98 (95% confidence interval, 1.22-3.22) in the subgroup of age equal to or older than 65 years. The risk of CP showed no difference between obesity and non-obesity groups in both sex.This population-based cohort study demonstrated that obesity was associated with the development of CP in Taiwan.

To evaluate the serum cortisol, salivary cortisol, and serum interleukin-1 B level in patients of chronic periodontitis with smoking and stress and without smoking and stress

The role of cognitive, social and biological factors in the etiology of chronic periodontitis has been reported.The aim of this study was to evaluate the salivary cortisol level and interleukin-1 B level in patients of Chronic periodontitis in smokers and stress and nonsmokers without stress.The design of study randomized, prospective, double-blinded, and prospective study.The total sample size was comprised of 600 subjects between the ages of 20 and 50 years. The sample size was divided into 300 males and 300 females. Out of 600 subjects, 200 subjects comprised of subjects with chronic periodontitis with positive depression level with a history of smoking (Group I), 200 subjects comprised of subjects with chronic periodontitis without depression and without smoking (Group II), and 200 subjects who were taken as the control group comprised of healthy subjects without chronic periodontitis, without depression level, and no smoking history (Group III). Salivary cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA).The result showed that there was a positive correlation between morning and evening salivary cortisol level in all the groups with correlation coefficient. There was significant higher value of salivary cortisol in Group I patients when compared with Group II and Group III. However, when the comparison of salivary cortisol levels was done between the Group II and Control group, the result showed nonsignificant P value.It is suggested that stress is positively correlated with the salivary cortisol levels in smokers and nonsmokers.

Detection of Salivary miRNAs That Predict Chronic Periodontitis Progression: A Cohort Study

The aim of this two-year cohort study was to investigate salivary microRNAs (miRNAs) that predict periodontitis progression. A total of 120 patients who underwent supportive periodontal therapy were recruited. Unstimulated whole saliva was collected at baseline. Two years later, 44 patients were followed up (median age, 67.1 years) and divided into two groups: progression group (n = 22), with one or more sites with clinical attachment level (CAL) progression (>3 mm compared with baseline) or tooth extraction due to periodontitis progression; and the control group (n = 22), which did not exhibit CAL progression. In the microarray analysis of salivary miRNAs, hsa-miR-5571-5p, hsa-miR-17-3p, hsa-let-7f-5p, hsa-miR-4724-3p, hsa-miR-99a-5p, hsa-miR-200a-3p, hsa-miR-28-5p, hsa-miR-320d, and hsa-miR-31-5p showed fold change values <0.5 or ≥2.0 in the progression group compared with the control group (p < 0.05). On receiver operating characteristic curve analysis, areas under the curves of hsa-miR-5571-5p, hsa-let-7f-5p, hsa-miR-99a-5p, hsa-miR-28-5p, and hsa-miR-320d were >0.7, indicating fair discrimination power. The expressions of salivary hsa-miR-5571-5p, hsa-let-7f-5p, hsa-miR-99a-5p, hsa-miR-28-5p, and hsa-miR-320d were associated with periodontitis progression in patients with chronic periodontitis. These salivary miRNAs may be new biomarkers for progression of periodontitis, and monitoring them may contribute to new diagnostics and precision medicine for periodontitis.

Evaluation of the efficiency of antibiotics in treating adult patients with symptomatic apical periodontitis: A protocol for systematic review and meta-analysis

BACKGROUND

When a person feels dental pain, it brings great discomfort and damages the quality of life. Symptomatic apical periodontitis is identified as the most frequent cause that triggers dental pain. Symptomatic apical periodontitis arises from an infection or inflammation in the pulpless root canal structure. According to clinical guidelines, the primary form of therapy for such teeth entails removing the inflammation or infection source through local surgical procedures. Presently, systemic antibiotics are recommended only for cases where there is clear indication of an infectious spread or a systemic involvement. Therefore, this study aims to assess the efficacy and level of safety of using antibiotics to treat adult symptomatic apical periodontitis patients.

METHODS

The present protocol study will conduct a search on electronic databases to look for randomized controlled trials (RCTs) that have evaluated the effectiveness and safety of antibiotics when used to treat adult patients with symptomatic apical periodontitis. The databases will be search from their beginning to April 2021. The search is not bound by publication status or language restrictions. The following databases will be searched: Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure, and EMBASE. This study will employ ZETOC Conference Proceedings and OpenGrey to identify potential grey literature. Afterwards, 2 independent authors will select the studies, extract data from the studies, and conduct a risk assessment to check for bias. All discrepancies between the authors will be resolute via discussion involving a third independent author. The data synthesis and statistical analysis of this study will be done with the RevMan software (Version: 5.3).

RESULTS

The present protocol report will provide high-quality evidence related to the efficacy and level of safety when using antibiotics to treat mature symptomatic apical periodontitis patients.

CONCLUSION

The outcomes of the present study will update the evidence available for assessing the efficacy and safeness of using antibiotics to treat mature symptomatic apical periodontitis patients.

ETHICS AND DISSEMINATION

This study does not require an ethical approval since individual patient data is not included in any form.

REGISTRATION NUMBER

DOI 10.17605/OSF.IO/CVP8 M (https://osf.io/cvp8m/).

NIK inhibitor impairs chronic periodontitis via suppressing non-canonical NF-κB and osteoclastogenesis

Periodontitis is an inflammatory disease that causes damages to periodontium and alveolar bone. Overactivation and formation of osteoclasts can cause bone destruction, which contributes to periodontitis development. Receptor activator of nuclear factor κB ligand (RANKL)-mediated NF-κB signaling plays an essential role in osteoclasts differentiation. We aimed to study the effects of NIK-SMI1, an NF-κB-inducing kinase (NIK) inhibitor, on the osteoclastogenesis in vitro and periodontitis progression in vivo. A ligature-induced mice model of periodontitis was incorporated to test the potential therapeutic effect of NIK-SMI1 on periodontitis. The target protein and mRNA expression levels were determined by Western blot assay and real-time PCR assay, respectively. We found that the administration of NIK-SMI1 strongly inhibited the RANKL-stimulated non-canonical NF-κB signaling as demonstrated by decreased nuclear p52 expression and activity. Blocking NIK activity also resulted in reduced osteoclasts specific genes expression and enhanced IFN-β expression. NIK-SMI1 treatment resulted in attenuated periodontitis progression and pro-inflammatory cytokines expression in vivo. Our study suggested that NIK-SMI1 exerts beneficial effects on the mitigation of osteoclastogenesis in vitro and periodontitis progression in vivo. Application of NIK-SMI1 may serve as a potential therapeutic approach for periodontitis.

[Сlinicmolecular indicators of inflammatory destructive damage of the oral cavity in periodontitis in persons with various group accessories of blood.]

