Plaque-induced gingivitis: Case definition and diagnostic considerations

Salivary calprotectin and neutrophils in inflammatory bowel disease in relation to oral diseases

OBJECTIVE

Calprotectin is elevated in saliva from inflammatory bowel disease (IBD) patients, but it is also affected by oral disease. We assessed the salivary concentration of calprotectin in IBD patients, in relation to intestinal and oral diseases. Furthermore, we investigated the phenotype of salivary neutrophils from IBD patients, and their ability to secrete calprotectin.

MATERIALS AND METHODS

Thirty IBD patients and 26 controls were orally examined and sampled for stimulated saliva. Twenty-five IBD patients provided fresh fecal samples. Calprotectin concentrations in saliva and feces were determined by an enzyme-linked immunosorbent assay. Expression of CD11b, CD15, and CD16 on oral neutrophils was assessed by flow cytometry. Secretion of calprotectin was evaluated in cultured oral neutrophils.

RESULTS

Calprotectin was significantly elevated in saliva of IBD patients compared to controls, particularly in Crohn's disease, irrespective of caries or periodontitis. Salivary calprotectin did not correlate to fecal calprotectin. CD11b expression was significantly reduced in salivary neutrophils from IBD patients. Salivary neutrophils from IBD patients tended to secrete more calprotectin than controls.

CONCLUSIONS

Salivary calprotectin is elevated in IBD regardless of oral diseases. Furthermore, salivary neutrophils secrete calprotectin, and display lower CD11b expression in IBD.

Conventional diagnostic criteria for periodontal diseases (plaque-induced gingivitis and periodontitis)

This narrative review addresses conventional diagnostic criteria used in clinical practice to discriminate between periodontal health, gingivitis, and periodontitis. Visual examination of the color and texture of the periodontal tissues, assessment of plaque deposits, periodontal probing assessments, and diagnostic imaging enable the collation of information to make a periodontal diagnosis, followed by an appropriate treatment plan. The periodontal probe is an essential diagnostic tool to assess probing pocket depth, clinical attachment level, bleeding on probing, and the degree of furcation involvement at multirooted teeth. When clinical signs and symptoms of periodontitis are identified, diagnostic imaging enables evaluation of the level and extent of bone destruction and bone defect morphology. The diagnostic process requires clinicians who are trained to evaluate, record, and interpret these measures. This narrative review focuses on conventional clinical diagnostic parameters which, despite their limitations, are considered the current standard of care.

The Association between Salivary Metabolites and Gingival Bleeding Score in Healthy Subjects: A Pilot Study

Periodontal diseases, including gingivitis and periodontitis, are among the most prevalent diseases in humans. Gingivitis is the mildest form of periodontal disease, characterized by inflammation of the gingiva caused by the accumulation of dental plaque. Salivary diagnostics are becoming increasingly popular due to the variation in saliva composition in response to pathological processes. We used a metabolomics approach to investigate whether a specific saliva metabolic composition could indicate preclinical stage of gingivitis. 1H-NMR spectroscopy was used to obtain the salivary metabolite profiles of 20 healthy subjects. Univariate/multivariate statistical analysis evaluated the whole saliva metabolite composition, and the Full-Mouth Bleeding Score (FMBS) was employed as a classification parameter. Identifying a signature of specific salivary metabolites could distinguish the subjects with high FMBS scores but still within the normal range. This set of metabolites may be due to the enzymatic activities of oral bacteria and be associated with the early stages of gingival inflammation. Although this analysis is to be considered exploratory, it seems feasible to establish an FMBS threshold that distinguishes between the absence and presence of early inflammatory alterations at the salivary level.

Air-polishing followed by ultrasonic calculus removal for the treatment of gingivitis: A 12-month, split-mouth randomized controlled clinical trial

OBJECTIVE

To evaluate the advantages of a novel protocol involving full-mouth erythritol-powder air-polishing followed by ultrasonic calculus removal in the maintenance of patients treated for gingivitis, with a focus on time and comfort.

METHODS

Systemically healthy patients with gingivitis were selected. Following a split-mouth design, quadrants 1-4 and 2-3 were randomly allocated to receive air-polishing followed by ultrasonic calculus removal following a protocol known as Guided Biofilm Therapy (GBT) or traditional full-mouth ultrasonic debridement followed by polishing with a rubber cup and prophylactic paste (US + P). Bleeding on probing (BoP) and the plaque index (PI) were collected at baseline (T0), 2 weeks (T1), 4 weeks (T2), 3 months (T3), and 6 months (T4) and 12 months (T5). Following the same randomization, prophylactic therapy was provided at 3 months (T3) and 6 months (T4). Clinical parameters, treatment time and patient comfort and satisfaction were evaluated.

RESULTS

A total of 41 patients were selected, 39 completed the study. The clinical parameters were clinically satisfactory for both treatments at every time. At 4 months after treatment, GBT maintained significantly lower BoP and PI. GBT protocol required a significantly lower treatment time, especially at T3 and T4, when it saved 24.5% and 25.1% of the time, respectively. Both treatments were rated positively by most patients. However, GBT was perceived as more comfortable, and a higher number of patients preferred it.

CONCLUSION

No significant difference was observed between GBT and conventional ultrasonic debridement and rubber cup polishing in terms of BoP and PI levels. The GBT protocol allowed less time expenditure and higher patients' perceived comfort.

IL-23/IL-17 axis levels in gingival crevicular fluid of subjects with periodontal disease: a systematic review

BACKGROUND

The IL-23/IL-17 axis plays an important role in the immunopathogenesis of periodontal disease. A systematic review was conducted to synthesize all research reporting on the levels of the IL-23/IL-17 axis in gingival crevicular fluid (GCF) from subjects with gingivits, and periodontitis, compared to healthy controls.

METHODS

The protocol followed the PRISMA, and Cochrane guidelines, and was registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/7495V . A search was conducted in the electronic databases PubMed/MEDLINE, Scopus, Google Schoolar, and Cochrane from November 15th, 2005, to May 10th, 2023. The quality of the studies was assessed using the JBI tool for cross-sectional studies.

RESULTS

The search strategy provided a total of 2,098 articles, of which 12 investigations met the inclusion criteria. The total number of patients studied was 537, of which 337 represented the case group (subjects with gingivitis, and chronic periodontitis), and 200 represented the control group (periodontally healthy subjects). The ages of the patients ranged from 20 to 50 years, with a mean (SD) of 36,6 ± 4,2, of which 47% were men, and 53% were women. 75% of the investigations collected GCF samples with absorbent paper strips, and analyzed cytokine IL-17 levels individually. In addition, qualitative analysis revealed that there are differences between IL-23/IL-17 axis levels in subjects with chronic periodontitis, gingivitis and healthy controls.

