[Research progress in association of neurological disorders and periodontal diseases]

Periodontal diseases are inflammatory diseases caused by oral pathogens around the periodontal supporting tissues, leading to systemic and chronic inflammatory conditions. The continuous chronic systemic inflammation may be a trigger of neuroinflammation, which is the prominent feature of a variety of neurological disorders. It implies that there may be a causal link between periodontal diseases and neurological disorders. This article presents epidemiological and biological evidences that periodontal diseases can induce or exacerbate neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis and major depressive disorder, and analyzes the possible mechanisms. The importance of maintaining oral health as well as preventing and treating periodontal diseases are emphasized. At the same time, this may provide novel approaches to study the relationship between periodontal diseases and neurological disorders in the prevention and treatment strategies of neurological disorders.

Impact of Oral Microbiome in Periodontal Health and Periodontitis: A Critical Review on Prevention and Treatment

The skin, oral cavity, digestive and reproductive tracts of the human body harbor symbiotic and commensal microorganisms living harmoniously with the host. The oral cavity houses one of the most heterogeneous microbial communities found in the human organism, ranking second in terms of species diversity and complexity only to the gastrointestinal microbiota and including bacteria, archaea, fungi, and viruses. The accumulation of microbial plaque in the oral cavity may lead, in susceptible individuals, to a complex host-mediated inflammatory and immune response representing the primary etiological factor of periodontal damage that occurs in periodontitis. Periodontal disease is a chronic inflammatory condition affecting about 20-50% of people worldwide and manifesting clinically through the detection of gingival inflammation, clinical attachment loss (CAL), radiographic assessed resorption of alveolar bone, periodontal pockets, gingival bleeding upon probing, teeth mobility and their potential loss in advanced stages. This review will evaluate the changes characterizing the oral microbiota in healthy periodontal tissues and those affected by periodontal disease through the evidence present in the literature. An important focus will be placed on the immediate and future impact of these changes on the modulation of the dysbiotic oral microbiome and clinical management of periodontal disease.

The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study

Background and Objectives: Cardiovascular disease is a leading cause of global death with a rising prevalence and a heavy economic burden. Periodontal disease has been associated with cardiovascular diseases—including incident coronary heart disease, peripheral artery disease and ischemic stroke. The study evaluates the quality of life of patients with cardiovascular and periodontal disease from the point of view of oral health by using the short version of the Oral Health Impact Profile (OHIP-14) questionnaire. Materials and Methods: This study included a total of 221 patients (61.86 ± 15.03 years old) selected from the Emergency Hospital of Sibiu, Romania. The participants self-completed the OHIP-14 questionnaire and they benefited from an oral health examination conducted to assess the presence and the severity of periodontal disease. Results: Out of the 147 patients with cardiovascular disease, 77.5% had periodontal disease (32.6% stage I, 29.2% stage II, and 15.6% stage III and IV). The presence of periodontal disease was associated with a lower oral-health-related quality of life (p < 0.001, ANOVA) and with a higher OHIP-14 score in patients with cardiovascular disease (18.67 ± 8.17, p < 0.001 ANOVA). No significant difference was observed concerning patient sex and background; however, age, body mass index and the lack of an appropriate oral hygiene routine had a strong association with the individual quality of life. The general OHIP-14 score was higher in patients with periodontal disease and associated cardiovascular disease, the presence of both cardiovascular and periodontal disease being associated with a lower quality of life. Conclusions: By increasing the patients’ awareness to oral healthcare measures, better outcomes and improved oral-health-related quality of life could be observed.

Is there an association between periodontal diseases and ABO blood group? Systematic review and meta-analysis

OBJECTIVES

To systematically review indexed literature that assessed the association between periodontal diseases and the ABO blood group.

METHOD AND MATERIALS

The addressed focused question was "Is there an association between periodontal diseases and the ABO blood group?" Indexed databases were searched without time and language restrictions using different key words. Original studies, case reports, and case series that assessed the association between periodontal diseases and the ABO blood group were included in a meta-analysis. The risk of bias was evaluated using the National Institutes of Health tool. Letters to the Editor, commentaries, and historical reviews were excluded.

RESULTS

A total of 17 studies including 8,543 individuals were included; periodontitis (n = 4,476), gingivitis (n = 1,582), and healthy (n = 1,610). The most frequent event rate of blood group phenotype in periodontitis was blood group type O 39.0 % (95% CI 0.35 to 0.43). The event rate of positive Rh was 90.7% (95% CI 0.89 to 0.92) compared to 9.2% (95% CI 0.06 to 0.13) for negative Rh. Fixed effect analysis showed that blood group AB had a protective value to periodontitis; odds ratio 0.66 (95% CI 0.50 to 0.80; P < .001). However, there was no significant association of blood group A, B, and O. In addition, there was no significant association between ABO blood group and gingivitis; odds ratios of blood group B and O were 1.18 (95% CI 0.80 to 1.67; P = .34) and 1.36 (95% CI 0.89 to 2.08; P = .16), respectively.

CONCLUSION

There is a discrepancy among published observations regarding the effect of the ABO blood group on periodontium health. Further studies are needed with a large sample population to build more robust evidence. (Quintessence Int 2022;53:404-412; doi: 10.3290/j.qi.b2644845).

Assessment of clinical depression in abdominally obese subjects with periodontal disease

BACKGROUND

Depression is a commonly prevailing condition that goes undetected in clinical settings. Both abdominal obesity and periodontal disease have a bearing on mental health and have an impact on the quality of life.

OBJECTIVE

To assess the level of clinical depression in abdominally obese subjects with periodontal disease.

METHODS

Two hundred and ten subjects with a mean age of 37.45 ± 9.59 years (males = 117; females = 93) were grouped as per their abdominal obesity and periodontal status and assessed for their clinical depression levels (mental health) using the Centre for Epidemiologic Studies-Depression Scale (CES-D). Collected data were analysed.

RESULTS

The clinical depression score significantly varied in subjects with different periodontal status in both non-obese (F (2,102) = 113.66, P < 0.0001) and abdominally obese subjects (F (2,102) = 132.04, P < 0.001). Significantly higher depression score was demonstrated in healthy (P < 0.001), gingivitis (P < 0.001), and periodontitis (P < 0.001) groups in abdominally obese subjects.

CONCLUSION

Clinical depression is significantly associated with abdominal obesity and periodontal disease in subjects with abdominal obesity and severe periodontal disease demonstrating higher depression scores.

The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study

AIM

We investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer's pathology.

MATERIALS AND METHODS

N = 1306 participants (Visit 5 mean age = 76.5 [standard deviation = 5.4] years) in the Atherosclerosis Risk in Communities study with completed dental exams at Visit 4 underwent brain magnetic resonance imaging scans at Visit 5 while N = 248 underwent positron emission tomography scans. Participants were classified as edentulous or, among the dentate, by the modified Periodontal Profile Class. Brain volumes were regressed on periodontal status in linear regressions. Cerebrovascular measures and β-amyloid positivity were regressed on periodontal status in logistic regressions.

RESULTS

Periodontal disease was not associated with brain volumes, microhaemorrhages, or elevated β-amyloid. Compared with periodontally healthy individuals, odds ratios [95% confidence interval] for all-type infarcts were 0.37 [0.20, 0.65] for severe tooth loss and 0.56 [0.31, 0.99] for edentulous participants.