In order to find a connection between the alteration of oral tissues and genetic predisposition to inflammatory and destructive processes in oral media, the cytokine profile of the oral fluid of clinically healthy individuals was determined for various blood group affiliations according to the AB0 system. The group-specific features of individuals with B(III) blood group were revealed: an increase of 32,5% in the content of interleukin-6 and 63,1% in the content of interleukin-8 compared with similar data for people with 0(I), A(II), AB(IV) blood groups, which can predispose to the greatest activity of the inflammatory process in the oral cavity in individuals with antigen B. Confirmation of this fact is an increase of IgA antibodies to gliadin in the blood among patients with chronic generalized periodontitis with B(III) blood group, up to 5,00 U/ml (p<0,01), which indicates the processes of acute inflammation, and along with an increase in blood IgG antibodies to transglutaminase in comparison with a group of clinically healthy individuals, it serves as an indicator of damage to the body's connective tissue at the molecular level. When examining the dental status, pronounced clinical manifestations of chronic generalized periodontitis were found in patients with A(II) blood group, the molecular foundation of which is the highest content of IgA and IgG antibodies to transglutaminase in the oral fluid (0,35 U/ml and 0,45 U/ml), which contributes to the activation of periodontal-destroying inflammatory and inflammatory processes, obviously, with a tendency to the chronic course of the disease. The studies performed allowed us to analyze in clinically healthy individuals a predisposition to alternative processes in oral environments, using gradation by group blood affiliation.

[Study of the functional state of the periodontium in older persons and its correction by means of oral hygiene.]

The study involved 258 older persons with generalized chronic periodontitis, who were monitored for a month. For an in-depth study of the properties and effectiveness of toothpastes recommended for older and elderly people with preventive anti-inflammatory purpose, tests were conducted to determine the true characteristics and properties of the studied pastes. Periodontal indices PMA and PI were used to study the anti-inflammatory effect of toothpastes. The most pronounced anti-inflammatory effect was revealed in the samples, the active components of which were oat extract, thymol, anise and essential oils of tea tree, as well as eucalyptus. Proper selection of means of individual oral hygiene and the development of «Individual hygienic program of prevention of chronic generalized periodontitis in older and elderly people» can reduce the phenomenon of inflammation in the periodontium, the development of mediators of inflammation and improve dental health of older and elderly people.

Elevated serum rheumatoid factor, anti-citrullinated protein antibodies and active rheumatoid arthritis disease are not associated with chronic periodontitis

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints with the involvement of other systems. Previous studies have demonstrated its association with chronic periodontitis (CP), a chronic inflammatory disease of tooth-supporting tissues. Positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in RA patients have been found to be associated with CP. The aim of this study is to determine the prevalence of CP in RA patients, and to investigate the association of ACPA, RF status and RA disease activity with CP and non-CP RA patients.

MATERIALS AND METHODS

A comparative cross-sectional study involving 98 RA patients was conducted at Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia. Clinical oral examination was carried out to determine the CP status of RA patients. RF, ACPA and erythrocyte sedimentation rate (ESR) were measured, and the 28-joint Disease Activity Score (DAS-28) was assessed.

RESULTS

Forty-five patients (45.9%) were found to have CP (95% CI: 0.36-0.56). No significant difference was observed in the prevalence of positive RF (p=0.989) or ACPA (p=0.431) in CP and non-CP RA patients. There was also no significant association between active RA disease (DAS-28 score ≥3.2) and RF positivity in CP (p=0.927) and non-CP (p=0.431) RA patients as well as ACPA positivity in CP (p=0.780) and non-CP (p=0.611) RA patients.

CONCLUSION

In our cohort of RA patients, we did not find significant associations between elevated RF, ACPA, or active RA disease with the presence of CP. There were also no significant associations between elevated RF or ACPA with active RA disease.

Post-periodontal surgery propounds early repair salivary biomarkers by 1H NMR based metabolomics

INTRODUCTION

Oral microflora is a well-orchestrated and acts as a sequential defense mechanism for any infection related to oral disease. Chronic periodontitis is a disease of a microbial challenge to symbiosis and homeostasis. Periodontal surgery is the most promising cure with repair process during periodontal regeneration. It has an encouraging outcome in terms of early recovery biomarkers.

OBJECTIVE

Saliva of periodontal surgery subjects with the chronic periodontitis have been evaluated by ¹H NMR spectroscopy in search of possible early metabolic differences that could be obtained in order to see the eradication of disease which favours the symbiotic condition.

METHOD

The study employed ¹H NMR spectroscopy on 176 human saliva samples in search of distinctive differences and their spectral data were further subjected to multivariate and quantitative analysis.

RESULT

The ¹H NMR study of periodontal surgery samples shows clear demarcation and profound metabolic differences when compared with the diseased condition. Several metabolites such as lactate, ethanol, succinate, and glutamate were found to be of higher significance in periodontal surgery in contrast to chronic periodontitis subjects. The PLS-DA model of the studied group resulted in R² of 0.83 and Q² of 0.70.

CONCLUSION

Significant metabolites could be considered as early repair markers for chronic periodontitis disease as they are being restored to achieve symbiosis. The study, therefore, concluded the early recovery process of the diseased subjects with the restoration of possible metabolomic profile similar to the healthy controls.

Altered levels of salivary biochemical markers in periodontitis

PURPOSE

To investigate the association between periodontitis and levels of biochemical markers as well as enzyme activity.

METHODS

Unstimulated whole saliva samples were obtained from 30 patients with periodontitis. Biochemical factors including the levels of malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), uric acid (UA), and lactoferrin, as well as β-hexosaminidase (β-HEX) activity were measured.

RESULTS

The levels of a salivary oxidant such as MDA and NO were statistically significantly higher in periodontitis patients than to that of healthy individuals. Similarly, the results indicated elevated levels of lactoferrin and β-HEX activity in saliva of the periodontitis group, which was statistically significant when compared to the controls. While the levels of an enzymatic antioxidant such as SOD were higher in the periodontitis patients than in the control subjects, uric acid levels were statistically significantly lower in the saliva of the periodontitis patients than in the healthy controls.

CLINICAL SIGNIFICANCE

Except for uric acid, as a non-enzymatic antioxidant, the levels of salivary oxidative stress generally increase in the saliva of periodontitis patients. Since altered levels of salivary biomarkers such as oxidative stress and antioxidant substances might contribute in systemic and local complications in the patients, these informative biomarkers can be used as a promising factor for the early diagnosis of the disease.

Serum sTWEAK levels in chronic periodontitis and type 2 diabetes mellitus

AIM

The two-way relationship between diabetes mellitus and periodontitis has been extensively studied with various interconnected biomarkers sharing a link. Soluble Tumour Necrosis Factor-like Weak inducer of apoptosis (sTWEAK) is gaining attention as an important mediator in chronic inflammatory diseases. Thus, the aim of this study was to detect, estimate and compare the levels of sTWEAK in the serum of health, chronic periodontitis (CP), and CP with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Forty-five participants between 18 and 65 years were divided into groups of 15 each as Group 1: healthy, Group 2: CP, and Group 3: CP + T2DM. Clinical periodontal parameters and glycemic status were assessed. sTWEAK in serum was estimated using a commercially available ELISA kit. The data was statistically analyzed.