CONCLUSIONS

Thus, IL-23/IL-17 axis levels could be used in the future as a diagnostic tool to distinguish between periodontal diseases.

Utilization of nanotechnology and experimental design in the development and optimization of a posaconazole‒calendula oil nanoemulgel for the treatment of mouth disorders

Introduction: Essential oil‒based nanoemulsions (NEs) are the subjects of extensive investigation due to their potential to address a variety of oral health issues. NEs are delivery systems that improve lipid medicine solubility and distribution to intended sites. The goal of the current study was to create and enhance a self-nanoemulsifying drug delivery paradigm based on calendula oil (CO) and decorated with chitosan (CS) that could deliver posaconazole (PSZ) for the treatment of gingivitis. Method: Employing a response-surface Box‒Behnken design, PSZ-CO-CS NEs were created with varying amounts of PSZ (10, 15, and 20 mg), percentages of CO (6%, 12%, and 18%), and percentages of CS (0.5%, 1.5%, and 2.5%). Results and conclusion: The optimized formulation resulted in a 22-mm bacterial growth suppression zone, 25-mm fungal growth inhibition zone, droplet sizes of 110 nm, and a viscosity of 750 centipoise (cP). Using the appropriate design, the ideal formulation was produced; it contained 20 mg of PSZ, 18% of CO, and 1.35% of CS. Furthermore, the optimal formulation had a more controlled drug release, larger inhibition zones of bacterial and fungal growth, and desirable rheologic properties. Additionally, the optimized formulation substantially lowered the ulcer index in rats when tested against other formulations. Thus, this investigation showed that PSZ-CO-CS NEs could provide efficient protection against microbially induced gingivitis.

Association between periodontal health status and quality of life: a cross-sectional study

Introduction

Attachment loss due to periodontal diseases is associated with functional limitations as well as physical pain and psychological discomfort, which may lead to a reduced quality of life. The purpose of this study is to determine if the oral health status, specifically the periodontal status, influences oral health-related quality of life.

Materials and methods

Survey data were collected in a US dental school clinical setting in a cross-sectional study. Quality of life related to oral health was assessed with the Oral Health Impact Profile-49 (OHIP-49). In addition, DMFT index, periodontal status, and health literacy scores (dental and medical health literacy) were recorded, and the data of n = 97 subjects were statistically analyzed.

Results

The DMFT index of the study population was 14.98 ± 6.21 (D: 4.72 ± 4.77; M: 3.19 ± 3.46; F: 7.12 ± 4.62). Of the subjects, 44% were identified as periodontitis cases. These periodontitis cases demonstrated significantly higher OHIP-49 scores (66.93 ± 30.72) than subjects without signs of periodontal diseases (NP) (32.40 ± 19.27, p < 0.05). There was also a significant difference between NP patients and patients with gingivitis (66.24 ± 46.12, p < 0.05). It was found that there was a statistically significant difference between Stage 3 (severe) periodontitis and periodontal health (p = 0.003). Pearson correlations were completed, and positive relationships were found with OHIP-49 and DMFT (0.206, p < 0.05), and periodontal risk self-assessment (0.237, p < 0.05). Age [odds ratio (OR) 4.46], smoking (OR 2.67), and the presence of mobile teeth (OR 2.96) are associated with periodontitis.

Conclusions

Periodontal diseases may negatively impact the oral health-related quality of life. Patients suffering from periodontitis also showed more missing teeth, which might influence function. Age and smoking are associated with a higher prevalence of periodontitis. A good general health literacy was no guarantee for having an adequate oral literacy.

Antibacterial and clinical effectiveness of a mouthwash with a novel active system of amine + zinc lactate + fluoride: a randomized controlled trial

OBJECTIVES

To support the daily oral hygiene of patients experiencing gum inflammation, a new mouthwash was developed containing an amine + zinc lactate + fluoride system. In vitro and clinical efficacy was assessed using traditional methods as well as using novel site-specific and subject-specific analyses of the clinical data.

MATERIALS AND METHODS

This mouthwash was evaluated in a 12-h biofilm regrowth assay against a negative control mouthwash and in a 6-month plaque and gingivitis clinical study as compared to a negative control mouthwash. Analyses of healthy versus inflamed sites, visible plaque versus non-visible plaque sites, as well as subject-level evaluations bring new perspectives to the overall performance of this mouthwash and its significance from a patient outcome perspective.

RESULTS

Studies demonstrated that this new mouthwash provided long-term (12-h) antibacterial activity after single application in vitro and reduced clinically all plaque and gingivitis parameters after 3 months and 6 months of use when compared to the negative control mouthwash. Examination of site-level and subject-level data determined that this mouthwash significantly increased the number of healthy sites in the oral cavity and significantly improved the gum health of subjects in the study, as compared to the negative control mouthwash.

CONCLUSIONS

In vitro and clinical research has demonstrated the antibacterial and clinical benefits of this mouthwash containing an amine compound + zinc lactate + fluoride system.

CLINICAL RELEVANCE

Our subject-specific and site-specific analyses provide the dental practitioner with tools that can be used to guide patients who suffer from gingivitis toward optimal product selection and use.

CLINICAL TRIAL REGISTRATION

The trial was registered at ClinicalTrials.gov (reference no. NCT05821712).

Oral health literacy and its association with oral health-related quality of life amongst pregnant women: a cross-sectional study

PURPOSE

This study aimed to evaluate the association of oral health literacy (OHL) and oral health-related quality of life (OHRQoL) of pregnant women.

METHODS

This cross-sectional study evaluated a representative sample of pregnant women assisted in public health services in southern Brazil. Demographic, socioeconomic, psychosocial and behavioural data were collected through structured questionnaires. The Oral Health Impact Profile (OHIP-14) questionnaire was used to evaluate the OHRQoL. The Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) was used to measure OHL. Dental caries and gingival bleeding were evaluated by clinical examinations. Adjusted multilevel Poisson regression models with a hierarchical approach were used to assess the associations. The results are presented as rate ratio (RR) and 95% confidence interval (95% CI).

RESULTS

A total of 520 pregnant women were evaluated. Pregnant women with lower levels of OHL presented overall OHIP-14 scores 14% higher (RR 1.14; 95% CI 1.07-1.22) than their counterparts. High household income and high education level were related to low overall OHIP-14 scores. Furthermore, less dental attendance, low social support, untreated dental caries and gingival bleeding were also associated with high overall OHIP-14 scores.