CONCLUSIONS

Within the limitations of this study, periodontal disease was not associated with altered brain volumes, microhaemorrhages, or β-amyloid positivity. Tooth loss was associated with lower odds of cerebral infarcts.

Association between osteoporosis and periodontal disease among menopausal women: The 2013-2015 Korea National Health and Nutrition Examination Survey

BACKGROUND

This cross-sectional study aimed to investigate the association between osteoporosis and periodontal disease among Korean menopausal women, as well as the association between osteoporosis and periodontal disease according to duration after menopause.

METHODS

Of a total of 22,948 subjects who participated in the Korea National Health and Nutrition Examination Survey, from 2013 to 2015 the final study population was limited to 2,573 subjects with no missing values. The subjects were divided into two groups, normal bone mineral density (BMD) and osteoporosis, according to the T-score obtained from bone densitometry. Scores of ≥ 3 points for the community periodontal index of treatment needs were reclassified as periodontal disease. Moreover, after stratification of the variable 'duration after menopause' into 0-4, 5-9, and ≥10 years, binary logistic regression analysis was performed to investigate the association between osteoporosis and periodontal disease according to the duration after menopause.

RESULTS

There was an association between osteoporosis and periodontal disease. The osteoporosis group had an adjusted odds ratio [OR] of 1.25 (95% confidence interval [CI]: 1.00-1.56) for periodontal disease compared to the normal BMD group. Of note, the osteoporosis group in the menopausal transition stage (0-4 years after menopause) showed an adjusted OR of 2.08 (95% CI: 1.15-3.77) for developing periodontal disease.

CONCLUSIONS

Osteoporosis was associated with periodontal disease and the association was strongest among women in the menopausal transition stage, 0-4 years after menopause. Oral health promotion, including regular oral examination and oral hygiene care, is particularly useful for menopausal transition women with osteoporosis.

Systemic Disorders Closely Associated with Malocclusion in Late Adolescence: A Review and Perspective

Oral diseases such as dental caries and periodontal disease are reported to be associated with various systemic diseases such as heart disease, respiratory disease, diabetes, rheumatism, and metabolic syndrome, thus increasing the importance of prevention and early treatment [...].

Effect of systemic bisphosphonate administration on patients with periodontal disease: a systematic review and meta-analysis protocol

INTRODUCTION

Periodontal disease is a chronic oral infectious disease affecting adults worldwide as well as a lifestyle-related disease related to diabetes. Bisphosphonate is a drug often taken by patients with osteoporosis; however, it reportedly can cause jawbone necrosis. Due to its mechanism of action on bone tissue, bisphosphonate has been used topically on periodontal tissue to treat periodontal disease. However, the long-term systemic effects of bisphosphonates on periodontal tissues are unclear. This paper describes a protocol evaluating the effects of systemic bisphosphonate administration to prevent periodontal tissue destruction in patients with periodontal disease. No systematic review has attempted to summarise the evidence for systemic bisphosphonates in periodontal therapy. The results of the proposed systematic review will inform the practice and design of future clinical trials.

METHODS AND ANALYSIS

This paper describes a protocol for a systematic review of the relevant published analytic research using an aggregative thematic approach according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Two authors will perform a comprehensive search for studies on Medline/PubMed, Scopus, Embase, LILACS and the Cochrane Central Register of Controlled Trials databases. Abstract screening, full-text screening and data extraction will be performed independently by two authors. A meta-analysis will be conducted as appropriate.

ETHICS AND DISSEMINATION

The protocol of this systematic review will be provided in a peer-reviewed journal. Formal ethics approval is not necessary because researchers will not identify individuals in the report.

PROSPERO REGISTRATION NUMBER

CRD42020212698 (http://www.crd.york.ac.uk/PROSPERO/).

Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring

Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.

Presence of periodontal pathogenic bacteria in blood of patients with coronary artery disease

It has been hypothesised that oral bacteria can migrate, through the blood, from the mouth to the arterial plaques, thus exacerbating atherosclerosis. This study compared bacteria present in the peripheral blood of individuals with and without coronary artery disease (CAD). RNA sequences obtained from blood were downloaded from GEO (GSE58150). Eight patients with coronary artery calcification (CAC) scoring > 500 and eight healthy individuals were analysed. After conducting quality control, the sequences were aligned to the hg38 reference genome using Hisat2. Bacterial taxa were analysed by inputting the unmapped sequences into Kraken. Ecological indices were calculated using Vegan. The package DESeq2 was used to compare the counts of bacteria per standard rank between groups. A total of 51 species were found only in patients with CAD and 41 were exclusively present in healthy individuals. The counts of one phylum, one class, three orders, two families and one genus were significantly different between the analysed groups (p < 0.00032, FDR < 10%), including the orders Cardiobacteriales, Corynebacteriales and Fusobacteriales. Twenty-three bacterial species belonging to the subgingival plaque bacterial complexes were also identified in the blood of individuals from both the groups; Fusobacterium nucleatum was significantly less frequent in patients with CAD (p = 0.0012, FDR = 4.8%). Furthermore, the frequency of another 11 bacteria differed significantly among patients with CAD than that among healthy individuals (p < 0.0030, FDR < 10%). These bacteria have not been previously reported in patients with atherosclerosis and periodontitis. The presence of members of the subgingival plaque bacterial complexes in the blood of patients with CAC supports the hypothesis that the periodontopathogens can be disseminated through the blood flow to other body parts where they may enhance inflammatory processes that can lead to the development or exacerbation of atherosclerosis.

Is There a Link between Oropharyngeal Microbiome and Schizophrenia? A Narrative Review

The study aimed to examine the impact of the oropharyngeal microbiome in the pathophysiology of schizophrenia and to clarify whether there might be a bidirectional link between the oral microbiota and the brain in a context of dysbiosis-related neuroinflammation. We selected nine articles including three systemic reviews with several articles from the same research team. Different themes emerged, which we grouped into 5 distinct parts concerning the oropharyngeal phageome, the oropharyngeal microbiome, the salivary microbiome and periodontal disease potentially associated with schizophrenia, and the impact of drugs on the microbiome and schizophrenia. We pointed out the presence of phageoma in patients suffering from schizophrenia and that periodontal disease reinforces the role of inflammation in the pathophysiology of schizophrenia. Moreover, saliva could be an interesting substrate to characterize the different stages of schizophrenia. However, the few studies we have on the subject are limited in scope, and some of them are the work of a single team. At this stage of knowledge, it is difficult to conclude on the existence of a bidirectional link between the brain and the oral microbiome. Future studies on the subject will clarify these questions that for the moment remain unresolved.

Pathological tooth migration-spontaneous correction of diastema after surgical periodontal therapy: a case report

A common consequence of moderate to extreme periodontitis is pathologic migration. This denotes tooth movement when the periodontal disease interjects the equilibrium among the elements that preserve physiological tooth position. The balancing factors can migrate the teeth in any direction. The etiology of pathological migration tends to be multifactorial, thus achieving early diagnosis is imperative, which will ultimately lead to the prompt removal of the etiological factors while avoiding severe bone destruction. In this case maxillary central incisors had diastema due to pathological migration with mobility grade I in maxillary left central incisor. Many cases of moderate to severe pathological migration need a suitable, interdisciplinary approach. Nevertheless, since it is possible to detect mild cases of Pathological tooth migration (PTM) at an early stage, spontaneous correction of migrated teeth can be accomplished by periodontal therapy alone. Regardless of the treatment selected, maintenance of stable results should be considered as an aim of treatment.