RESULTS

sTWEAK was detected in all participants. Significant differences were observed between the groups for sTWEAK; highest in health, lower in CP and lowest in CP + T2DM. In the diseased groups, the clinical and glycemic parameters correlated positively with each other, whereas sTWEAK correlated negatively with each of the parameters.

CONCLUSION

The literature reports lower concentrations of systemic sTWEAK in T2DM which may be comparable to our observations in CP + T2DM when compared to health and its negative correlation with all the parameters suggesting an association with both clinical periodontal parameters and glycemic levels. However, serum sTWEAK levels may not be necessarily elevated in periodontitis as previously reported, and hence has the potential to be studied extensively for clarification with its association with T2DM.

Gingival crevicular fluid resistin levels in chronic periodontitis with type 2 diabetes before and after non-surgical periodontal therapy: A clinico-biochemical study

AIM

Periodontitis and diabetes mellitus share a bidirectional relationship. Resistin is an adipocytokine shown to be associated with type 2 diabetes mellitus. Hence, the present study aims to estimate the effect of non-surgical periodontal therapy (NSPT) on GCF resistin levels in healthy individuals with gingivitis and well controlled diabetics with periodontitis, and correlate the same with HbA1c levels of the diabetic subjects.

MATERIALS AND METHODS

The present study was a comparative interventional trial set in Department of Periodontics, the Oxford Dental College, Bangalore. Forty subjects participated in the study and were divided into two groups; group I (healthy individuals with gingivitis) and group II (diabetic individuals with mild to moderate periodontitis). Periodontal parameters were assessed and GCF was collected and analysed for resistin before and 3 months after NSPT.

STATISTICAL ANALYSIS

All the analysis was done using SPSS version 18. A P value of < 0.05 was considered statistically significant.

RESULTS

A significant difference was observed in GCF resistin concentrations between the two groups at baseline, wherein group II had significantly higher values. Following NSPT, there was a significant reduction in GCF resistin concentrations in both the groups, however intergroup comparison showed no difference in the amount of reduction. When all samples were analysed together, no significant correlation could be found between resistin and the parameters assessed.

CONCLUSION

Resistin levels are increased in diabetes related periodontitis. However, post treatment a similar response can be seen between healthy and well controlled diabetics. Hence, resistin can be used as an inflammatory biomarker for diabetes related periodontal disease.

Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis

Chronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.

Resistin and Plasma-reactive Oxygen Metabolite Levels in Obese and Non-obese Individuals with Chronic Periodontitis in Response to Non-surgical Periodontal Therapy

AIM

To assess and compare the impact of non-surgical periodontal therapy on plasma reactive oxygen metabolites and resistin values in chronic periodontitis obese and non-obese patients.

MATERIALS AND METHODS

Total 200 subjects were included in the present study and were broadly divided into two study groups with 100 patients in each group as follows: group A: Obese patients with chronic periodontitis, group B: Non-obese, normal weight patients with chronic periodontitis. Various following periodontal parameter were calculated at the baseline time and two months after the non-surgical periodontal therapy. Plasma reactive oxygen metabolite (RM) and serum and GCF resistin levelswere evaluated. Assessment of all the results was done by Statistical Package for Social Sciences (SPSS) software.

RESULTS

Significant results were obtained while doing an inter-group comparison of clinical attachment levels between two study groups. Significant results were obtained while comparing the clinical attachment levels in both the study groups at different time intervals. Significant 9 reduction in the RM was seen in Group B subjects in comparison to Group A subjects 2 months after non-surgical periodontal therapy.

CONCLUSION

In patients with chronic periodontitis, obesity can be considered as an important factor in the alteration of resistin levels.

CLINICAL SIGNIFICANCE

Obese patients should be motivated for reducing weight so that periodontal therapy and other treatment modalities could be carried out more effectively.

Assessment of Sirtuin 3 and Sirtuin 4 Level in Patients with Diabetes Mellitus and Periodontitis: A Clinical Study

AIM

Periodontitis is considered as infection in periodontal supporting structure leading to tooth mobility and ulcerated periodontal pockets. The present study was conducted to assess Sirtuin 3 (SIRT 3) and SIRT 4 level in patients with diabetes mellitus (DM) and periodontitis.

MATERIALS AND METHODS

The present study was conducted on 60 subjects. Subjects were divided into four groups, groups I to IV. Each group comprised of 15 subjects. In all subjects, fasting blood glucose level was assessed. Plaque index (PI), bleeding on probing (BOP), gingival index (GI), and clinical attachment level (CAL) were measured. The SIRT 3 and SIRT 4 were estimated by Western blot analysis.

RESULTS

In group I, mean age was 44.13 ± 1.35 years, in group II, it was 43.53 ± 1.45 years, in group III it was 43.93 ± 1.22 years, and in group IV, it was 44.47 ± 0.74 years. The mean BOP score was significantly higher in group IV (5.74 ± 0.30) compared with group I (1.92 ± 0.44), group II (2.25 ± 0.22), and group III (5.31 ± 0.54). A statistically significant (p < 0.001) difference was observed in mean PI score in group I (2.25 ± 0.23), group II (2.26 ± 0.13), group III (4.37 ± 0.60), and group IV (3.25 ± 0.16). Mean GI score was significantly higher in group IV (8.89 ± 0.89) as compared with group I (0.78 ± 0.23), group II (0.95 ± 0.18), and group III (8.69 ± 1.13). A statistically significant difference was seen in mean CAL in group III (5.66 ± 0.64) and group IV (6.37 ± 0.30). Mean fasting blood sugar (mg/dL) in group I was 80.40 ± 13.05, in group II, it was 160.40 ± 27.20, in group III, it was 77.00 ± 12.78, and in group IV, it was 264.20 ± 53.17. The nonsignificant mean expression of SIRT 3 was seen in group I (29.20 ± 3.14), group II (29.19 ± 2.18), group III (28.89 ± 2.77), and group IV (29.59 ± 5.82). In group I, the mean level of SIRT 4 was 28.93 ± 12.55, in group II, it was 28.82 ± 9.14, in group III, it was 28.88 ± 6.03, and in group IV, it was 29.05 ± 10.68.

CONCLUSION

Association of DM and periodontitis is well known. The SIRT 3 and SIRT 4 are useful indicators of glycemic level in patients with DM.

CLINICAL SIGNIFICANCE

The SIRT 3 and SIRT 4 in DM show variation in their level. Early assessment may be proved beneficial in patients who are not responding to other drugs.

Effect of Subgingival Doxycycline Placement on Clinical and Microbiological Parameters in Inflammatory Periodontal Disease: Both in Vivo and in Vitro Studies

AIM

To eva luate the effect of subgingival placement of doxycy-cline in the form of a resorbable membrane on the clinical and microbiological parameters in the treatment of inflammatory periodontal disease. Material and methods; We evaluated the effects of a controlled release system containing doxycycline both in vivo and in vitro conditions. Drug systems were prepared for both, and a total of 19 patients were included in the study with age range from 35 to 50 years. Clinical parameters like gingival index, probing depth, attachment loss, and gingival shrinkage were evaluated along with microbiological evaluation as well for a period of 10 weeks.