CONCLUSION

Our findings reinforce that health literacy levels influence patient-reported outcomes. Pregnant women with lower OHL were more likely to present poorer OHRQoL.

Convolutional-neural-network-based radiographs evaluation assisting in early diagnosis of the periodontal bone loss via periapical radiograph

Background/Purpose

The preciseness of detecting periodontal bone loss is examiners dependent, and this leads to low reliability. The need for automated assistance systems on dental radiographic images has been increased. To the best of our knowledge, no studies have quantitatively and automatically staged periodontitis using dental periapical radiographs. The purpose of this study was to evaluate periodontal bone loss and periodontitis stage on dental periapical radiographs using deep convolutional neural networks (CNNs).

Materials and methods

336 periapical radiographic images (teeth: 390) between January 2017 and December 2019 were collected and de-identified. All periapical radiographic image datasets were divided into training dataset (n = 82, teeth: 123) and test dataset (n = 336, teeth: 390). For creating an optimal deep CNN algorithm model, the training datasets were directly used for the segmentation and individual tooth detection. To evaluate the diagnostic power, we calculated the degree of alveolar bone loss deviation between our proposed method and ground truth, the Pearson correlation coefficients (PCC), and the diagnostic accuracy of the proposed method in the test datasets.

Results

The periodontal bone loss degree deviation between our proposed method and the ground truth drawn by the three periodontists was 6.5 %. In addition, the overall PCC value of our proposed system and the periodontists' diagnoses was 0.828 (P < 0.01). The total diagnostic accuracy of our proposed method was 72.8 %. The diagnostic accuracy was highest for stage III (97.0 %).

Conclusion

This tool helps with diagnosis and prevents omission, and this may be especially helpful for inexperienced younger doctors and doctors in underdeveloped countries. It could also dramatically reduce the workload of clinicians and timely access to periodontist care for people requiring advanced periodontal treatment.

Periodontitis is associated with airflow obstruction in the Malmö Offspring Dental Study

AIM

To investigate the association between periodontitis and lung function in the Malmö Offspring Dental Study.

MATERIALS AND METHODS

In all 1001 individuals (49.9% female, mean age: 44.6) from Malmö Offspring Dental Study were included. Periodontitis was assessed by a full-mouth examination protocol including bleeding on probing and classified according to the American Academy of Periodontology/Center for Disease Control definitions. Forced expiratory volume in 1 s (FEV1 ) and forced vital capacity (FVC) were expressed as absolute values and %predicted according to Global Lung Function Initiative reference values. FEV1 , FVC and FEV1 /FVC were analysed in relation to periodontal status using linear regression.

RESULTS

Severe periodontitis was found in 7% of the population. Adjusted regression models showed significant associations between lung function and severe periodontitis with 2.1 unit lower FEV1 /FVC ratio (95% CI: -3.91, -0.23) and odds ratio (adjusted) of 2.56 (95% CI: 1.40, 4.75, p = .003) for airflow obstruction (FEV1 /FVC less than the lower limit of normal) if having severe periodontitis. Lower values of %predicted FEV1 and %predicted FVC, but not FEV1 /FVC, were found in individuals with >25% bleeding on probing.

CONCLUSIONS

Severe periodontitis was associated with lower FEV1 /FVC ratio and airflow obstruction in the present cohort. More large-scale prospective studies and intervention studies are required for a comprehensive evaluation.

Artificial intelligence models for diagnosing gingivitis and periodontal disease: A systematic review

STATEMENT OF PROBLEM

Artificial intelligence (AI) models have been developed for periodontal applications, including diagnosing gingivitis and periodontal disease, but their accuracy and maturity of the technology remain unclear.

PURPOSE

The purpose of this systematic review was to evaluate the performance of the AI models for detecting dental plaque and diagnosing gingivitis and periodontal disease.

MATERIAL AND METHODS

A review was performed in 4 databases: MEDLINE/PubMed, World of Science, Cochrane, and Scopus. A manual search was also conducted. Studies were classified into 4 groups: detecting dental plaque, diagnosis of gingivitis, diagnosis of periodontal disease from intraoral images, and diagnosis of alveolar bone loss from periapical, bitewing, and panoramic radiographs. Two investigators evaluated the studies independently by applying the Joanna Briggs Institute critical appraisal. A third examiner was consulted to resolve any lack of consensus.

RESULTS

Twenty-four articles were included: 2 studies developed AI models for detecting plaque, resulting in accuracy ranging from 73.6% to 99%; 7 studies assessed the ability to diagnose gingivitis from intraoral photographs reporting an accuracy between 74% and 78.20%; 1 study used fluorescent intraoral images to diagnose gingivitis reporting 67.7% to 73.72% accuracy; 3 studies assessed the ability to diagnose periodontal disease from intraoral photographs with an accuracy between 47% and 81%, and 11 studies evaluated the performance of AI models for detecting alveolar bone loss from radiographic images reporting an accuracy between 73.4% and 99%.

CONCLUSIONS

AI models for periodontology applications are still in development but might provide a powerful diagnostic tool.

Relationship between 1-, 3-, and 6-Month Gingival Bleeding Outcomes

INTRODUCTION

Results from systematic reviews and meta-analyses show generally consistent antigingivitis effects between 3- and 6-mo observation time points with twice-daily use of stannous fluoride (SnF2) dentifrice. However, the relationship between 1-, 3-, and 6-mo gingivitis responses has not been investigated.

METHODS

This pooled analysis was conducted to understand the relationship of 1-, 3-, and 6-mo gingival bleeding outcomes. Number of bleeding sites, derived from Löe-Silness Gingival Index (LSGI) or Gingival Bleeding Index, was identified as the primary end point of the analysis for the biological and clinical relevance. Randomized, double-blinded, controlled clinical studies meeting the following predefined selection criteria were identified: 1) published and unpublished gingivitis clinical trials conducted from 1995 to 2022 comparing efficacy of 0.454% SnF2 dentifrices to negative controls (sodium fluoride or sodium monofluorophosphate dentifrice) and 2) studies with a 3-mo assessment and at least a 1- or 6-mo assessment.

