Periodontal health and global public health

Periodontal disease and periodontal bacteria as triggers for rheumatoid arthritis

There is an epidemiological association between periodontitis and rheumatoid arthritis (RA), which is hypothesised to lead to enhanced generation of RA-related autoantibodies that can be detected years before the onset of RA symptoms. Periodontitis is a common dysbiotic disease; tissue damage occurs because the immune system fails to limit both the resident microbial community and the associated local immune response. Certain periodontal bacteria, including Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, may contribute to RA autoantibody production through direct post-translational modification of proteins or, indirectly, by influencing neutrophil-mediated neo-epitope generation. Oral bacteria that invade the blood may also contribute to chronic inflammatory responses and generation of autoantibodies. The putative association between periodontitis and the development of RA raises the potential of finding novel predictive markers of disease and disease progression and for periodontitis treatment to be included in the future as an adjunct to conventional RA immunotherapy or as part of a preventive strategy.

Is the oral fungal pathogen Candida albicans a cariogen?

Pathobiology of dental caries is complex. Data from recent molecular microbiologic studies have further redefined the role of the oral microbiome in the etiology of dental caries. This new information challenges the conventional view on the hegemony of classic cariogenic prokaryotes such as Streptococcus mutans in caries etiology, and raises the intriguing possibility of the participation of the eukaryotic oral fungal pathogen Candida in the caries process. The virulence attributes of Candida species such as their acidogenicity and aciduric nature, the ability to develop profuse biofilms, ferment and assimilate dietary sugars, and produce collagenolytic proteinases are all indicative of their latent cariogenic potential. Based on the above, oral candidal counts have been used by some as a caries risk indicator. On the contrary, other studies suggest that Candida is merely a passenger extant in an acidic cariogenic milieu, and not a true pathogen. In this review, we critically examine the varying roles of Candida, and traditionally accepted cariogens such as the mutans group of streptococci in the pathobiology of dental caries. The weight of available data tends to imply that Candida may play a pivotal role as a secondary agent perpetuating the carious process, especially in dentinal caries.

Conditioned medium from relapsing-remitting multiple sclerosis patients reduces the expression and release of inflammatory cytokines induced by LPS-gingivalis in THP-1 and MO3.13 cell lines

The present research was aimed at evaluating the effect of the conditioned medium (CM) from human periodontal ligament stem cells (hPDLSCs) obtained from healthy donors (hPDLSCs-CM) and from Relapsing-Remitting Multiple Sclerosis patients (RR-MS-CM) on inflammatory response induced by Porphyromonas gingivalis lipopolysaccharide (LPS-G) in a monocytoid human cell line (THP-1) and human oligodendrocyte cell line (MO3.13). Human periodontal ligament biopsies were carried out from control donor patients and selected RR-MS donors. Sample tissues were obtained from premolar teeth during root scaling and subsequently cultured. The effect of hPDLSCs-CM and RR-MS-CM on cell viability in PMA differentiated THP-1 (as a model of microglia) was measured using a 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) assay. The same experiments were performed in undifferentiated and differentiated MO3.13 cells used as models of progenitor cells and oligodendrocytes, respectively. The expression of tumor necrosis factor alpha (TNF)-α, interleukin (IL)-1β and IL-6 was evaluated by Real-Time Polymerase Chain Reaction (RT-PCR), and enzyme-linked immunosorbent assay (ELISA). The expression level of the Toll-like receptor 4 (TLR-4), for which LPS-G is a ligand, was evaluated by Western blot analysis. The results were analyzed by ANOVA using Graph Pad Prism software. LPS-G significantly increased TNFα, IL-1β and IL-6 mRNA expression and protein levels in the differentiated THP-1 cells and oligodendrocyte MO3.13 progenitor cells. Treatment with hPDLSCs-CM or with RR-MS-CM significantly attenuated the LPS-induced expression and production of these pro-inflammatory cytokines. The CM from both healthy donors and RR-MS patients also reduced the LPS-G stimulated protein levels of TLR-4 in differentiated THP-1 cells. On the whole our data add new evidence on the anti-inflammatory effects of these peculiar stem cells even when derived from RR-MS patients and open novel perspectives in the therapeutic use of autologous periodontal stem cells in neuroinflammatory/neurodegenerative diseases including MS.