RESULTS

In vitro study showed that the doxycycline hydroxy-propyl methylcellulose films are capable of releasing the drug in a sustained way with respect to time. It was observed that the gingival index score, periodontal probing depth, and gingival shrinkage showed low levels at the doxycycline-treated sites as compared to the placebo group. The microbial culture results also showed a marked reduction in the total anaerobic count post-treatment and till the end of the 10 week study period in the doxycycline-treated group. Thus, overall results showed that 30% doxycycline methylcellulose strips have significant effects and benefits on clinical and microbial parameters in more than 5 mm deep periodontal pockets.

CONCLUSION

We conclude that 30% doxycycline both in vivo and vitro study has proven to be an effective antibiotic of choice both clinically and microbiologically.

CLINICAL SIGNIFICANCE

Doxycycline has proven to have great promise as an antibiotic of choice. Thus, there is a significant advantage in the clinical use of doxycycline formulation for both the therapist and the patient. It can help dental professionals as an additional means to maintain an improved clinical health in periodontal problems of their patients. With this new therapeutic modality, we can augment the ability to treat periodontitis more effectively.

Evaluation of Clinical Periodontal Indices and Serum Interleukin-27 by One-stage Full-mouth Disinfection and Quadrant Scaling and Root Planing in Periodontitis

INTRODUCTION

One-stage oral disinfection technique has been developed to prevent cross-contamination between the treated and untreated areas between treatment sessions. Considering the role of inflammatory mediators in periodontitis, this study has been designed to compare the effects of one-stage oral disinfection with quadrant scaling and root planing (Q-SRP) on serum interleukin-27 (IL-27) levels in patients with moderate-to-advanced periodontitis.

MATERIALS AND METHODS

In this study, two groups were considered. One group was treated with one-stage full-mouth oral disinfection (FMD), while the other group was treated with Q-SRP. In each group, 20 patients with chronic periodontitis were randomly selected based on the inclusion criteria. To evaluate the periodontal status, the clinical parameters of bleeding on probing (BOP), clinical attachment level (CAL), and probing depth (PD) were measured before treatment as well as at 2- and 4-month intervals after treatment. At the same intervals, the immunological index of the study (serum IL-27) was measured by special laboratory kits. The data were analyzed using the Statistical Package for the Social Sciences, version 16 (SPSS 16) software. In this study, p-value < 0.05 was considered statistically significant.

RESULTS

The results of this study indicate that there has been an elevation in the mean of serum IL-27 after treatment in both treatment groups. There is no significant difference between the levels of IL-27 in the FMD group during the study period (p = 0.20). All periodontal indices (BOP, CAL, and PD) show clinical improvement in each group (p < 0.001). However, no significant difference was observed in the improvement of periodontal indices of CAL and PD (p < 0.05).

CONCLUSION

According to the findings of this study, it can be said that both FMD and Q-SRP improve the periodontal indices and increase the serum level of the inflammatory mediator IL-27 in patients with periodontitis.

CLINICAL SIGNIFICANCE

Considering the benefits of the FMD method, such as patient and dentist comfort, systemic effects, and its cost-effectiveness, use of this method is suggested in patients suffering from periodontitis.

Effect of 0.8% Hyaluronic Acid in Conventional Treatment of Moderate to Severe Chronic Periodontitis

OBJECTIVE

The aim of this study is to evaluate the effect of the subgingival application of 0.8% hyaluronic acid (HA) gel (GENGIGEL®) as an adjunct to scaling and root planing (SRP) on clinical parameters and expression of human beta defensin-2 (hBD-2) in patients with moderate to severe chronic periodontitis.

MATERIALS AND METHODS

In this randomized, split mouth design study, 24 participants with moderate to severe chronic periodontitis were evaluated after full mouth SRP. In the test sites 1 mL of 0.8% hyaluronan gel was applied subgingivally after SRP at baseline and 1 week post therapy. Plaque index (PI), gingival index (GI), papillary bleeding index (PBI), periodontal probing depth (PPD), and clinical attachment loss (CAL) were recorded and gingival crevicular fluid (GCF) samples were collected at baseline, after 6 and 12 weeks. Expression of human beta defensin-2 (hBD-2) was analyzed by enzyme-linked immunosorbent assay.

RESULTS

At baseline, there were no statistical differences between test and control sites in all clinical parameters and hBD-2 expression. An improvement of PI, GI, PBI, PPD, and CAL was observed at 6 and 12 weeks (p < 0.05) in both groups. Clinically, it was noticed that all indices except CAL had more statistically significant reduction in test sites than control sites at 6 and 12 weeks. The hBD-2 levels were significantly higher in the test sites than in the control sites at 6 and 12 weeks.

CONCLUSION

The local application of 0.8% hyaluronan gel with SRP have a positive effect on periodontal health of moderate to severe chronic periodontitis patients after 6 and 12 weeks.

CLINICAL SIGNIFICANCE

Subgingival application of 0.8% HA gel following SRP has shown anti-inflammatory effect and has a beneficial effect on clinical parameters in moderate to severe chronic periodontitis patients.

Assessment of Pyrexia and Associated Sickness Behavior in Patients with Chronic Periodontitis

BACKGROUND AND OBJECTIVES

The purpose of this study was to assess pyrexia and sickness behavior such as anxiety, depression, lethargy, and weight loss in subjects with chronic periodontitis, and evaluate inflammatory mediators such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the patients with fever.

METHODS

This was a cross-sectional study that consisted of 150 chronic periodontitis and 150 healthy subjects. Sublingual and subgingival temperatures were assessed using a digital temperature probe. Associated sickness behavior was assessed for all the subjects. Pathological tests, i.e., ESR and CRP were done for subjects with fever.

RESULTS

Evaluating the presence of fever with the severity of periodontal disease, 66.7% of the subjects with fever were in the group diagnosed with severe periodontitis, 20.4% had with moderate periodontitis, and 5.3% were in the healthy group. Subjects diagnosed with periodontitis comprised 66.2% of the subjects with higher (i.e., > 36.3°C) subgingival temperatures and healthy subjects made up the remaining 33.8% (p < 0.001). A correlation between the sublingual and subgingival temperature with the Pearson ρ correlation coefficient of 0.227 (p < 0.001) was observed. A statistically significant mean value of 37.05 ± 11.24 of ESR and 1.59 ± 1.11 mg/L of CRP was reported amongst the subjects with fever (p < 0.001). The association of sickness behavior with the severity of periodontitis was found to be significant: depression 40.006, anxiety 50.857, reported weight loss 76.463, and lethargy 141.581 (p < 0.001).

DISCUSSION AND CONCLUSION

The study demonstrated that there is a significant increase in the sublingual temperature amongst patients with severe chronic periodontitis. The subgingival temperature has a positive correlation with the sublingual temperature. There was a linear trend of an association of sickness behavior with the severity of chronic periodontitis. A significant increase in the circulating inflammatory mediators, CRP and ESR, were noticed in subjects with elevated body temperature.