RESULTS

The search resulted in ten 6-mo and fourteen 3-mo studies meeting selection criteria. A mixed-effects model was performed on the pooled data to assess gingival bleeding outcomes across time. The bleeding efficacy significantly increased between months 1 and 3 (P < 0.0001) and plateaued between months 3 and 6 (P = 0.007), supporting the fact that bleeding reduction relative to control established by 1 mo will increase and be maintained through 3 and 6 mo (R2 = 0.857). In addition, gingival bleeding and gingivitis efficacy, as measured by LSGI, were found to be highly correlated (R2 = 0.874).

CONCLUSION

A clear relationship has been demonstrated between 1-, 3-, and 6-mo gingival bleeding outcomes in gingivitis clinical studies comparing SnF2 dentifrice to negative control dentifrice. These findings have important implications to the dental practice and scientific research as antigingivitis efficacy evaluations can be observed as early as 1 mo and are consistent with those seen at 3 or 6 mo.

KNOWLEDGE TRANSFER STATEMENT

Outcomes from this investigation indicate that the clinical evaluation of antigingivitis efficacy at 1 mo is predictive of that at 3 and 6 mo, supporting studies of 1-mo duration as a viable method of knowledge acquisition. This more efficient, expedited research design has positive implications for patient care, clinical practice guidelines, protocols, and policies.

Periodontal pathogens of the interdental microbiota in a 3 months pregnant population with an intact periodontium

Steroid hormones and the oral microbiota of pregnant women both appear as cumulative risk factors for gingivitis. This cross-sectional study, using real-time PCR, investigated the composition and diversity of the microbiota in interdental spaces of 3 months pregnant women with intact periodontium according the 2018 EFP/AAP classification. Bacteria identified were belonged to the red (Porphyromonas gingivalis Treponema denticola, and Tanerella forsythia), orange (Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Parvimonas micra), and green (Eikenella corrodens and A. actinomycetencomitans) Socransky complexes. Approximatively 109.11 bacteria were counted per interdental space in pregnant women. Bacteria from the red complex represented 33.80% versus 62.81% for the orange group versus 3.39% for the green group of the total number spread over the 3 groups. Dietary habits and physical activity did not have a significant impact on interdental microbiota, although a decrease in the median amount of 9 periodontopathogens was observed when fruit and vegetable consumption increased. Pregnant women who brushed their teeth at least twice a day had lower counts of total bacteria and 9 periodontal pathogens than those who brushed less. In 3 months pregnant women at high risk of periodontal disease (>30% bleeding sites), the dendogram revealed 2 clusters of the 9 periodontopathogens. This provides further support for the "key pathogen" hypothesis, among which Porphyromonas gingivalis plays a key role, indicating that specific bacteria in limited quantities can influence the host immune system and convert the microbiota from symbiotic to dysbiotic to induce inflammatory disorder. As a result, this study reported that 3 months pregnant women with healthy periodontium had high levels of interdental bleeding and a dysbiotic microbiota with periodontal pathogens of the Socransky orange and red complexes. These subjects were therefore potentially at increased risk of developing periodontal disease and, consequently, an adverse pregnancy outcome. So, preventive oral prophylaxis measures, in particular individual interdental prophylaxis, should be implemented as soon as pregnancy is established.

Comparison of immunoexpression of dendritic cells, mast cells and blood vessels in periodontal disease between adults and elderly

OBJECTIVE

The aim of this study was to compare, in adults and elderly individuals, the immunoexpression of immature and mature dendritic cells (DCs), mast cells, and blood vessels in healthy and diseased gingival tissues.

MATERIALS AND METHODS

The expressions of immunohistochemical markers, including CD1a (immature dendritic cells), CD83 (mature dendritic cells), tryptase (mast cells) and CD34 (blood vessels), were analyzed in gingival biopsies from elderly (n = 27) and adult (n = 127) patients presenting health, gingivitis and periodontitis. Positive cells for each specimen and marker were counted.

RESULTS

There were no differences in the immunostaining of DCs, mast cells and the amount of blood vessels among gingival biopsies with health, gingivitis and periodontitis in adult and elderly subjects (p > 0.05). Immature DCs were more frequent in tissues with gingivitis and periodontitis in elderly patients, when compared to adults (p < 0.05). Furthermore, degranulated mast cell counts were higher, whereas the number of microvessels was lower in gingivitis in the elderly, when compared to adults (p < 0.05).

CONCLUSIONS

Diseased periodontal sites in the elderly present an overall significant overexpression of immature DCs and degranulated mast cells, in relation to those of adults. Furthermore, gingivitis in elderly is associated with decreased microvessel growth. These immunoinflammatory differences between elderly and adults may have implications in periodontal tissue breakdown in the late adulthood. Further studies should be performed to elucidate this hypothesis.

CLINICAL RELEVANCE

Understading the relationship between aging and changes in immune cells during periodontal inflammation may lead to therapeutic targets for the future management of periodontal diseases.

Severe Chronic Gingivitis in Association With Hypothyroidism and Grade 2 Adenoid Hypertrophy: A Case Report

Hypothyroidism is the second-commonest endocrine disorder in the world. Similarly, gingivitis is also a highly prevalent oral condition in every population globally. Adenoid hypertrophy and associated mouth breathing may aggravate preexisting gingival inflammation. Here, we are presenting the case of a 22-year-old female gingivitis patient with bleeding from gums on the slightest provocation and with a two-year history of preexisting hypothyroidism. Thorough systemic examinations and investigations ruled out the presence of hematological and/or coagulation disorders. However, she was found to have grade 2 adenoid hypertrophy along with a habit of mouth breathing. Periodontal and systemic management of the patient has resolved her gingival bleeding to a greater extent. Still, there remain a lot of ambiguity and a lack of clarity about the exact etiology and mechanism of pathogenesis behind her oral and general health status. Cases like these pose a diagnostic challenge for the treating dentist or periodontist and thus require a coordinated and collaborative effort of multiple health specialties.

Evaluating the Turkish validity and reliability of the Brief Illness Perception Questionnaire in periodontal diseases

Background

The Brief Illness Perception Questionnaire (Brief IPQ) is a widely used multifactorial scale that assesses the individuals' perceptions of illness. Although there are studies investigating the psychometric properties of the Brief IPQ in many languages, the Turkish version of Brief IPQ on periodontal diseases has not been revealed so far. This study aimed to evaluate the Turkish validity and reliability of the Brief IPQ and contribute to the literature. It is also aimed to evaluate the patients' illness perception with periodontal disease and to reveal the possible effects of the disease on the patients' daily life.