Periodontal status in crack and cocaine addicted men: a cross-sectional study

This cross-sectional study evaluated the association between crack/cocaine addiction and periodontal disease in men. Periodontal examination (probing depth, clinical attachment level, bleeding on probing, and plaque index) and interviews were performed in 160 patients (≥18 years) from the Federal University of Bahia. Crack and cocaine dependence was defined according to the medical records and interviews of each patient; all drug addicted volunteers used both crack and cocaine. T test, Chi-square test, and logistic regression were used to assess the associations between destructive periodontal disease and crack/cocaine dependence (p ≤ 0.05). Probing depth was significantly greater in crack/cocaine addicted individuals (2.84 ± 0.76 mm) compared with non-addicted individuals (2.55 ± 0.73 mm, p = 0.04). After adjusting for covariates, periodontitis was not significantly associated with crack/cocaine addiction (OR = 2.31, 95 % CI = 0.82-6.46, p = 0.11), which was only associated with age ≥35 years (OR = 4.16, 95 % CI = 1.65-10.50, p = 0.003) and higher dental plaque index (OR = 6.46, 95 % CI = 1.95-21.42, p = 0.002). In conclusion, although probing depth was greater in crack/cocaine addicted individuals, destructive periodontal disease was not associated with crack and cocaine addiction in the present population. Destructive periodontal disease was associated with age and dental plaque. Further studies in a larger sample size are required to confirm the results.

Correlation of crevicular fluid and serum levels of retinol-binding protein 4 and leptin in chronic periodontitis and obesity

OBJECTIVE

Retinol-binding protein 4 (RBP4) and leptin are both adipokines and involved in the pathophysiology of different vascular and inflammatory diseases and selectively elevated in patients with obesity. The aim of the present study was to determine and correlate the levels of RBP4 and leptin in gingival crevicular fluid (GCF) and serum in patients with chronic periodontitis (CP) and obesity.

MATERIALS AND METHODS

A total of 70 patients with age group 25 to 45 years were divided into four groups based on gingival index (GI), probing depth (PD), clinical attachment level (CAL), body mass index (BMI) and radiographic evidence of bone loss. The groups were (1) group I (non-obese periodontally healthy), (2) group II (obese periodontally healthy), (3) group III (non-obese with chronic periodontitis) and (4) group IV (obese with chronic periodontitis). The GCF and serum levels of human RBP4 and leptin were quantified using ELISA.

RESULTS

An increase in RBP4 levels from group I to group IV was found in both GCF and serum. However, GCF leptin levels was found to be greatest in group II, then group I, group IV and group III showing the least while an increase in serum levels from group I to group IV was found. The GCF and serum values of the inflammatory mediator correlated with the evaluated periodontal parameters and with each other (p < 0.05).

CONCLUSION

RBP4 and leptin can be considered as possible GCF and serum markers of inflammatory activity in CP and obesity, which further longitudinal studies are needed.

Contextual and Individual Factors Influencing Periodontal Treatment Needs by Elderly Brazilians: A Multilevel Analysis

Objective

To assess the relationship between periodontal treatment needs by elderly Brazilians and contextual as well as individual variables.

Methods

A cross-sectional study was carried out to assess the need for clinical periodontal treatment, based on National Oral Health Survey (SB Brasil 2010) data on the presence of dental calculus, shallow (3–5 mm) and deep (≥ 6 mm) periodontal pockets, and gingival bleeding in elderly people (n = 7,619). The contextual variables included the Municipal Human Development Index (MHDI), income inequality (Gini Index) and coverage of the municipal population by the Family Health Strategy (FHS) program oral health teams.<0} The individual variables were sex, income, education level and self-reported skin color. Multilevel logistic regression models were used to calculate the odds ratio (OR) and 95% confidence intervals (CI95%) between periodontal treatment needs and the contextual as well as individual variables.