Discrepancy of Clinical Parameters between the First and Second Molars Can Help to Differentiate Subjects with Aggressive Periodontitis from Chronic Periodontitis: a Cross-sectional Study Based on a Large Chinese Population

OBJECTIVE

To explore associations between mean discrepancy values for the first and second molars (MDVFSs) and generalised aggressive periodontitis (GAgP) using hospital-based periodontal examination records from a large Chinese population.

METHODS

Data from consecutive patients diagnosed as having chronic periodontitis (CP, n = 51,849) and GAgP (n = 2,706) were included. Patient ages, gender, smoking status, mean full-mouth probing depth (PD), and mean full-mouth attachment loss (AL), as well as MDVFSs for PD and AL, were extracted. Multivariate linear regression was used to test associations between MDVFSs and GAgP.

RESULTS

After multivariate risk adjustment for potential confounding factors (age, smoking status, and mean PD and AL), the MDVFSs for PD (OR = 2.20, 95%CI: 2.04 to 2.38, P < 0.001) and AL (OR = 1.51, 95CI%: 1.44 to 1.59, P < 0.001) were significantly associated with GAgP. The probability of GAgP was associated with MDVFS for PD falling between 0 mm and 2.5 mm (OR = 4.55, 95%CI: 4.01 to 5.17) and MDVFS for AL falling between 0 mm and 3.5 mm (OR = 2.01, 95%CI: 1.86 to 2.16, P < 0.001).

CONCLUSION

This study revealed associations between MDVFSs and GAgP, demonstrating that MDVFSs can serve as promising auxiliary references for the differential diagnosis between CP and GAgP.

Comparison of clinical parameters, microbiological effects and calprotectin counts in gingival crevicular fluid between Er: YAG laser and conventional periodontal therapies: A split-mouth, single-blinded, randomized controlled trial

BACKGROUND

The erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser is thought to be the most promising laser for periodontal treatment; however, its application is still under consideration. The aim of this study was to compare Er:YAG laser monotherapy with conventional scaling and root planing (SRP) for chronic periodontitis using clinical parameters, the detection rate of periodontal pathogens, and the calprotectin level in gingival crevicular fluid.

METHODS

Twenty-seven participants with moderate-to-advanced chronic periodontitis were included. In a split-mouth design, the 2 half-mouths of each participant were randomly assigned to Er:YAG laser or SRP (combination of ultrasonic and manual instruments) treatment. Clinical parameters were recorded at baseline, 6 weeks, and 3 and 6 months after treatment. At the same time points, gingival crevicular fluid was collected to analyze the detection rate of 6 periodontal pathogens by polymerase chain reaction and the levels of calprotectin by enzyme-linked immunosorbent assay.

RESULTS

Both treatment groups showed significant reductions in probing depth (PD), bleeding index (BI), and clinical attachment level (CAL) from baseline to 6 months. For sites with 4 mm ≤ PD ≤ 6 mm at baseline, SRP resulted in a greater reduction in PD and CAL than Er:YAG laser treatment, and the difference remained at 6 months post-treatment (P = .01 and P < .01, respectively). For sites with PD ≥7 mm at baseline, the clinical parameters showed similar results between the 2 groups. SRP resulted in a lower detection rate of Porphyromonas gingivalis at 6 months post-treatment. The levels of calprotectin were significantly decreased from baseline to 6 months in both groups, without a significant difference between the groups.

CONCLUSION

For mild pockets, conventional SRP may still be the preferred choice. For deep pockets, Er:YAG laser treatment could be an effective alternative. Studies are needed to explore more advanced instruments and new application methods for the Er:YAG laser for periodontal treatment in deep pockets.

Microbial profile comparisons of saliva, pooled and site-specific subgingival samples in periodontitis patients

Objectives

The purpose of this study was to compare microbial profiles of saliva, pooled and site-specific subgingival samples in patients with periodontitis. We tested the hypotheses that saliva can be an alternative to pooled subgingival samples, when screening for presence of periopathogens.

Design

Site specific subgingival plaque samples (n = 54), pooled subgingival plaque samples (n = 18) and stimulated saliva samples (n = 18) were collected from 18 patients with generalized chronic periodontitis. Subgingival and salivary microbiotas were characterized by means of HOMINGS (Human Oral Microbe Identification using Next Generation Sequencing) and microbial community profiles were compared using Spearman rank correlation coefficient.

Results

Pronounced intraindividual differences were recorded in site-specific microbial profiles, and site-specific information was in general not reflected by pooled subgingival samples. Presence of Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Filifactor alocis, Tannerella forsythia and Parvimona micra in site-specific subgingival samples were detected in saliva with an AUC of 0.79 (sensitivity: 0.61, specificity: 0.94), compared to an AUC of 0.76 (sensitivity: 0.56, specificity: 0.94) in pooled subgingival samples.

Conclusions

Site-specific presence of periodontal pathogens was detected with comparable accuracy in stimulated saliva samples and pooled subgingival plaque samples. Consequently, saliva may be a reasonable surrogate for pooled subgingival samples when screening for presence of periopathogens. Future large-scale studies are needed to confirm findings from this study.

The association between interleukin-28B gene polymorphisms as a potential biomarker and the risk of chronic Periodontitis in an Iranian population

BACKGROUND

Chronic Periodontitis (CP) is a common inflammatory disease affects supporting tissues of the teeth and can lead to tooth loss. The objective of this study was to determine the relationship between polymorphisms in the IL-28B gene and chronic periodontitis in an Iranian population.

METHODS

Two hundred and ten CP patients and one hundred healthy subjects were enrolled in the present case-control study. The rs12979860 and rs8099917 SNPs were identified using RFLP and T-ARMS-PCR methods respectively.

RESULTS

SNP analysis revealed that the G allele of rs8099917 SNP and T allele of rs12979860 SNP increased susceptibility to CP compared to the A allele and C allele (p < 0.0001, OR = 2.712, CI = 1.783-4.126; p < 0.0001, OR = 2.538, CI = 1.784-3.613 respectively). In addition, the CT/GT, TT/GG and TT/GT haplotypes were predominant in CP patients and significantly associated with the increased risk of CP.

CONCLUSION

IL-28B polymorphisms may be useful predictive factors for chronic periodontitis and correlated to the susceptibility to CP infection in our population.