Methods

This cross-sectional study was conducted with 209 patients with periodontal diseases (137 gingivitis and 72 periodontitis cases). Sociodemographic characteristics and clinical periodontal measurements of all patients were recorded. The Turkish versions of the Brief IPQ and the HAD Scale were applied to the patients via face-to-face. The construct validity was determined using confirmatory factor analysis. Test-retest reliability and internal consistency were performed using ICC test and Cronbach's alpha, respectively. The concurrent validity was determined by using Spearman's correlation coefficient.

Results

The confirmatory factor analysis showed that the scale has one factor. The Spearman's correlation coefficient results were found 0.843 and 0.854 for concurrent validity. Cronbach's alpha value of the scale was 0.944 in the internal consistency analysis. ICC value was found to be 0.987 for test-retest reliability. Floor/ceiling effects were considered not to be present.

Conclusions

It was found that the Turkish version of The Brief Illness Perception Questionnaire is valid and reliable. Brief IPQ may be used to determine the illness perception in patients with periodontal diseases.

Prevalence of different stages of periodontal diseases among a sample of young adult obese Egyptian patients: a hospital based Cross-sectional study over 1 year

BACKGROUND

This cross-sectional study aimed to determine the prevalence of different stages of periodontal diseases based on the recent classification in a sample of young adult obese Egyptian dental outpatients.

METHODS

This study included 314 patients seeking dental treatment at the Diagnostic Center of the Dental hospital, Faculty of Dentistry, Cairo University. Validated oral health questionnaire for adults regarding their age, gender, level of education and oral health routines as well as oral health impact profile questionnaire for chronic periodontitis (OHIP-CP) were filled by all patients. Obesity parameters were also assessed through person's weight in kilograms, height in centimeters and waist circumference to determine the obesity stage. Diagnosis was made based on measurements of clinical periodontal parameters including a full mouth plaque index (PI), bleeding on probing (BoP), pocket depth (PD), clinical attachment level (CAL) and gingival recession depth (RD). Radiographic examination was performed using periapical radiographs. Ordinal logistic regression analysis was used to determine significant predictors of periodontal diseases and discriminant analysis was performed to predict periodontal disease classification.  RESULTS: The age range in the study sample was 19-39 years old. The prevalence of different stages of periodontal diseases was 100%. Gingivitis was the most prevalent periodontal disease (63.7%) followed by Periodontitis Stage III (22.6%) then Stage II (11.1%). Stage I showed the least prevalence (2.5%). An increase in BMI was statistically associated with an increase in PD, CAL, RD, PI and vice versa (P-value < 0.05). The total OHIP-CP was 15.99 ± 3.06 for all participants.

CONCLUSIONS

There was a statistically significant association between periodontal diseases and obesity in young adults, as well as a statistically significant direct correlation between BMI and periodontal parameters. Self-assessment of oral health and obesity were significant predictors of periodontal disease.

CLINICAL TRIAL REGISTRATION ID

NCT04618068.

Effects of water flossing on gingival inflammation and supragingival plaque microbiota: a 12-week randomized controlled trial

OBJECTIVES

The effects of water flossing on dental plaque removal have been suggested, but its ecological impact on dental plaque microbiota needs further investigation. In addition, whether this plaque control measure by water flossing promotes the control of halitosis still needs clinical validation. The aim of this study was to evaluate the effects of water flossing on gingival inflammation and supragingival plaque microbiota.

MATERIALS AND METHODS

Seventy participants with gingivitis were randomly assigned to control (toothbrushing) and experimental (toothbrushing + water flossing) groups (n = 35). Participants were recalled at 4, 8, and 12 weeks, and their gingival index, sulcus bleeding index, bleeding on probing, dental plaque index, and oral malodor values were measured. The microbiota of supragingival plaque was further investigated using 16S rRNA sequencing and qPCR.

RESULTS

Sixty-three participants completed all revisits (control: n = 33; experimental: n = 30). The experimental and control groups exhibited similar clinical characteristics and dental plaque microbiota at baseline. Adjunctive water flossing effectively reduced the gingival index and sulcus bleeding index as compared to the toothbrushing control group. The water-flossing group showed reduced oral malodor at week 12 as compared to the baseline. Consistently, the water-flossing group exhibited altered dental plaque microbiota at week 12, characterized by a depletion of Prevotella at genus level and Prevotella intermedia at species level as compared to the toothbrushing control. In addition, the plaque microbiota of water-flossing group exhibited a more aerobic phenotype, while the control group was more anaerobic.

CONCLUSIONS

Daily water flossing can effectively alleviate gingival inflammation and reduce oral malodor, possibly by depleting oral anaerobes and altering the oral microbiota to a more aerobic phenotype.

CLINICAL RELEVANCE

Water flossing adjunctive to toothbrushing effectively alleviated gingival inflammation, representing a promising oral hygiene practice to promote oral health.

CLINICAL TRIAL REGISTRATION

The trial was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showprojen.aspx?proj=61797 , #ChiCTR2000038508) on September 23, 2020.

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in Dakar, Senegal. Demographic characteristics, lifestyle habits, prenatal clinical status, and oral clinical parameters were recorded. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. Eighty-eight percent of women had gingivitis, 15% were classified as moderate and 73% as severe. A total of 66.7% (95% CI [28.8-92.1]) of the sites had bleeding on interdental brushing. The odds for gingivitis decreased significantly for women consuming more than five portions of fruits and vegetables per day (OR = 0.15; 95% CI [0.03-0.66]) and increased in women who had a professional activity (OR = 6.75; 95% CI [1.27-35.87]) and high education. Concomitantly, the percentage of dental plaque (OR = 131.6; 95% CI [10.80-1619.71] and the severity of clinical attachment loss (OR = 7.70; 95% CI [3.16-18.92]) were important risk factors. Inverse associations were observed with increasing body mass index (OR = 0.76; 95% CI [0.63-0.93]). Our results underline that gingivitis cases and bleeding were particularly high among 3-month pregnant women. Literacy and adequate oral hygiene actions to modify behaviors and to achieve meticulous biofilm disorganization could make a favorable change in the gingival health outcome. Additionally, further research is necessary to precisely determine the role of biofilm-induced gingivitis and systemic-induced gingivitis in improving gingival conditions.