Metformin and risk of gingival/periodontal diseases in diabetes patients: A retrospective cohort study

AIM

To compare the risk of gingival and periodontal diseases (GPD) between ever users and never users of metformin in patients with type 2 diabetes mellitus.

METHODS

The Taiwan's National Health Insurance database was used to enroll 423,949 patients with new onset diabetes mellitus from 1999 to 2005. After excluding ineligible patients, 60,309 ever users and 5578 never users were followed up for the incidence of GPD from January 1, 2006 until December 31, 2011. Propensity score-weighted hazard ratios were estimated by Cox regression.

RESULTS

GPD was newly diagnosed in 18,528 ever users (incidence: 7746.51 per 100,000 person-years) and 2283 never users (incidence: 12158.59 per 100,000 person-years). The hazard ratio that compared ever users to never users was 0.627 (95% confidence interval: 0.600-0.655). When metformin use was categorized by tertiles of cumulative duration and cumulative dose, the risk significantly reduced in a dose-response pattern when the cumulative duration reached approximately 2 years or the cumulative dose reached 670 grams. Analyses on the tertiles of defined daily dose of metformin showed that the reduction of GPD risk could be seen in all three subgroups but the benefit would be greater when the daily dose increased.

CONCLUSION

Long-term use of metformin is associated with a significantly reduced risk of GPD.

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

OBJECTIVES

To identify the association between periodontal diseases (gingivitis and periodontitis) and chronic diseases including cardiovascular disease, cardiometabolic disease, autoimmune disease and mental ill health.

DESIGN

Retrospective cohort.

SETTING

IQVIA Medical Research Data-UK between 1 January 1995 and 1 January 2019.

PARTICIPANTS

64 379 adult patients with a general practitioner recorded diagnosis of periodontal disease (exposed patients) were matched to 251 161 unexposed patients by age, sex, deprivation and registration date.

MAIN OUTCOME MEASURES

Logistic regression models accounting for covariates of clinical importance were undertaken to estimate the adjusted OR (aOR) of having chronic diseases at baseline in the exposed compared with the unexposed group. Incidence rates for each outcome of interest were then provided followed by the calculation of adjusted HRs using cox regression modelling to describe the risk of outcome development in each group.

RESULTS

The average age at cohort entry was 45 years and the median follow-up was 3.4 years. At study entry, the exposed cohort had an increased likelihood of having a diagnosis of cardiovascular disease (aOR 1.43; 95% CI 1.38 to 1.48), cardiometabolic disease (aOR 1.16; 95% CI 1.13 to 1.19), autoimmune disease (aOR 1.33; 95% CI 1.28 to 1.37) and mental ill health (aOR 1.79; 95% CI 1.75 to 1.83) compared with the unexposed group. During the follow-up of individuals without pre-existing outcomes of interest, the exposed group had an increased risk of developing cardiovascular disease (HR 1.18; 95% CI 1.13 to 1.23), cardiometabolic disease (HR 1.07; 95% CI 1.03 to 1.10), autoimmune disease (HR 1.33; 95% CI 1.26 to 1.40) and mental ill health (HR 1.37; 95% CI 1.33 to 1.42) compared with the unexposed group.

CONCLUSIONS

In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health. Periodontal diseases are very common; therefore, an increased risk of other chronic diseases represent a substantial public health burden.

A cross-sectional study of relationships between periodontal disease and general health: The Hitachi Oral Healthcare Survey

BACKGROUND

This cross-sectional study performed to clarify the relationship between periodontal disease and non-communicable diseases (NCDs), such as obesity, diabetes mellitus, impaired glucose tolerance (IGT), chronic obstructive pulmonary disease (COPD), and atherosclerotic cardiovascular disease (ASCVD) by introducing dental examinations into the annual health examinations conducted by Japanese companies, and to highlights the importance of a medical system that connects dental and medical professionals.

METHODS

A total of 1.022 Hitachi Ltd. employees were enrolled in this cross-sectional study. We examined correlations and odds ratios (ORs) between the dental and overall health of employees using stratification and multiple logistic regression analyses based on the periodontal health indicators, general health indicators, and occlusal force.

RESULTS

The adjusted OR of PPD for obesity (OR, 1.42; 95% confidence interval [CI], 1.09-1.84; p = 0.009), IGT (OR, 1.48; 95% CI, 1.00-2.20; p = 0.049), and COPD (OR, 1.38; 95% CI, 1.02-1.88; p = 0.038) significantly differed. The adjusted OR of body mass index (OR, 1.28; 95% CI 1.15-1.42; p < 0.001), haemoglobin A1C (HbA1c) (OR, 4.34; 95% CI, 1.89-9.98; p < 0.001), fasting blood glucose (FBG) levels (OR, 1.08; 95% CI 1.04-1.11; p < 0.001), postbronchodilator forced expiratory volume in one second/forced vital capacity ratio (%FEV1) (OR, 0.95; 95% CI 0.91-1.00; p = 0.031) and smoking (OR, 2.32; 95% CI 1.62-3.33; p < 0.001) for severe periodontal disease also significantly differed. Occlusal force was significantly reduced in employees aged 50-59 years compared to those aged 40-49 years. Both PPD, HbA1c, FBG levels were significantly associated with occlusal force among employees with moderate/severe periodontitis. PPD was significantly associated with occlusal force among employees with and moderate COPD, and ASCVD. %FEV1 was significantly associated with occlusal force among employees with IGT.

CONCLUSIONS

This cross-sectional study revealed mutual relationships among periodontal disease, NCDs, and occlusal force on Japanese corporate workers. We demonstrated that a comprehensive, regional healthcare system centred on annual integrated dental and physical health examinations in the workplace will benefit employees and positively impact corporate health insurance.

Does periodontal disease have an association with prostate cancer?

Data sources The electronic databases PubMed, Embase and the Cochrane Oral Health Group's Trials Register up to 7 July 2020 were searched to identify eligible studies. Information sources in the grey literature were not cited.Study selection Cohort studies and case-control studies in English were selected by two reviewers independently. All articles had to include a control patient group (without periodontal disease) and a group with periodontal disease and both groups with prostate cancer outcomes. Also, all articles reported the hazard ratio (HR), relative risk (RR) or odds ratio (OR) estimates with their 95% confidence intervals (CIs).Data extraction and synthesis Data extraction and risk of bias assessments were performed by two reviewers independently and any disagreements between these authors were resolved through discussion or by consulting a third author. Data were synthesised qualitatively by the Newcastle-Ottawa Scale. RR with 95% CI was used as the pooled estimate to assess the association of periodontal disease and the risk of prostate cancer. When the outcome of interest was rare, it was considered that the OR approximated the RR (24). HR was also treated as RR when pooled in this meta-analysis. The heterogeneity across studies was evaluated by Q test (statistical significance was considered when P <0.1) and the I2 statistic (I2 ≥50% indicated significant heterogeneity).Results Seven studies were included in the meta-analyses, with four being prospective cohort studies and three retrospective cohort studies. All studies were of high quality except one study that was considered to be of moderate quality. Pooled estimates indicated that periodontal disease had a significant statistical relationship with the risk of prostate cancer (RR = 1.17; 95% CI = 1.07-1.27; P = 0.001). No significant heterogeneity across studies was observed (P = 0.383; I2 = 5.8%). The studies include Asian, European and American populations.Conclusions The authors of this review concluded that periodontal disease could be a possible risk for prostate cancer and that the male public, and clinicians, should be aware of the importance of maintaining good periodontal health.