Results

Gingival bleeding was found in 20.7% of the elderly analyzed (n = 1,577), dental calculus in 34% (n = 2,590), shallow periodontal pockets in 15.6% (n = 1,189), and deep periodontal pockets in 4.2% (n = 320). Individual factors were correlated with all the outcomes assessed. Sex was a protective factor in regard to gingival bleeding (OR = 0.87; CI95% 0.76–1.00), dental calculus (OR = 0.86; CI95% 0.75–0.99), shallow periodontal pockets (OR = 0.69; CI95% 0.60–0.80) and deep periodontal pockets (OR = 0.58; CI95% 0.45–0.74). It was found that fewer women needed treatment. Elderly people who self-reported having nonwhite skin had higher chances of needing periodontal treatment. Skin color was a risk factor for gingival bleeding (OR = 1.32; CI95% 1.14–1.53), dental calculus (OR = 1.32; CI95%1.14–1.54) and shallow periodontal pockets (OR = 1.27; CI95% 1.09–1.49). Education level was associated with the presence of dental calculus (OR = 0.77; CI95% 0.66–0.89), shallow periodontal pockets (OR = 0.86; CI95% 0.73–1.00) and deep periodontal pockets (OR = 0.74; CI95% 0.57–0.97), thus acting as a risk factor for undereducated elderly people. There was a correlation between population coverage by the Family Health Strategy (FHS) program oral health teams and the presence of gingival bleeding (OR = 0.67; CI95% 0.52–0.88), shallow periodontal pockets (OR = 0.76; CI95% 0.58–0.98) and deep periodontal pockets (OR = 0.62; CI95% 0.44–0.89), making these teams act as a protective factor.

Conclusions

This study showed evidence of the sociocontextual as well as individual sociodemographic characteristics influencing periodontal treatment needed by elderly Brazilians, based on the clinical features of periodontal disease. The results suggest the existence of inequality related to periodontal treatment needs among elderly Brazilians, especially in regard to sex and ethnicity, in addition to a potentially positive impact from the expansion of the Family Health Strategy (FHS) program oral health teams.

Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria

OBJECTIVE

To assess internal medicine residents' knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health.

METHODS

A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents' demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05).

RESULTS

Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents' information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for regular periodontal care.

CONCLUSIONS

Knowledge of periodontal disease as a risk factor for systemic illnesses among medical residents in Nigeria is inadequate. These relationships should be emphasized in continuing medical education courses.

Periodontal conditions and associated factors among adults and the elderly: findings from the first National Oral Health Survey in Uruguay

Abstract The aims of this study were to assess the prevalence of periodontal conditions in the Uruguayan adult and elderly population and its association with socioeconomic and behavioral characteristics. Data from adults (35-44, n = 358) and elderly (65-74, n = 411) who participated in the first National Oral Health Survey, Uruguay, 2011, were used. The survey included a household questionnaire addressing socioeconomic characteristics, and tobacco use. Bleeding on probing (BOP), periodontal pockets (CPI) and clinical attachment loss (CAL) were measured by clinical examination. A multivariable analysis was carried out. Considering both age groups, the prevalence of mild/severe periodontal disease was 21.8% and 9.12% for severe periodontal disease. Adjusted analyses revealed an association between high education and all outcomes. Attendance at dental services was negatively associated with BOP and mild to severe periodontitis. Periodontal outcomes were higher in disadvantaged socioeconomic groups. Tobacco consumption has a strong association with periodontal disease in the elderly.

Periodontal Disease Awareness and Knowledge among Nigerian Primary School Teachers

Background:

Teacher-led oral health education is equally effective in improving the oral health knowledge and oral hygiene status of adolescents as dentist-led and peer-led strategies.

Aim:

The aim was to determine periodontal disease awareness and knowledge among Nigerian primary school teachers.

Subjects and Methods:

This cross-sectional study was conducted among primary school teachers in Edo State, Nigeria. A self-administered questionnaire which elicited information on demography, awareness of the periodontal disease and source of information, knowledge of etiology, and symptoms of the periodontal disease, was the data collection tool.. The test of association was done using either Chi-square or Fisher's exact statistics. P value was set at 0.05 for significance level.

Results:

Out of 180 teachers recruited from seven public primary schools in Benin City, Edo State, Nigeria, 151 of them fully participated by filling the study questionnaires giving a 83.9% (151/180) response rate. The majority 74.2% (112/151) of the participants reported having heard of the periodontal disease and the leading source of information was television. A total of 29.8% (45/151) of participants considered periodontal disease as the main cause of tooth loss among adult Nigerian. Only 12.6% (19/151) of the participants knew dental plaque as soft debris on teeth and 29.1% (44/151) attested that plaque can cause periodontal disease. The majority of the participants were not aware of age 81.5% (123/151) and gender 96.7% (146/151) predisposition to periodontal disease. The perceived manifestations of the periodontal disease reported by were mainly gum bleeding 35.1% (53/151) and swollen gum 20.5% (31/151). A total of 70.2% (106/151) of the participants considered periodontal disease as a preventable disease and about half 49.0% (74/151) of the participants considered daily mouth cleaning as the best preventive method. The majority 95.4% (144/151) of the participants expressed interest in learning about the periodontal disease and the most preferred methods were workshops and lectures.