Randomized clinical trial on the clinical effects of a toothpaste containing extra virgin olive oil, xylitol, and betaine in gingivitis

To determine the effects on gingival bleeding, dental biofilm, and salivary flow and pH in patients with gingivitis of using toothpaste with extra-virgin olive oil (EVOO), xylitol, and betaine in comparison to a placebo or commercial toothpaste. This controlled, double blinded, and multicenter randomized clinical trial included patients with gingivitis randomly assigned to one of three groups: test group (EVOO, xylitol, and betaine toothpaste), control group 1 (placebo toothpaste), or control group 2 (commercial toothpaste). Percentage supragingival biofilm and gingival bleeding were evaluated at baseline (T0), 2 months (T2), and 4 months (T4), measuring non-stimulated salivary flow and salivary pH. Comparisons were performed between and within groups. The final study sample comprised 20 in the test group, 21 in control group 1, and 20 in control group 2. In comparison to control group 1, the test group showed significantly greater decreases in gingival bleeding between T4 and T0 (p = 0.02) and in biofilm between T2 and T0 (p = 0.02) and between T4 and T0 (p = 0.01). In the test group, salivary flow significantly increased between T2 and T0 (p = 0.01), while pH alkalization was significantly greater between T4 and T0 versus control group 2 (p = 0.01) and close-to-significantly greater versus control group 1 (p = 0.06). The toothpaste with EVOO, xylitol, and betaine obtained the best outcomes in patients with gingivitis, who showed reductions in gingival bleeding and supragingival biofilm and an increase in pH at 4 months in comparison to a commercial toothpaste.

A randomised controlled trial evaluating the impact of oral health advice on gingival health using intra oral images combined with a gingivitis specific toothpaste

OBJECTIVES

Does a complex intervention of oral hygiene advice (OHA) delivered with intra-oral scanner images, anti-gingivitis toothpaste and motivational reminders, improve oral health more than a standard of care control arm of fluoride toothpaste, with OHA without scanner images?

METHODS

Adult participants with pre-existing gingivitis were randomised to intervention or control. Following enrolment, baseline and each subsequent visit (V) (3-weeks, V2; 3-months, V3; 6-months, V4) followed the same schedule. Bleeding on Probing (BOP) was assessed and Intra Oral Scan IOS(1) recorded. Plaque was disclosed, scored and re-scanned (IOS(2)). The intervention group received OHA with IOS images, control group receiving OHA without IOS images. Participants brushed with their allocated toothpaste (fluoride, control; anti-gingivitis, intervention), IOS(3) was recorded. Between visits participants brushed with their allocated toothpaste, intervention group received motivational reminders.

RESULTS

BOP scores from baseline were significantly improved in the intervention group compared to control at all visits for all surfaces (p<0.001); differences at V4 were 0.292 (all), 0.211 (buccal/labial) and 0.375 (lingual/palatal). Plaque scores from baseline pre-brushing to each visit pre- and post-brushing also favoured the intervention group, the difference always significant on lingual/palatal surfaces (p<0.05), significant for all but pre-brushing-V4 (p<0.05) on all surfaces, but only significant for pre-brushing-V3 (p<0.05) buccally/labially. Differences from baseline to post-brushing at V4 were: 0.200 (all), 0.098 (buccal/labial) and 0.291 (lingual/palatal).

CONCLUSION

A complex intervention comprising OHA delivered with IOS-images, anti-gingivitis toothpaste and motivational reminders improved gingival health more than existing standard of care-OHA together with a standard fluoride toothpaste over a 6-month period.

CLINICAL SIGNIFICANCE STATEMENT

Intra-oral scans (IOS) are now frequently used in general dental practice for a variety of purposes. IOS use, in combination with motivational texts and an anti-gingivitis toothpaste, could be further deployed to promote oral hygiene behaviour change in patients and improve gingival health, in a cost-effective manner.

The current regenerative medicine approaches of craniofacial diseases: A narrative review

Craniofacial deformities (CFDs) develop following oncological resection, trauma, or congenital disorders. Trauma is one of the top five causes of death globally, with rates varying from country to country. They result in a non-healing composite tissue wound as they degenerate in soft or hard tissues. Approximately one-third of oral diseases are caused by gum disease. Due to the complexity of anatomical structures in the region and the variety of tissue-specific requirements, CFD treatments present many challenges. Many treatment methods for CFDs are available today, such as drugs, regenerative medicine (RM), surgery, and tissue engineering. Functional restoration of a tissue or an organ after trauma or other chronic diseases is the focus of this emerging field of science. The materials and methodologies used in craniofacial reconstruction have significantly improved in the last few years. A facial fracture requires bone preservation as much as possible, so tiny fragments are removed initially. It is possible to replace bone marrow stem cells with oral stem cells for CFDs due to their excellent potential for bone formation. This review article discusses regenerative approaches for different types of craniofacial diseases.

Practical Guidelines for Patients with Hypertension and Periodontitis

Arterial hypertension (AH) and periodontitis are among the most common non-communicable chronic diseases worldwide. Besides sharing common risk factors, an increasing body of evidence supports an independent association between the two conditions, with low-grade systemic inflammation acting as the plausible biological link with increased cardiovascular risk. In 2021, the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) have joined forces and published a joint report on the relationships between AH and periodontitis, reviewing the existing scientific evidence and underlining the need to increase awareness of the strong connection between the two conditions and promote treatment strategies for the control of gums inflammation in patients with AH. The current document extends the previous joint report, providing clinical practical guidelines aimed to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions. These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are supported by SIIA and SIdP.

Clinical Evaluation of Toothbrushes for Elderly Patients: A Crossover Study

OBJECTIVES

The aim of this study was to evaluate the efficacy of 2 newly designed toothbrushes used by elderly individuals based on plaque removal and gingival inflammation reduction compared with 2 commercially available toothbrushes.

MATERIALS AND METHODS

This was a randomised, controlled, single-blind, 4-period crossover clinical trial. Thirty elderly participants meeting the inclusion criteria were randomly allocated into 4 groups, which determined the sequence of the 4 toothbrushes: CUdent/extra soft, CUdent/soft, GoodAge, and Colgate. The participants' baseline bleeding on probing (BOP) and plaque index (PI) were assessed by one blinded calibrated examiner, then their teeth were professionally cleaned. The participants were assigned to use the tested toothbrush and were recalled for postbrushing examination 2 weeks later to evaluate their BOP and PI. At the end of each test period, the participants used their own toothbrush during the 2-week washout period before using the next tested toothbrush.

RESULTS

The mean age of the 30 participants was 63.2 years. The mean baseline BOP score was 44.4%, and mean baseline PI was 2.7. Three participants dropped out; thus, 27 participants (15 females and 12 males) provided data throughout the study period. The participant characteristics and baseline data between the groups were similar. CUdent/extra soft and CUdent/soft demonstrated significantly better PI scores at the buccal surfaces than GoodAge (P < .05). CUdent/soft had the lowest PI scores and Colgate presented the lowest BOP score in every comparison for other areas; however, the differences were not significant. No signs of tissue trauma or abrasion were observed.