Periodontal Diseases: Major Exacerbators of Pulmonary Diseases?

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.

Covid-19 and oral diseases: Crosstalk, synergy or association?

The coronavirus disease 2019 (Covid-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin-converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid-19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid-19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid-19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid-19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS-CoV-2 exhibits tropism for endothelial cells and Covid-19-mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid-19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune-mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid-19 subjects, indicating SARS-CoV-2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS-CoV-2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.

Effect of Orthodontic Treatment on Anterior Tooth Displacement in Patients with Periodontal Disease: A Meta-Analysis

OBJECTIVE

To systematically evaluate the effect of orthodontic treatment (ODT) on anterior tooth displacement (ATD) in patients with periodontal disease.

METHODS

PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases were electronically searched for relevant literature studies on ODT and basic treatment for ATD in patients with periodontal disease, and then the related journals and reference lists of the included studies were manually searched. The search time was set from January 2010 to May 2021. Stata 16.0 software was used for meta-analysis.

RESULTS

Totally, 783 articles were retrieved, and finally, 14 studies were included. The effective rate of basic treatment combined with OTD was significantly higher than that of basic treatment alone (OR = 7.27, 95% CI: 3.76, 14.04). Specifically, the combined treatment led to lower values of periodontal pocket depth (SMD = -2.30, 95% CI: -2.94, -1.66), anterior overjet (SMD = -2.75, 95% CI: -3.72, -1.78), anterior overbite (SMD = -2.13, 95% CI: -3.16, -1.10), and periodontal bleeding index (SMD = -4.25, 95% CI: -5.48, -3.03) compared with those of basic treatment alone.

CONCLUSION

Compared with basic treatment, ODT combined with basic treatment is more effective for patients with periodontal disease-caused ATD and can also improve the clinical symptoms of patients.

Glucose variability and periodontal disease in type 1 diabetes: a cross-sectional study-The "PAROdontopatia e DIAbete" (PARODIA) project

AIMS

Periodontal disease (PD) is a chronic inflammation of periodontal tissue associated with infection from specific anaerobic pathogens contained in dental plaque. Both type 1 and type 2 diabetes are associated with an increased prevalence of PDs. A two-way relationship between diabetes and periodontitis has been proposed, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. To date, the relationship between PD and glucose variability in type 1 diabetes has not been evaluated. To investigate the prevalence of PD in patients with type 1 diabetes and its association with glycemic control and glucose variability.

METHODS

In this cross-sectional study, all enrolled patients were scheduled to attend both a diabetologic and a periodontal visit. HbA1c, glucose coefficient of variation (CV), loss of clinical attachment (CAL), and periodontal probing depth (PPD) were collected.

RESULTS

136 patients were included in the analysis. The prevalence of PD was 63%. A significant correlation was found between mean CAL and glucose CV (r = 0.31, p = 0.002), but not with HbA1c. Mean PPD was also associated with glucose CV (r = 0.27 and 0.044), but not with HbA1c. In a multiple linear regression model, with mean CAL as dependent variable, age, glucose CV, and smoking habit resulted significantly associated (r = 0.23, p = 0.013; r = 0.33, p = 0.001; r = 0.34, p < 0.001, respectively). Assuming mean PPD as dependent variable, multiple linear regression analysis showed a significant association with glucose CV and smoking habits only.

CONCLUSIONS

PD is associated with glucose variability in patients with type 1 diabetes also after adjusting for the main confounders.

Association between periodontal disease and osteoporosis in postmenopausal women: a protocol for systematic review and meta-analysis

INTRODUCTION

Periodontal disease and osteoporosis are common chronic diseases, especially for the postmenopausal women. Several original studies explore the association, but there still controversial. Therefore, we will conduct this systematic review and meta-analysis to assess the association between periodontal disease and osteoporosis in postmenopausal women.

METHODS AND ANALYSIS

This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols. We will systematically search Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and Scopus from inception to August 2021 to collect all relevant publications, with no restrictions on publication date or languages. Study selection, data extraction and risk of bias assessment will be conducted independently by two trained reviewers independently. The Cochrane's tool for assessing risk of bias, Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality will be used for the risk of bias assessment. OR, HR and risk ratio with 95% CI were considered as the effect size for dichotomous outcomes, weighted mean difference with 95% CI were calculated as the effect size for continuous outcomes. Random-effects models will be used. Heterogeneity between studies will be assessed via the forest plot and I². Publication bias will detected by funnel plots, Begg's test and Egger's test. The subgroup analyses and sensitivity ananlyses will also be used to explore and interpret the heterogeneity.

ETHICS AND DISSEMINATION

This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42021225746.

Analysis the Link between Periodontal Diseases and Alzheimer's Disease: A Systematic Review

The hypothesis of an infectious connection from the oro-pharyngeal sphere to the brain underlines the interest in analyzing the link between periodontal disease and Alzheimer’s disease. The aim of this systematic review was to examine the link between Alzheimer’s disease and periodontal disease in patients aged 65 and over. Databases (PubMed (MEDLINE), the Cochrane Library, and Embase) were analyzed for relevant references up to 21 June 2021. The authors independently selected the studies and extracted the data. The quality of included studies was checked using the National Institutes of Health’s quality assessment tools. Five studies were included. The selected studies described in their results an increase in F. nucleatum in Alzheimer’s disease patients (adjusted p = 0.02), and its incidence was linked to C. rectus and P. gingivalis (adjusted HR = 1.22 (1.04–1.43), p = 0.012) as well as A. naeslundii (crude HR = 2.0 (1.1–3.8)). The presence of periodontitis at baseline was associated with a six-fold increase in the rate of cognitive decline over a 6-month follow-up period (ADAS-Cog mean change = 2.9 ± 6.6). The current review suggests an association between periodontal disease and Alzheimer’s disease. The treatment of periodontal disease could be a way to explore Alzheimer’s disease prevention.

Aggravated Dental and Periodontal Status in Patients with Sickle Cell Disease and Its Association with Serum Ferritin

AIM

The present study aimed to evaluate the possible consequences of sickle cell disease (SCD) on dental and periodontal health in middle-aged patients and to examine the association of certain cardiovascular parameters and serum ferritin with the dental and periodontal status.

MATERIALS AND METHODS

Thirty-seven patients (mean age 43.2 years old) with SCD and 30 non-SCD and otherwise healthy individuals (mean age 38.9 years old) were examined for caries experience and periodontal status in addition to cardiovascular characteristics and ferritin level in serum.

RESULTS

Compared to controls, SCD patients exhibited higher plaque and gingival bleeding scores, higher prevalence of periodontal diseases, and higher caries experience. Multiple stepwise linear regression analysis showed that caries experience was predominantly determined by the presence of SCD and the age, while major determinants of periodontitis were the ferritin levels and the male gender. The results reveal an aggravation of oral health in SCD patients regarding both caries and periodontal diseases.

CONCLUSION

A potential role of the increased central inflammatory response, reflected by the elevated ferritin level in serum, is suggested for the impaired periodontal health of SCD patients.