Gingival crevicular fluid as a source of biomarkers for periodontitis

In evaluating the pathogenesis of periodontal diseases, the diagnostic potential of gingival crevicular fluid has been extensively explored during the last twenty years, from initially just confirming health and disease states to more recently investigating it as a potential prognostic tool. As host susceptibility is a critical determinant in periodontal disease pathogenesis, the inflammatory mediator levels present in gingival crevicular fluid represent relevant risk indicators for disease activity. Considerable work has been carried out to identify the many different cytokine inflammatory pathways and microbial stimuli that are associated with periodontal disease pathogenesis. Now, 'omics' approaches aim to summarize how these pathways interact and probably converge to create critical inflammatory networks. More recently, gingival crevicular fluid metabolomics appears promising as an additional diagnostic method. Biofilm structure and the host inflammatory response to the microbial challenge may induce specific inflammatory signatures. Host genetics and epigenetics may also modulate microbial colonization, adding to the multiplicity of potential causal pathways. Omics analyses of gingival crevicular fluid, measuring microbial and host interactions in association with the onset and progression of periodontal diseases, still show the potential to expand the landscape for the discovery of diagnostic, prognostic and therapeutic markers.

Helicobacter pylori in periodontal pockets and saliva: a possible role in gastric infection relapses

It has been a long time since the scientific community started to speculate upon the presence of Helicobacter pylori (HP) in periodontal pockets as an extra-gastric reservoir responsible for gastric relapses after eradication therapy. The aim of this study is to evaluate the presence of oral HP in a group of patients who underwent examination for gastric infection. Sixty patients were enrolled in the current study, subdivided into two groups: 30 patients with a positive result for HP gastric infection with C-Breath Test Urea examination, and 30 patients with a negative result for HP gastric infection. Crevicular fluid and salivary samples were collected in a sterile tube and then sent to the laboratory for evaluation. Specimens were processed to quantify the levels of HP and bacterial load by real time PCR technique. Even though there was no statistically significant difference among the two groups (A vs B) with regard to the total amount of HP in saliva or in periodontal tissues, this study demonstrates that the oral cavity is an extra-gastric reservoir of HP when it is affected by periodontal disease, and that periodontal disease is correlated to gastric HP infection.

The efficacy of proanthocyanidins and secnidazole in the treatment of chronic periodontitis after scaling and root planing therapy

The aim of this study is to evaluate the clinical and microbiological effect of the systemic antibiotic therapy of proanthocyanidins and secnidazole on periodontitis. Seventy-five subjects with chronic periodontitis were randomly divided into two treatment groups (secnidazole or proanthocyanidins) and one placebo control group (25 cases each). Plaque index (PI), gingival index (GI), gingival bleeding index (BI), probing pocket depth (PPD), and clinical attachment level (CAL) were carried out at baseline, post-treatment and 3 months after treatment. Microbial analysis was performed at baseline and post-treatment. The results show that the two treatment groups had greater mean reduction in BI, GI, and PPD evaluated at both post-treatment and 3 months after treatment compared to the control group (p less than 0.05), but there were no significant differences in those of PI and CAL (except CAL evaluated at post-treatment, p 0.05). After treatment, culturable bacteria counts significantly decreased. In conclusion, the adjunctive use of proanthocyanidins or secnidazole in combination with scaling and root planing in adults with periodontitis is effective in reducing the pathogenic flora and achieves significantly better clinical results to a certain degree.

Is chronic periodontitis premature in systemic lupus erythematosus patients?

The aim of this study was to compare the frequency and severity of chronic periodontitis (CP) in systemic lupus erythematosus (SLE) patients with individuals without rheumatic diseases. Seventy-five patients with SLE were compared to 75 individuals without rheumatic diseases (control group) matched for age, educational level, and income. The activity of SLE was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus evaluated SLE-related damage. Dental evaluation included measuring plaque index and parameters of periodontal disease (probing depth, clinical attachment level, and bleeding on probing). Fifty-one (68 %) SLE patients and 42 (56 %) control individuals had CP (p = 0.13). Periodontal status was similar in both groups. Considering only individuals with CP, SLE patients were younger than controls (40.7 ± 9.8 versus 46.14 ± 12.5 years of age, p = 0.02). CP was not associated with activity or therapeutics in SLE patients. Severity of periodontal parameters was similar in SLE patients and control subjects; however, CP occurred earlier in SLE patients.

Clinical, imagistic and histopathological study of chronic apical periodontitis

Periapical lesions are among the most frequent periodontal pathologies in human teeth, generally called apical periodontitis. Apical periodontitis is a continuation of the endodontic space infection and it is manifested as a response of the host defense against the microbial action. It may determine local inflammation, hard tissue resorption, destruction of other periapical tissues. The preliminary diagnosis of chronic periapical lesions is based on the clinical symptoms and imagistic investigation, which represent a reliable diagnosis instrument, but the histological investigation remains essential for a certain diagnosis. We performed a clinical and histological study of the periapical lesions, evaluating the various clinical and imagistic aspects and we compared them with the results of the histological examination, in order to establish the correspondence between the clinical-imagistic aspects and the morphological ones. The relation between the histological aspects, the clinical signs and imagistic aspects may provide valuable data both for establishing an accurate diagnosis and for adopting the most efficient treatment.

Association between Herpesviruses and Chronic Periodontitis: A Meta-Analysis Based on Case-Control Studies

OBJECTIVE

Numerous studies have investigated the associations between herpesviruses and chronic periodontitis; however, the results remain controversial. To derive a more precise estimation, a meta-analysis on all available studies was performed to identify the association between herpesviruses and chronic periodontitis.

METHODS

A computerized literature search was conducted in December 2014 to identify eligible case-control studies from the PUBMED and EMBASE databases according to inclusion and exclusion criteria. Data were extracted and pooled odds ratios (OR) with 95% confidence intervals (CI) were used to assess the association between herpesviruses and risk of chronic periodontitis. A fixed or random effects model was determined based on a heterogeneity test. Sensitivity analysis was conducted to investigate stability and reliability. Publication bias was investigated using the Begg rank correlation test and Egger's funnel plot.

RESULTS

Ten eligible studies were included to investigate the association between Epstein-Barr virus (EBV) and chronic periodontitis. The results showed that EBV has a significant association with chronic periodontitis compared with periodontally healthy group (OR = 5.74, 95% CI = 2.53-13.00, P<0.001). The association between human cytomegalovirus (HCMV) and chronic periodontitis was analyzed in 10 studies. The pooled result showed that HCMV also has a significant association with chronic periodontitis (OR = 3.59, 95% CI = 1.41-9.16, P = 0.007). Similar results were found in the sensitivity analyses. No significant publication bias was observed. Two eligible studies were included to investigate the association between herpes simplex virus (HSV) and chronic periodontitis risk. The association between HSV and chronic periodontitis was inconclusive (OR = 2.81 95% CI = 0.95-8.27, P = 0.06). Only one included study investigated the association between human herpesvirus 7 (HHV-7) and chronic periodontitis risk (OR = 1.00, 95% CI = 0.21-4.86).

CONCLUSION

The findings of this meta-analysis suggest that two members of the herpesvirus family, EBV and HCMV, are significantly associated with chronic periodontitis. There is insufficient evidence to support associations between HSV, HHV-7 and chronic periodontitis.