CONCLUSIONS

The newly designed toothbrushes were comparable to the commercially available toothbrushes in plaque removal efficacy and reducing gingival inflammation. CUdent/extra soft and soft were significantly more effective in plaque removal in the buccal regions than GoodAge.

Free Sugar Intake and Periodontal Diseases: A Systematic Review

High free sugar intake is associated with an increased risk of various non-communicable diseases. We aimed to systematically review articles investigating the association between free sugar intake and periodontal diseases. This systematic review was conducted according to PRISMA guidelines and was registered in the PROSPERO database (CRD42022337828). We obtained articles from PubMed, Web of Science, and Scopus in April 2022. The study selection was performed according to predefined eligibility criteria based on the following PECOS: (P) general population, (E/C) free-sugar-containing food/beverage intake, (O) clinically measured periodontal diseases, and (S) observational study and clinical trial. Of the 839 screened records, 13 studies were included in the review. Most studies (n = 12) had a cross-sectional design. The age groups in the included studies were children/adolescents (n = 5) and adults (n = 8). Among the included studies, 11 reported a significant association between the frequent intake of free-sugar-containing food or beverages and a higher prevalence or incidence of periodontal diseases. The quality of most of the included studies was scored "fair" based on the Newcastle-Ottawa Quality Assessment Scale. Although the majority of the included studies reported a significant positive association between high free sugar intake and periodontal diseases, the evidence is considered to be limited due to the study designs.

Outcome measurements and quality of randomized controlled clinical trials of tooth-supported fixed dental prostheses: A systematic review and qualitative analysis

STATEMENT OF PROBLEM

The lack of consensus regarding a standardized set of outcome measurements and noncompliance with current reporting guidelines in clinical trials of tooth-supported fixed dental prostheses (FDPs) hamper interstudy comparability, compromise scientific evidence, and waste research effort and resources in prosthetic dentistry.

PURPOSE

The primary objective of this systematic review was to identify all primary and secondary outcome measurements assessed in randomized controlled trials (RCTs) of tooth-supported FDPs. Secondary objectives were to assess their methodological quality by using the Cochrane Collaboration's risk of bias tool (RoB, v2.0) and their reporting quality by means of a standardized 16-item CONSORT assessment tool through published reports.

MATERIAL AND METHODS

An electronic search was conducted in MEDLINE, EMBASE, and Cochrane library to identify all RCT-related articles published in the past 10 years. Differences in RoB were tested with the Pearson chi-square test, and those in CONSORT score with the Student t test.

RESULTS

A total of 64 RCTs from 79 publications were deemed eligible. The diversity of outcome measures used in the field is apparent. Twenty percent of the included studies had a low RoB, 79% showed some concerns, and 1% had a high RoB. The mean ±standard deviation CONSORT compliance score was 22.56 ±3.17. Trials adhered to the CONSORT statement reported lower RoB than those that did not adhere (P<.001). RCTs with a low RoB reported more comprehensive adherence to CONSORT guidelines than those with some concerns (MD 4 [95% CI 1.52-6.48]; P=.004).

CONCLUSIONS

A standardized core outcome reporting set in clinical research on tooth-supported FDPs remains evident. Adherence to the CONSORT statement continues to be low, with some RoB concerns that can be improved.

Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China

Background

Inappropriate use of glucocorticoids in primary care institutions is serious. It not only causes economic burden, but leads to many adverse reactions. The purpose of this study is to explore systemic glucocorticoid prescription pattern and factors of inappropriate use in primary care institutions.

Methods

This is a retrospective study. Systemic glucocorticoids prescribed in 58 primary care institutions in Guizhou province of Southwest China in 2020 were selected from the Health Information System. All prescriptions were classified as appropriate or inappropriate use. Inappropriate use was classified into the following two categories: (a) Inappropriate indications; (b) Inappropriate selection of glucocorticoids. Multivariate analysis was used to explore the factors associated with inappropriate use of systemic glucocorticoids.

Results

A total of 63,315 glucocorticoid prescriptions were included in the analysis. Diseases of the respiratory system (60.8%) and diseases of the skin and subcutaneous tissue (23.1%) were the most common indications for use. Injections (89.8%) predominated and dexamethasone (86.5%) was the most prescribed glucocorticoid. 68.2% of all prescriptions were inappropriate. Compared to physicians with a college degree, physicians with a junior college (OR: 1.12, 95% CI: 1.08-1.17) and technical secondary education (OR: 1.12, 95% CI:1.05-1.19) were more likely to prescribe glucocorticoids inappropriately as were attending physicians (OR: 1.12, 95% CI: 1.01-1.25) and resident physicians (OR: 1.31, 95% CI: 1.15-1.48) compared to associate chief physicians. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older (OR: 6.00, 95% CI: 5.62-6.40). In contrast, prescriptions given by injection were more likely to be used inappropriately than those given orally (OR: 0.44, 95% CI: 0.41-0.46).

Conclusion

Inappropriate use of systemic glucocorticoids without appropriate indications was extremely prominent in primary care institutions of Guizhou Province, especially in diseases of the respiratory system and among the elderly. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older. It is important to note that physicians younger than 33, with more than 40 years of service, and attending or residents were more likely to inappropriately prescribe glucocorticoids.

Oral microbiota associated with gingiva of healthy, gingivitis and periodontitis cases

Oral microbes coexist with each other in a symbiotic relationship or as commensals in healthy body. Teeth and oral cavity harbor diverse community of fungi and bacteria. This study focused on bacterial and fungal component of gingiva, where the last occupy little attention. In addition to study the antimicrobial activity of toothpastes, mouth washes and natural oils against microorganisms. Sixty swabs from outer surfaces of gingiva in healthy persons, as well as patients complaining of gingivitis and periodontitis were collected for fungal and bacterial analyses. Sensitivity of the isolated microorganisms to some pharmaceutical preparations and natural oils was also performed. Ten fungal and 9 bacterial species were identified. There is a highly significant variation in the frequency of Klebsiella pneumonia among healthy, gingivitis and periodontitis. Also, Candida tropicalis and cocci bacteria showed significant diversity among the three tested groups. Among pharmaceutical preparations (toothpastes and mouth washes) and natural oils, Paradontax, Hexitol and clove oil showed the best antimicrobial activity against tested fungal and bacterial strains. Although, minimum inhibition concentrations (MICs) of clove oil were high compared to Paradontax and Hexitol, nevertheless, it is highly recommended as both antifungal and antibacterial agent against oral pathogenic microorganisms, because it is a natural compound and nearly devoid of side effects.