CLINICAL SIGNIFICANCE

Compliance with precautionary dental checks and early management of dental complications is of great importance in order to improve oral health status and prevent general health complications in SCD patients.

Saliva pH and Flow Rate in Patients with Periodontal Disease and Associated Cardiovascular Disease

BACKGROUND Periodontal disease, a frequent oral health problem, is connected with cardiovascular morbidity and mortality. This study aimed to assess the unstimulated saliva flow rate and saliva pH as markers of the severity of periodontal disease in patients with cardiovascular disease. MATERIAL AND METHODS A cohort of 155 patients (78 men and 77 women, aged 30-92 years) was included, and a structured questionnaire obtained information about their health status, oral healthcare behaviors, and eating habits. An oral examination was performed to assess periodontal status and presence of dental calculus. The unstimulated whole salivary flow rate and salivary pH were measured. An oral hygienization was performed, and 3 months later, salivary flow rate and pH were reevaluated. RESULTS A severe form of periodontal disease was found in 22.4% of patients. Disease severity was strongly correlated with low pH values (6.25 in stage IV periodontal disease), lower salivary flow rate (0.28 mL/min), smoking, poor oral hygiene habits and obesity, with no significant differences by sex. We observed a significant increase of pH (up to 6.30±0.17) in patients with severe periodontal disease (P=0.001) and salivary flow rate values (0.29±0.07 mL/min; P=0.014) 3 months after oral hygienization. There was a strong association between the severity of periodontal disease and presence of cardiovascular disease (P=0.001). CONCLUSIONS Our study suggests that the decrease of salivary flow rate and pH level might be associated with the severity of periodontal disease.

Additive Effect of Periodontal Disease and Obesity on COVID-19 Outcomes

This study aims to examine the impact of periodontal disease in obesity on COVID-19 infection and associated outcomes. This retrospective longitudinal study included 58,897 UK Biobank participants tested for COVID-19 between March 2020 and February 2021. Self-reported oral health indicators (bleeding gums, painful gums, and loose teeth) were used as surrogates for periodontal disease. Body fat levels were quantified by body mass index (BMI) and categorized as normal weight (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), and obese (≥30 kg/m²). Multivariable logistic regression and Cox proportional hazard models were used to quantify risk of COVID-19 infection, hospital admission, and mortality, adjusted for participants’ demographics and covariates. Of 58,897 participants, 14,466 (24.6%) tested positive for COVID-19 infection. COVID-19 infection was higher for participants who were overweight (odds ratio, 1.18; 95% CI, 1.12 to 1.24) and obese (odds ratio, 1.33; 95% CI, 1.26 to 1.41) as compared with those of normal weight, but infection was not affected by periodontal disease. The hospital admission rate was 57% higher (hazard ratio, 1.57; 95% CI, 1.25 to 1.97) in the obese group with periodontal disease than without periodontal disease, and admission rates increased with BMI category (normal weight, 4.4%; overweight, 6.8%; obese, 10.1%). Mortality rates also increased with BMI category (normal weight, 1.9%; overweight, 3.17%; obese, 4.5%). In addition, for participants with obesity, the mortality rate was much higher (hazard ratio, 3.11; 95% CI, 1.91 to 5.06) in participants with periodontal disease than those without. Obesity is associated with higher hospitalization and mortality rates, and periodontal disease may exacerbate this impact. The results could inform health providers, policy makers, and the general public of the importance to maintain good oral health through seamless provision of dental services and public oral health prevention initiatives.

Periodontal Disease, Atrial Fibrillation and Stroke

BACKGROUND

We recently described the association between periodontal disease (PD) and stroke risk.

PURPOSE

The purpose of this study was to test the association between PD, dental care utilization and incident atrial fibrillation (AF), as well as AF as a mediator to PD- stroke association.

METHODS

In dental cohort of the Atherosclerosis Risk in Communities Study (ARIC), participants without prior AF underwent full-mouth periodontal measurements. PD was defined on an ordinal scale as healthy (referent), mild, moderate and severe. In ARIC main cohort, participants were classified as regular or episodic dental care users. These patients were followed for AF, over 17 years. Cox proportional hazards models adjusted for AF risk factors were used to study relationships between PD severity, dental care utilization and AF. Mediation analysis was used to test if AF mediated the PD- stroke association.

RESULTS

In dental ARIC cohort, 5,958 were assessed without prior AF, 754 were found to have AF. Severe PD was associated with AF on both univariable (crude HR, 1.54; 95% CI, 1.26-1.87) and multivariable (adjusted HR, 1.31, 95% CI, 1.06-1.62) analyses. Mediation analysis suggested AF mediates the association between PD and stroke. In the main ARIC cohort, 9,666 participants without prior AF were assessed for dental care use, 1558 were found to have AF. Compared with episodic users, regular users had a lower risk for AF on univariable (crude HR, 0.82, 95% CI, 0.74-0.90) and multivariable (adjusted HR, 0.88, 95% CI, 0.78-0.99) analyses.

CONCLUSIONS

PD is associated with AF. The association may explain the PD-stroke risk. Regular users had a lower risk of incident AF compared with episodic users.

Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study

OBJECTIVES

Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain whether periodontal disease affects the risk of mortality and morbidity in patients with advanced CKD.

MATERIALS AND METHODS

Taiwan's National Health Insurance Research Database was used to conduct a nationwide population-based cohort study. Propensity score matching procedures were performed to select people with stage 5 CKD and to compare the long-term risk of mortality, end-stage renal disease, and major adverse cardiovascular events (MACE) between people with and without periodontal disease. Multivariable Cox regression analyses were conducted to calculate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the outcome of interest.

RESULTS

A total of 8119 subjects with stage 5 CKD were initially included. After matching to demographic and clinical covariates, 1254 subjects with 7099 person-years of follow-up were selected for analyses. Periodontal disease was not associated with long-term risks of all-cause mortality (aHR: 0.77, 95% CI: 0.49-1.22), progression to end-stage renal disease (aHR: 0.91, 95% CI: 0.75-1.10), or MACE (aHR: 1.18, 95% CI: 0.91-1.53). These findings were generally consistent across subgroups of age, sex, comorbid diabetes, uses of systemic antibiotic, and different dental procedures.

CONCLUSIONS

Periodontal disease is not a predictor for long-term mortality or morbidity in patients with advanced CKD.

CLINICAL RELEVANCE

These results provide important evidence to elucidate the relationship between periodontitis and critical clinical outcomes of advanced CKD.

Relationship between NAFLD and Periodontal Disease from the View of Clinical and Basic Research, and Immunological Response

Periodontal disease is an inflammatory disease caused by pathogenic oral microorganisms that leads to the destruction of alveolar bone and connective tissues around the teeth. Although many studies have shown that periodontal disease is a risk factor for systemic diseases, such as type 2 diabetes and cardiovascular diseases, the relationship between nonalcoholic fatty liver disease (NAFLD) and periodontal disease has not yet been clarified. Thus, the purpose of this review was to reveal the relationship between NAFLD and periodontal disease based on epidemiological studies, basic research, and immunology. Many cross-sectional and prospective epidemiological studies have indicated that periodontal disease is a risk factor for NAFLD. An in vivo animal model revealed that infection with periodontopathic bacteria accelerates the progression of NAFLD accompanied by enhanced steatosis. Moreover, the detection of periodontopathic bacteria in the liver may demonstrate that the bacteria have a direct impact on NAFLD. Furthermore, Porphyromonas gingivalis lipopolysaccharide induces inflammation and accumulation of intracellular lipids in hepatocytes. Th17 may be a key molecule for explaining the relationship between periodontal disease and NAFLD. In this review, we attempted to establish that oral health is essential for systemic health, especially in patients with NAFLD.