[CHRONIC PERIODONTITIS WITH SYMPTOMATIC HYPERTROPHIC GINGIVITIS: CASE REPORT AND REVIEW OF THE LITERATURE]

Gingivitis in traditional national dentistry referred to independent diseases or symptomatic condition in periodontitis and classified morphologically. The diagnostic features of the diseases are characteristic, but the clinical presentation of symptomatic gingivitis and patterns of bone destructions may vary between patients. Successful treatment of the disease depends from proper diagnosis and advanced disease stages, but for symptomatic gingivitis that accompanying chronic periodontitis, protocols include surgical excision. Despite of the high prevalence of chronic generalized periodontitis, its active treatment often start in severe destruction and bone loss (2-3 stage severity). Today etiotropic antimicrobial therapy is real way to control microbial biofilm and has solid evidence base. Applying of etiotropic antimicrobial therapy as systemic azithromycin with timely treatment of mild to moderate periodontal and bone destruction may reduce severe periodontitis incidence of and treatment-related complications in the future. This paper attempts to describe the clinical diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of chronic generalized periodontitis and hypertrophic gingivitis patient with case reports and a brief review.

Polymorphisms of Toll-Like Receptor 4 as a Risk Factor for Periodontitis: Meta-Analysis

BACKGROUND

Toll-like receptors play an important role in the recognition of periopathogens. There are widely known polymorphisms of these receptors that may alter host susceptibility to periodontitis.

OBJECTIVES

Evaluating the association of TLR4 polymorphisms (Asp299 and Thr399Ile) with the occurrence of periodontitis and its two clinical types: chronic (CP) and aggressive (AgP) among Caucasians.

MATERIAL AND METHODS

A review of 4 electronic databases was made to identify studies that match the inclusion criteria for the meta-analysis and were published up to December 31, 2013.

RESULTS

Fifteen studies met the inclusion criteria. For Asp299Gly polymorphism 1621 patients with periodontitis (1148 with CP and 473 with AgP) and 1755 individuals without clinical signs of periodontitis were included in the meta-analysis. The occurrence of polymorphism The 399Ile was evaluated among 1522 patients with periodontitis (1017 with CP and 505 with AgP) and 1461 subjects in the control group. The pooled OR with a random effects model for the Asp299Gly and chronic periodontitis was 1.35 (95% CI: 1.02-1.8, p = 0.038), indicating a possible association between this polymorphism and CP. Other published meta-analyzes showed no significant association between single nucleotide polymorphisms of TLR4 and periodontitis nor its clinical types. No publication bias was reported.

CONCLUSIONS

Our meta-analysis showed statistically significant association between TLR4 Asp299Gly allele and increased susceptibility to chronic periodontitis.

Detection of toxic elements using laser-induced breakdown spectroscopy in smokers' and nonsmokers' teeth and investigation of periodontal parameters

A laser-induced breakdown spectrometer (LIBS) was built and optimized to detect levels of toxic elements such as lead, cadmium, and arsenic present in the roots of extracted teeth of smokers and nonsmokers. Sixty extracted teeth from patients having a history of chronic periodontitis were divided into two groups of 30 teeth each for smoker and nonsmoker patients and, as controls, a third group of 30 patients who did not have a history of chronic periodontitis. The respective elemental concentration (Pb, Cd, and As) 23-29, 0.26-0. 31, and 0.64-11 ppm are for nonsmokers, 35-55, 0.33-0.51, and 0.91-1.5 ppm are for smokers, and lastly 0.17-0.31, 0.01-0.05, and 0.05-0.09 ppm are for control group. In order to test the validity of the results achieved using our LIBS system, a standard inductively coupled plasma (ICP) technique was also applied for the analysis of the same teeth samples, and ICP results were found to be in excellent agreement with our LIBS results. In addition to this, the gingival index, plaque index, clinical attachment loss (CAL) and probing pocket depth were also recorded. Our LIBS spectroscopic analysis showed high levels of lead, cadmium, and arsenic concentration on root surfaces of teeth, which may be due to CAL.

Pleiotropic effects of statins on the treatment of chronic periodontitis--a systematic review

AIM

Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase and are an important group of hypolipidaemic drugs, widely used in the treatment of hypercholesterolaemia and cardiovascular disease. Some studies have shown that statins are able to modulate inflammation and alveolar bone loss.

METHODS

In order to evaluate whether statins could influence periodontal treatment, improving the clinical and radiographic parameters in chronic periodontitis, a systematic review was conducted in the databases PUBMED and BIREME, searching for articles in English and Portuguese, published between the years 2004 and 2014, using the combined keywords statin, periodontal disease, periodontitis and alveolar bone. Studies regarding the treatment of chronic periodontitis in humans, blind or double-blind, retrospective cohort or randomized controlled trials that used statins topically or systemically were selected.

RESULTS

Statins have important anti-inflammatory and immune effects, reducing levels of C-reactive protein and matrix metalloproteinases and their intermediate products, such as tumour necrosis factor-α, and are also able to inhibit the adhesion and extravasation of leukocytes, which block the co-stimulation of T cells. Statins reduce bone resorption by inhibiting osteoclast formation and lead to increased apoptosis of these cells. The effect of statins on bone formation is related to the increased gene expression of bone morphogenetic protein in osteoblasts.

CONCLUSION

Although we found biological mechanisms and clinical results that show lower alveolar bone loss and reduction of clinical signs of inflammation, further studies are needed to evaluate the clinical applicability of statins in the routine treatment of chronic periodontitis.

[REAL-TIME PCR IN THE COMPLEX DIAGNOSTICS OF COMBINED PATHOLOGY OF THE PERIODONTIUM AND GASTRO-DUODENAL ZONE]

Biological material of 92 patients (18-85 years old) with different severity chronic periodontitis were analyzed for bacterial pathogen colonization by using Dentofol kit (DNA-technology, Moscow). The cohort included 70 individuals with chronic gastritis, 2 patients with gastric and duodenal ulceration and 20 individuals with no gastric/duodenal pathology. The tight- est association with severity of the chronic periodontitis in the analyzed sub-cohort with the chronic gastritis was found with the prevalence of a complex T. for sythensis/T. denticola. Key contribution of this complex to progression of periodon- titis in males of the eldest group (above 55) was hypothesized. This data essentially differ from published results of other research groups where T. forsythensis and T. denticola were never reported as the principal causative agents of the chronic periodonitis in the gender/age/combined pathology normalized cohorts.

Periodontal Examination Profiles and Treatment Approaches of a Group of Turkish General Dentists

PURPOSE

To investigate the periodontal examination profiles and treatment approaches of a group of Turkish general dentists.

MATERIALS AND METHODS

457 general dentists were called and 173 dentists agreed to participate in the study. The questionnaire comprised 10 questions including gender, years of experience, periodontal probing during examination, oral hygiene motivation methods (do you perform, yes/no; the oral hygiene motivation method; verbal expression or using visual materials), periodontal treatments (supragingival scaling, subgingival scaling and planing or surgery) and knowledge about diagnosis and treatment for aggressive and chronic periodontitis. The participants were grouped according to their years of clinical experience: group 1: 0 to 10 years of clinical practice (n = 58); group 2: 10 to 20 years (n = 68); group 3: >20 years (n = 47).