Conclusion:

A significant proportion of the participants heard about periodontal disease from nondental clinic sources. There existed a poor awareness of etiology, age and gender predispositions, manifestation, complications, and the preventable nature of periodontal disease among the participants. However, the majority of them indicated interest in learning about periodontal disease which should be utilized in optimizing their knowledge.

Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases

BACKGROUND

To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs).

METHODS

Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA).

RESULTS

The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women (OR= 2.3; P<0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P<0.001). For both genders, a relatively better condition was observed in the 25-34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P<0.001) and economic status (P<0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors.

CONCLUSION

OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities.

Nothing to smile about

BACKGROUND

Several studies have demonstrated the high incidence of periodontal disorders among patients suffering from mental illnesses, probably because of self-care impairment, the difficult financial conditions, and the lack of motivation. The primary aim of this study was to evaluate the impact of depression and alexithymia on periodontal status. Due to the influence of personality traits on behavior in general, the secondary aim of our study was to investigate the possible impact of personality disorders on dental status.

METHODS

Patients with major depression (DP) referred to our psychiatry unit and healthy individuals (controls) were consecutively enrolled during the period April 2012-September 2012. All the participants to the study underwent a psychiatric evaluation (through questionnaires investigating the presence of depression, anxiety, personality disorders, and alexithymia) and a dental examination through the following indexes: plaque index, gingival index, simplified oral hygiene index, periodontal index.

RESULTS

Fifty DP (aged 56.7±15.2 years) and 40 controls (aged 56.1±15.9 years) were enrolled in the study. DP showed a worse oral hygiene status. In particular, statistically significant differences were found when comparing DP and controls in terms of plaque index, simplified oral hygiene index, gingival index, periodontal index, and oral health impact profile. In addition, periodontal health was found to be negatively related to the severity of depression and the presence of alexithymia. The strength of association between depression and dental indexes was reduced after adjusting for the other psychiatric variables (alexithymia and personality disorders) and was confirmed only for oral health impact profile.

CONCLUSION

Psychiatric variables seem to affect the patients' periodontal status; due to the high frequency of dental problems, patients suffering from mental illnesses should be referred to the oral health services for evaluation.

Relationship Between Periodontal Disease and Obesity: The Role of Life-Course Events

Periodontal disease is ranked among the 10 most prevalent chronic diseases worldwide, and is considered a major public health problem. Its etiology has been associated with local and general conditions that could interfere in the host immune response. Obesity, like periodontal disease, has emerged as a prevalent chronic disease in high-, low- and medium-income countries, recognized as risk factor for cardiovascular disease and cancer. A relationship between periodontal health and obesity may exist, but the mechanism that would explain this association remains unclear. Life-course epidemiology could be a useful instrument to investigate a casual association between early exposures and later outcomes, being appropriate for understanding the establishment of chronic conditions. This approach comprehends different theories, considering the time, the duration and the intensity of early exposition, and its impact on the development of chronic diseases in later life. Thus, the aim of this study is to hypothesize the different life-course epidemiology theories to explain the possible association between periodontal health and nutritional status in adulthood.

Destructive periodontal disease in adult Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators

AIM

The aim of this cross-sectional study was to evaluate the prevalence of destructive periodontal disease and its risk indicators in adult Kiriri Indians from Northeast Brazil.

MATERIALS AND METHODS

Full-mouth periodontal examinations were performed on a sample of 215 Indians (≥19 years). Bivariate analyses and logistic models were applied to assess associations between periodontitis and its putative risk factors.

RESULTS

Prevalence of clinical attachment loss of ≥3, ≥5 and ≥7 mm was 97.8%, 63.8% and 30.8% respectively. Percentage of teeth per individual showing clinical attachment loss of ≥3, ≥5 and ≥7 mm was 49.8%, 18.4% and 8.0% respectively. After adjustment for covariates, individuals aged ≥35 years (OR = 5.83, 95% CI: 3.09-11.00; p < 0.001), men (OR = 2.18, 95% CI: 1.15-4.11; p = 0.02) and diabetics (OR = 3.92, 95% CI 1.03-14.99; p = 0.05) had a higher risk for destructive periodontitis, classified according to the CDC/AAP case definition.

CONCLUSION

Though periodontitis was highly prevalent in Kiriri Indians, only few teeth showed advanced disease, and periodontitis was associated with higher age, male sex and diabetes. A public health action that includes programs of prevention and treatment targeting high-risk groups is vital to improve the periodontal status of this population.