A retrospective study of orthodontic treatment on anterior tooth displacement caused by periodontal disease

This retrospective study aimed to explore the effect of orthodontic treatment (ODT) on anterior tooth displacement (ATD) caused by periodontal disease (PD).A total of 72 patients were selected and were divided into a control group (n = 36) and an experimental group (n = 36). Patients in both groups received conventional periodontal treatment. In addition, patients in the experimental group also received ODT. Outcomes include probing depth, percentage of bleeding sites, clinical attachment loss, clinical crown length, tooth root length, and periodontal tissue of the affected tooth (alveolar bone height, periodontal pocket depth, bleeding index).After treatment, the patients in the experimental group achieved more improvements in probing depth (P < .01), percentage of bleeding sites (P < .01), clinical attachment loss (P < .01), clinical crown length (P = .04), and periodontal tissue of the affected tooth (periodontal pocket depth (P < .01), and bleeding index (P < .01)), than those of patients in the control group.This study suggests that ODT is beneficial for ATD caused by PD. Future studies are still needed to verify the findings of this study.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview

INTRODUCTION

We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations.

MATERIALS AND METHODS

The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis.

RESULTS

Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease.

CONCLUSION

Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

The Prevalence of Periodontal Pathogenic Bacteria in Atherosclerotic Cardiovascular Disease

BACKGROUND

A possible link between periodontal pathogenic bacteria and atherosclerosis may exist based on the inflammatory mechanisms initiated by bacteria found in periodontal lesions. Our aim was to investigate the presence of DNA originating from T. denticola, C. rectus, T. forsythia, and P. gingivalis in the vascular tissue specimens obtained from patients who underwent surgery for arteriosclerotic vascular disease in this study.

METHODS

A total of 96 patients diagnosed with valvular heart disease due to atherosclerosis and 85 patients with advanced aortic valve stenosis due to rheumatic fever and had undergone aortic valve replacement were included as the study (PG) and the control groups (CG), respectively. Atheroma plaques and vascular tissue specimens were collected from PG and CG during cardiovascular surgical procedures. Revitalization of the lyophilized T. denticola, ATCC 35405; C. rectus, ATCC 33238; P. gingivalis, ATCC 33277 and T. forsythia, ATCC 43037 strains was performed according to the manufacturer's instructions. C. rectus, T. forsythia, and T. denticola DNA samples were analyzed using the one-step in-house PCR method.

RESULTS

In one (1.04%) and three (3.13%) out of 96 atherosclerotic PG tissue specimens, P. gingivalis and T. for-sythia DNA were detected, respectively. No T. denticola or C. rectus DNA was found in the study specimens. Periodontal pathogenic bacteria were not observed in 85 CG tissue specimens. There was no statistically significant difference between PG and CG for the presence of P. gingivalis and T. forsythia DNA using Fischer's Exact test (p > 0.05).

CONCLUSIONS

In conclusion, with the case-control studies on a small scale such as in our study, it is not possible to determine a causality relationship between periodontal pathogenic bacteria and formation of atherosclerosis. Periodontal pathogenic bacteria may not be the only factor that causes inflammatory diseases associated with atherosclerosis. Host response and inflammatory mechanisms may be affected by other factors such as ethnicity, dietary habits, nutritional availability, and lifestyle. Taken together, it is difficult to conclude a causal link between periodontal pathogenic bacteria and formation of atherosclerosis.

Periodontal Diseases and Adverse Pregnancy Outcomes: Review of Two Decades of Clinical Research

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected.

Periodontal Disease in Type 1 Diabetes Mellitus: Influence of Pubertal Stage and Glycemic Control

OBJECTIVE

Though gingivitis is common in children with type 1 diabetes mellitus (T1DM), the overall periodontal health in T1DM during the pubertal stage is less well-characterized. The study was undertaken to explore the possible influence of puberty and metabolic derangement on periodontal health in T1DM.

METHODS

In this cross-sectional study, 110 subjects between 10-18 years with T1DM and 52 healthy siblings of similar age were evaluated for pubertal stage, glycosylated hemoglobin (HbA1c), and periodontal health. Simplified oral hygiene index (OHIS), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and probing depth (PPD) were evaluated at 4 sites per tooth as per 6 Ramfjord index teeth used to assess periodontal disease (PD).

RESULTS

PD not merely gingivitis was significantly higher in T1DM (84/110, 76.36%) than the control group (28/52, 53.8%) (P = .004). Irrespective of pubertal status, children with T1DM had worse GI, PI, BOP, and PPD than nondiabetic subjects, although OHIS was better in diabetes. In both T1DM and nondiabetic subjects, pubertal subjects showed significantly worse OHIS, PPD, BOP, and GI than prepubertal subjects. PD was correlated with pubertal stage, age, and HbA1c, although less strongly with the duration of diabetes. In logistic regression, pubertal stage was a stronger predictor of PD (OR = 14.26) than age (OR = 2.22), and HbA1c (OR = 1.5) rather than the presence of diabetes and its duration.

CONCLUSIONS

Though pubertal status, age, and poor glycemic control rather than the presence of diabetes and its duration are associated with gingivitis and other forms of PD, puberty had a more profound effect in the pathogenesis of PD in T1DM.

Periodontal Disease and Tooth Wear in a Sample of German Soldiers with Posttraumatic Stress Disorder

PURPOSE

Dental symptoms of post-traumatic stress disorder (PTSD) patients include a majority of painful temporomandibular joint and masticatory muscle findings, restricted mouth opening, and pronounced attritions. Traumatic occlusal force resulting in injury of the teeth and/or the periodontal attachment apparatus may exceed the adaptive capacity of the individual person or site. This observational cross-sectional study in soldiers with PTSD and a non-PTSD control group after military deployments aimed to evaluate a possible relationship between bruxism and periodontal diagnosis.

MATERIALS AND METHODS

Ninety-six in-patients and 27 out-patients (21 women, 102 men) with specialist-confirmed PTSD and bruxism after up to 17 foreign assignments, and 36 male non-PTSD controls with up to 15 foreign assignments underwent general dental, functional, and periodontal examinations.

RESULTS

All three groups showed no statistically significant differences in terms of age (34.8 ± 8.6 years), number of teeth (n: 26.3 ± 3.4), status of dentition (DMFT 9.7 ± 6.6), incidence of periodontitis (36%) and recessions (n: 5.8 ± 5.7). From the control group to the out-patient group to the in-patient group, the proportion of smokers and tobacco use increased statistically significantly, as did the extent of attrition. In the in-patient group, with statistically significantly lower educational levels, the number of perceived prophylaxis sessions was statistically significantly reduced in the last two years.

CONCLUSIONS

Taking into account the retrospective recording of the last traumatic event, the average time of five years until therapy does not seem to have any consequences for the frequency and severity of inflammatory periodontal disease, recession, and wedge-shaped defects in soldiers with bruxism in PTSD, regardless of the need for in-patient or out-patient treatment.