RESULTS

The 'periodontal probing' performance percentages were 70.69%, 26.47% and 40.43% in groups 1, 2 and 3, respectively. The oral hygiene motivation rate was high in the first 10 years of clinical practice (60.3%). In addition, 72.4% of the dentists in group 1 used visual materials in addition to verbal expression during oral hygiene motivation. 72.25% of the general dentists performed supragingival scaling. The knowledge of diagnosis and treatment of chronic periodontitis was present in >90% of the dentists surveyed. In contrast, >50% of the general dentists were not knowledgeable in the diagnosis and treatment of aggressive periodontitis.

CONCLUSION

Periodontal probing is a gold standard for periodontal diagnosis, but as the dentists' clinical experience increases, the frequency of its performance decreases. The percentage of the knowledge and treatment of chronic periodontitis is higher than that of aggressive periodontitis. Postgraduate education in periodontology is important to keep general dentists up to date on current periodontal practice and improve awareness of periodontal diseases.

[The condition of the system "peroxide oxidation of lipids-antioxidant defense" in mixed saliva of patients with chronic generalized periodontitis]

The comparative analysis was made concerning conditions of the system "Peroxide oxidation of lipids-antioxidant defenses in mixed saliva of patients with chronic disseminated periodontitis of light (n = 45), mean (n = 36) and severe (n = 18) degrees. The control group consisted of 25 clinically healthy persons with intact periodontium. The study revealed that in comparison with control group, in patients with chronic disseminated periodontitis occurred an increasing of content of heptane-soluble diene conjugates, isopropanol-soluble ketodienes and conjugated trienes, ceruloplasmin and a decreasing of level of alpha-tocopherol, especially under severe degree of disease. The study also established a non-linear U-dependence between indicators of the system "Peroxide oxidation of lipids-antioxidant defenses" in mixed saliva and severity of affection of tissues of periodontium in patients with chronic disseminated dermatosis.

SELF-DIRECTED LEARNING, TEAMWORK, HOLISTIC VIEW AND ORAL HEALTH

The dental program at the Malmö Dental School, the so called Malmö-model, is guided by four linked principles: self-directed learning, teamwork, a holistic view of patient care, and oral health (Fig.1). Self-assessment ability is a critical competence for healthcare professionals, necessary for the successful adaptation to the modern life-long learning environment. Educational research seems to point out two critical factors for the development of such skills, continuous practice of self-assessment and constructive feedback. The first study presented in this thesis assessed students' self-assessment ability by means of the Interactive Examination in a cohort of senior dental students, who had gone through an identical assessment procedure during their second year of studies. The results indicated that self-assessment ability was not directly relevant to subject knowledge. Upon graduation, there were a number of students (10%) with significant self-assessment difficulties. Early detection of students with weak self-assessment abilities appears possible to achieve. The aim of the second study, concerning teamwork and holistic view, was to investigate if highlighting teamwork between dental and dental hygienist students could improve the students' holistic view on patients, as well as their knowledge of, and insight into, each other's future professions. This project showed that by initiating teamwork between dental and dental hygienist students, it was possible to increase students' knowledge on dental hygienists competence, develop students' perceived holistic view on patients, and prepare students for teamwork. The third study explored findings clinicians used when diagnosing chronic periodontitis. A questionnaire was distributed to students, dental teachers and clinical supervisors in the Public Dental Services. Within all categories of clinicians, the majority of the clinicians used deepened pocket, bone loss on x-rays, and bleeding as findings. There were differences in the use of findings between the categories of clinicians. None of the supervisors used attachment loss as a finding, while 13% to 27% of the other categories of clinicians used this finding. A higher frequency of dental hygienist students used plaque, calculus and pus, compared to the other categories. Dental hygienist students used more findings for diagnosing as compared to the other categories of clinicians. Fifty-eight of the 76 clinicians used each finding solitarily, i.e. one at a time, and not in combination to diagnose chronic periodontitis. However, about a third of the dental students and the supervisors only used findings either from the soft tissue inflammation subgroup or the loss of supporting tissue subgroup. With the exception of the dental teachers, the majority of clinicians within each category used irrelevant findings. The third study gave valuable information when designing the fourth study. In the fourth study, a questionnaire was distributed to 2,455 professional clinicians, i.e. dentists and dental hygienists in public and private activity, and dental students at the Dental School in Malmö. The results showed that two groups, representing dentists and dental hygienists delivering basic periodontal care in Sweden, were to a significant degree not sharing the knowledge basis for diagnosis and treatment planning. This may result in a less optimal utilization of resources in Swedish dentistry. The delivery of basic periodontal care was not in line with the severity of disease and too much attention was paid to the needs of relatively healthy persons. To change this pattern, the incentives in, and structure of, the national assurance system need to be adapted in order to stimulate a better inter-collegial cooperation between dentists and dental hygienists in basic periodontal care.

Consensus training: an effective tool to minimize variations in periodontal diagnosis and treatment planning among dental faculty and students

Considerable disagreements and variations exist in diagnosis and treatment planning of periodontal disease. Achieving high interrater periodontal diagnosis can prove challenging. The objectives of this study were to measure variations in periodontal diagnosis and treatment planning among predoctoral periodontics faculty members after consensus training and to compare such variation with those identified in third- and fourth-year dental students. Nine electronically stored case vignettes and survey instruments were made available to eighteen faculty members and twenty dental students under standardized conditions. A chi-square test was used to compare responses between groups, and multirater kappa tests were used to evaluate interrater agreement/reliability. Of the nine cases, only one differed between groups significantly in terms of treatment. Also, third-year students differed from fourth-year students on the diagnosis of aggressive periodontitis versus chronic periodontitis. Most respondents were able to distinguish clearly among diagnoses of chronic periodontitis, aggressive periodontitis, and gingivitis. This study established a baseline assessment of the current status of consensus after training. We will reassess variations after addressing the specific challenges identified. Programs designed and implemented to help decrease the variation in periodontal diagnosis and treatment planning among faculty members may ultimately translate into better agreement and better standardization of dental instruction.

Diffuse peripheral odontogenic fibroma with concomitant plasma cell gingivitis--a case report and literature review

Peripheral odontogenic fibroma is a rare odontogenic neoplasm that occurs on the gingiva, and cases of diffuse gingival involvement are most uncommon. An example of such a case compounded by superimposed plasma cell gingivtis is presented together wth a review of the literature.

[Comparative characteristics of oral microbiocenosis in patients with chronic generalized and aggressive periodontitis before and after treatment]

The modern level of knowledge on the etiology and pathogenesis of periodontal disease identifies microbial factor as the dominant cause of the development of aggressive and typical forms of periodontitis. The study involved 125 patients with chronic generalized periodontitis and aggressive forms of periodontitis divided in 2 groups. The treatment tactics was chosen selectively depending on the amount of periodontopathogenic microorganisms revealed by real-time PCR. In patients treated with antibiotics this amount decreased significantly resulting in clinical improvement and rapid remission.