RESOURCES TO IMPROVE THE EFFECTIVENESS OF PERIODONTAL TREATMENT IN PATIENTS WITH DIABETES MELLITUS

OBJECTIVE

The aim: Is to characterize the «Medico-sociological map» developed by us to identify systemic and local risk factors for periodontal disease in patients with type I and II diabetes mellitus as a resource to improve the treatment of generalized periodontitis.

PATIENTS AND METHODS

Materials and methods: We have developed a Medic-sociological map to identify systemic and local risk factors for periodontal disease in patients with type I and type II diabetes mellitus. Methods of accumulation of primary dental and endocrinological information, review and analytical methods. Statistical methods for comparing empirical data and their generalization.

RESULTS

Results: Thanks to the «Medico-sociological map» developed by us, systemic and local risk factors for the development of periodontal tissue diseases in patients with type I and II diabetes mellitus have been identified. Factors for improving the well-being of patients in the treatment of periodontal diseases have been comprehensively studied. Patients with type 1 and type 2 diabetes mellitus have been shown to give up healthy habits (cigarette smoking) and lead a healthy lifestyle and reduce the health risks that can be caused by generalized periodontitis in combination with diabetes mellitus.

CONCLUSION

Conclusions: It has been demonstrated that resources to improve the effectiveness of periodontitis treatment in patients with diabetes mellitus include not only cooperation with endocrinologists, but also our «Medico-sociological map» to identify systemic and local risk factors for periodontal disease in patients with type I and II diabetes mellitus.

The Link Between Periodontitis/Peri-implantitis and Cardiovascular Disease: A Systematic Literature Review

A link between periodontitis and cardiovascular disease has been reported in the literature. For this systematic review, the keywords "cardiovascular disease" (CVD) were combined with "periodontitis" and "peri-implantitis" and were used to search for literature published on MEDLINE and PubMed between 1990 and 2020. Hand searching was also performed. A total of 206 articles were identified, 51 of which were reviewed. A link between periodontal disease and CVD can be explained by both the infection and inflammatory pathways. Interventional studies on the treatment of periodontal disease related to CVD have shown conflicting results. Therefore, based on published studies, CVD should presently be considered a comorbidity of periodontitis (with an association but no direct cause and effect documented). The association of CVD with peri-implantitis has too few studies to draw any conclusions. More studies are necessary before any conclusions can be made between CVD and periodontitis and CVD and peri-implantitis regarding possible links and the extent of association.

The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.

Awareness of Diabetic Patients Regarding the Bidirectional Association between Periodontal Disease and Diabetes Mellitus: A Public Oral Health Concern

AIM AND OBJECTIVE

The literature regarding the perception of the two-way relationship between diabetes mellitus and periodontal disease representing diabetic patients living in Australia is scarce. The study aimed to evaluate the knowledge and attitudes of diabetic patients regarding the bidirectional link and the role of medical healthcare professionals in providing oral health advice to their patients.

MATERIALS AND METHODS

A convenience sample of diabetic patients attending general practice-based medical and dental centers was invited to complete a questionnaire-based survey. The survey was anonymous, and the responses of the participants were not identifiable.

RESULTS

A total of 241 participants completed the questionnaire; however, three survey responses were excluded as most of the critical questions were not answered. The majority (87.81%) of the participants reported with type 2 diabetes mellitus, while 11.76% had type 1 diabetes mellitus. Just over 61% of the participants reported brushing their teeth twice a day. The majority of participants (66.38%) said that their medical practitioner/diabetic educator never asked or examined their oral hygiene or any issues with the gums or teeth. The study noted that 54% of the participants never received any information regarding the bidirectional relationship between periodontal disease and diabetes mellitus and were unaware of the association.

CONCLUSION

Patients with diabetes mellitus lack knowledge of the bidirectional association between periodontal disease and diabetes mellitus. In this regard, the study urged the need to implement European Federation of Periodontology and International Diabetes Federation guidelines effectively. Medical healthcare professionals and dentists should provide mutual care and should consider every patient as a shared responsibility.

CLINICAL SIGNIFICANCE

Early detection of the disease, timely referrals, and a collaborative approach will enhance patient care and improve the quality of life of individuals living with periodontal disease.

Periodontal Disease and Age-Related Macular Degeneration: A Meta-Analysis of 112,240 Participants

OBJECTIVE

Epidemiological studies have shown a correlation between periodontal disease (PD) and age-related macular degeneration (AMD). However, the results have been inconsistent, and no relevant meta-analysis has been performed on this topic. Hence, we performed a meta-analysis to evaluate whether the two diseases are related. Material and Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to April 20, 2020, for related articles. Two authors independently conducted literature screening and data extraction and then used the Stata 15.1 software to calculate the relative risk (RRs) and 95% confidence intervals (CIs) to assess the association between PD and AMD.

RESULTS

A total of 5 observational studies involving 112,240 participants and 5,005 AMD patients were included. The results of meta-analysis using the random-effects model showed that the incidence of AMD in PD patients was 1.35 times that of non-PD patients; the difference was statistically significant (RR = 1.35, 95%CI = 1.07-1.70, P = 0.011). Sensitivity analysis showed that the results were stable.

CONCLUSIONS

PD patients have a higher risk of AMD, but the causal relationship between PD and AMD has not been confirmed. Further research should be carried out to verify the exact relationship between the two.

The Effect of Gaseous Ozone Therapy in Conjunction with Periodontal Treatment on Glycated Hemoglobin Level in Subjects with Type 2 Diabetes Mellitus: An Unmasked Randomized Controlled Trial

BACKGROUND

It is established that inflammation is involved in the pathogenesis of Type 2 Diabetes Mellitus (T2DM) by promoting insulin resistance and impaired beta cell function in the pancreas. Among the hypothesized independent risk factors implicated in the pathogenetic basis of disease, periodontal infection has been proposed to promote an amplification of the magnitude of the advanced glycation end product (AGE)-mediated upregulation of cytokine synthesis and secretion. These findings suggest an interrelationship between periodontal disease and type 2 diabetes, describing poor metabolic control in subjects with periodontitis as compared to nondiabetic subjects and more severe periodontitis in subjects with T2DM as compared to a healthy population, with a significant positive correlation between periodontal inflammatory parameters and glycated hemoglobin level. Results from clinical trials show that periodontal treatment is able to improve glycemic control in subjects with diabetes. Many therapeutic strategies have been developed to improve periodontal conditions in conjunction with conventional treatment, among which ozone (O₃) is of specific concern. The principal aim of this trial was to compare the clinical effectiveness of an intensive periodontal intervention consisting of conventional periodontal treatment in conjunction with ozone gas therapy in reducing glycated hemoglobin level in type 2 diabetic patients and standard periodontal treatment.

METHODS

This study was a 12-month unmasked randomized trial and included 100 patients aged 40-74 years older, with type 2 diabetes mellitus diagnosed. All the patients received conventional periodontal treatment, or periodontal treatment in conjunction with ozone gas therapy in a randomly assigned order (1:1). The primary outcome was a clinical measure of glycated hemoglobin level at 3, 6, 9 and 12 months from randomization. Secondary outcomes were changes in periodontal inflammatory parameters.

RESULTS

At 12 months, the periodontal treatment in conjunction with ozone gas therapy did not show significant differences than standard therapy in decreasing glycated hemoglobin (HbA1C) level and the lack of significant differences in balance is evident.

CONCLUSIONS

Although the change was not significant, periodontal treatment in conjunction with the gaseous ozone therapy tended to reduce the levels of glycated hemoglobin. The study shows a benefit with ozone therapy as compared to traditional periodontal treatment.

Close Associations of Gum Bleeding with Systemic Diseases in Late Adolescence

BACKGROUND

Though it is well known that periodontal diseases are associated with various systemic diseases in adults, the associations in late adolescents have not been adequately elucidated. We investigated the association between gum bleeding (a major symptom of periodontal diseases) and common systemic diseases in late adolescents: allergic, respiratory, and otorhinolaryngologic diseases.

METHODS

We conducted a retrospective review of the mandatory medical questionnaires administered as a part of legally required freshman medical checkup between April 2017 and April 2019 at the University of Tokyo. Among the total of 9376 sets of responses, 9098 sets from students aged less than 20 were analyzed. An χ2 test and univariate and multivariate binomial logistic regression analyses were performed using SAS ver. 9.4. A value of p < 0.05 was accepted as significant.

RESULTS

According to the questionnaire data, 3321 students (36.5%; 2780 males and 541 females) responded that they experienced gum bleeding whenever they brushed their teeth. These students had significantly higher incidence rates of otitis media/externa and asthma/cough-variant asthma (p = 0.001 and p = 0.006, respectively). The results of the multivariate analysis showed significant rates of the following complications among these students: (1) otitis media/externa (odds ratio (OR) 1.691; 95% confidence interval (CI): 1.193-2.396; p = 0.003), (2) asthma/cough-variant asthma (OR 1.303; 95% CI: 1.091-1.556; p = 0.003), and (3) male gender (OR 1.536; 95% CI: 1.337-1.765; p < 0.001).

CONCLUSIONS

Gum bleeding was closely associated with otitis media/externa and asthma in late adolescents. Our study reinforces new evidence about the association between periodontal diseases and asthma, and it reveals a novel and close association between gum bleeding and otitis media/externa.

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and adverse pregnancy outcomes: A position paper from the Canadian Dental Hygienists Association

Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion for the profession and public.

Aim

To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes.

Methods

The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.

Results

Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes.

Conclusion

Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available.

Automated Process Incorporating Machine Learning Segmentation and Correlation of Oral Diseases with Systemic Health

Imaging fluorescent disease biomarkers in tissues and skin is a non-invasive method to screen for health conditions. We report an automated process that combines intraoral fluorescent porphyrin biomarker imaging, clinical examinations and machine learning for correlation of systemic health conditions with periodontal disease. 1215 intraoral fluorescent images, from 284 consenting adults aged 18-90, were analyzed using a machine learning classifier that can segment periodontal inflammation. The classifier achieved an AUC of 0.677 with precision and recall of 0.271 and 0.429, respectively, indicating a learned association between disease signatures in collected images. Periodontal diseases were more prevalent among males (p=0.0012) and older subjects (p=0.0224) in the screened population. Physicians independently examined the collected images, assigning localized modified gingival indices (MGIs). MGIs and periodontal disease were then cross-correlated with responses to a medical history questionnaire, blood pressure and body mass index measurements, and optic nerve, tympanic membrane, neurological, and cardiac rhythm imaging examinations. Gingivitis and early periodontal disease were associated with subjects diagnosed with optic nerve abnormalities (p<; 0.0001) in their retinal scans. We also report significant co-occurrences of periodontal disease in subjects reporting swollen joints (p=0.0422) and a family history of eye disease (p=0.0337). These results indicate cross-correlation of poor periodontal health with systemic health outcomes and stress the importance of oral health screenings at the primary care level. Our screening process and analysis method, using images and machine learning, can be generalized for automated diagnoses and systemic health screenings for other diseases.

Association between Sleep Quality and Duration and Periodontal Disease among University Students: A Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the association between sleep quality and duration, and periodontal disease among a group of young Japanese university students. First-year students (n = 1934) at Okayama University who voluntarily underwent oral health examinations were included in the analysis. Sleep quality and duration were assessed by the Japanese version of the Pittsburgh Sleep Quality Index. Dentists examined Oral Hygiene Index-Simplified (OHI-S), probing pocket depth (PPD), and percentage of sites with bleeding on probing (BOP). Periodontal disease was defined as presence of PPD ≥ 4 mm and BOP ≥ 30%. Overall, 283 (14.6%) students had periodontal disease. Poor sleep quality was observed among 372 (19.2%) students. Mean (± standard deviation) sleep duration was 7.1 ± 1.1 (hours/night). In the logistic regression analysis, periodontal disease was significantly associated with OHI-S (odds ratio [OR]: 2.30, 95% confident interval [CI]: 1.83–2.90; p < 0.001), but not sleep quality (OR: 1.09, 95% CI: 0.79–1.53; p = 0.577) or sleep duration (OR: 0.98, CI: 0.87–1.10; p = 0.717). In conclusion, sleep quality and duration were not associated with periodontal disease among this group of young Japanese university students.

Acute and chronic diabetes complications associated with self-reported oral health: a retrospective cohort study

BACKGROUND

Oral health is associated with diabetes, but the chances of experiencing acute or chronic diabetes complications as per this association is unknown in Canada's most populous province, Ontario. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics.

METHODS

A retrospective cohort study was conducted of diabetics (n = 5183) who participated in the Canadian Community Health Survey 2003 and 2007-08. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, 2016. Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status.

RESULTS

Thirty-eight percent of diabetics reporting "poor to fair" oral health experienced a diabetes complication, in comparison to 34% of those reporting "good to excellent" oral health. The odds of an acute or chronic complication among participants reporting "poor to fair" oral health status was 10% (OR 1.10; 95% CI 0.81, 1.51) and 34% (OR 1.34; 95% CI 1.11, 1.61) greater respectively, than among participants experiencing no complications and reporting "good to excellent" oral health.

CONCLUSION

Self-reporting "poor to fair" oral health status is associated with a greater likelihood of chronic complications than acute complications. Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed.

Periodontal Condition Is Correlated with Deep and Subcortical White Matter Hyperintensity Lesions in Japanese Adults

Deep and subcortical white matter hyperintensity (DSWMH) lesions are a small-vessel disease of the brain. The aim of this cross-sectional study was to investigate the relationship between DSWMH lesions and periodontal status in Japanese adults who participated in a health check. We enrolled 444 consecutive participants (mean age, 54.5 years) who received both brain and oral health evaluation services at the Asahi University Hospital. Magnetic resonance imaging was used to detect DSWMH lesions. Periodontal status was assessed using the community periodontal index. Of the study participants, 215 (48.4%) had DSWMH lesions. Multivariate logistic regression showed that the presence of DSWMH lesions was significantly related to age ≥ 65 years (vs. < 65 years, odds ratio [OR] = 2.984, 95% confidence interval [CI] = 1.696-5.232), systolic blood pressure ≥ 140 mmHg (vs. < 140 mmHg, OR = 2.579, 95% CI = 1.252-5.314), the presence of ≥ 28 teeth (vs. < 28 teeth, OR = 0.635, 95% CI = 0.420-0.961), and probing pocket depth (PPD) ≥ 6 mm (vs. PPD < 6 mm, OR = 1.948, 95% CI = 1.132-3.354) after adjustment for confounding factors. Having PPD ≥ 6 mm may be a risk factor for DSWMH lesions in Japanese adults.