Assessment of Negative Gingival Recession: A Critical Component of Periodontal Diagnosis

Accurate measurement of negative gingival recession (GR) is essential to accurately determine the clinical attachment loss, which leads to an accurate diagnosis and optimal therapy of periodontal disease. However, the accuracy of measuring the negative GR has been shown to be low and highly variable between examiners. The position of the gingiva margin in relation to the cemento-enamel junction (CEJ) varies among different stages of passive eruption. The amount of negative GR is about 2 mm on average at the mid-facial sites and ranges from 2 to 3.5 mm at interproximal sites in periodontally healthy patients. Some other clinical conditions may change the gingival dimension coronal to the CEJ, such as altered passive eruption and gingival enlargement. In addition to the traditional approach using a periodontal probe to assess the negative GR, nowadays dental ultrasound imaging may be able to assist in accurately measuring the amount of negative GR. This narrative review will discuss the existing evidence of the dimension of dentogingival tissue and the clinical assessment of negative GR using different clinical tools.

Diagnostic performance of the AAP/EFP classification and the CDC/AAP case definition among pregnant women and a practical screening tool for maternal periodontal diseases

Background and Objective

There is a limited number of studies on the performance assessment of the 2017 AAP/EFP classification and the CDC/AAP case definition among pregnant females. This study evaluated the agreement between these two systems and explored a practical tool for screening maternal periodontal diseases by general dentists.

Materials and Methods

Totally, 204 systemically healthy females at different phases of pregnancy underwent a full‐mouth periodontal examination. Demographic characteristics, lifestyles, and systemic conditions were recorded. Referring to the CDC/AAP definition, the diagnostic performance of the AAP/EFP classification was evaluated by the area under the ROC curve (AUC) and statistical tests (e.g., Youden's index and kappa coefficient). Additionally, a modified scoring system of the FDI Periodontal Diseases Chairside Guide (FDI‐CG) was formulated with the addition of pregnancy for testing accordingly.

Results

Overall, there were 22.1% of the participants in early phase of pregnancy (7–13 weeks) and 77.9% in late phase (34–36 weeks). The majority of them were below 35 years and non‐smokers without gestational diabetes. Notably, 30.9% of subjects presented with Moderate/Severe periodontitis (CDC/AAP), and 35.8% with Stages II‐IV periodontitis (AAP/EFP). Referring to the CDC/AAP definition, the AUC, Youden's index, and κ of the AAP/EFP classification were 0.979, 0.890, and 92.9%, respectively. The modified FDI‐CG system improved the AUC (0.815), Youden's index (63.0%), and κ (0.544) with reference to the original one.

Conclusions

This study shows that the AAP/EFP classification is in high agreement with the CDC/AAP definition among the pregnant women. The phases of pregnancy‐integrated FDI scoring system may serve as a convenient screening tool for maternal periodontal diseases in general dental practice.

Simultaneous presence of Mycoplasma salivarium and Tannerella forsythia in the implant sulcus after lateral augmentation with autogenous root grafts is associated with increased sulcus probing depth

Objective

To characterize a potential pathogenic role of Mycoplasma salivarium and bacterial co-detection patterns on different implant augmentation types.

Material and methods

36 patients were non-randomly assigned to autogenous lateral alveolar ridge augmentation with either cortical autogenous bone blocks, or healthy autogenous tooth roots or non-preservable teeth. Mucosal inflammation was assessed by probing pocket depth (PD) at all sampling sites and by bleeding on probing (BOP) in a subset of sampling sites, and standardized biofilm samples were obtained from the submucosal peri-implant sulcus and sulcus of a contralateral tooth at two times (t1 after implant placement; t2 after six months). Seven bacterial species were quantified using Taqman PCR.

Results

Mucosal inflammation did not differ between augmentation groups, but peri-implant sulci showed increased abundance of M. salivarium after augmentation with autogenous tooth roots lasting for at least six months (t1 p = 0.05, t2 p = 0.011). In M. salivarium-positive samples, Tannerella forsythia was correlated with PD (R = 0.25, p = 0.035) This correlation was not observed in M. salivarium-negative samples. Compared to all other samples, PD was deeper in co-detection (i.e., simultaneous M. salivarium and T. forsythia) positive samples (p = 0.022). No association of single or co-detection of bacteria with BOP was observed.

Conclusion

Presence of M. salivarium in peri-implant sulci varies with augmentation method and is associated with increased PD but not BOP. A potential causal role of M. salivarium in inflammation through a mechanism involving co-presence of T. forsythia requires further study.

The Effectiveness of Use of Herbal Dental Paste on Gingivitis Marginalis in Peukan Bada District, Aceh Besar Regency

BACKGROUND: The most common periodontal disease in developing countries is gingivitis. Gingivitis is a dental and oral health problem with a reasonably high prevalence in society at all age groups. Gingivitis is characterized by inflammation and bleeding of the gums. One way to prevent bleeding gums is to use herbal toothpaste. AIM: The aim of the study was to determine the effectiveness of using betel leaf herbal toothpaste against gingivitis marginalis in Rima Jeuneu Village, Peukan Bada District, Aceh Besar District. METHODS: This study used analytical survey research with a cross-sectional design. The location for this research is Rima Jeuneu Village, District. This research was conducted from September to October 2021. Bivariate data analysis to determine the relationship between the independent variable (brushing teeth using betel herbal toothpaste) and the dependent variable (gingivitis marginalis) in this study used the Chi-square test. RESULTS: The results of statistical analysis using the Chi-square test found that there was a significant relationship between brushing teeth using herbal betel toothpaste and gingivitis marginalized in the community ((p) = 0.000 <0.05). A survey reinforces that brushing teeth using herbal betel toothpaste has healthy gingival conditions (71.9%). The use of herbal betel toothpaste is effective in preventing gingivitis marginalis. Betel leaf toothpaste has an antibacterial effect against several types of bacteria, one of which is Streptococcus mutans. CONCLUSION: There is a relationship between brushing teeth using herbal betel toothpaste with gingivitis marginalis in the people of Peukan Bada District, Aceh Besar District. Brushing teeth using betel herbal toothpaste is effective in reducing the level of gingivitis

Association of Salivary IGF and IGF/IGFBP-3 Molar Ratio with Cervical Vertebral Maturation Stages from Pre-Adolescent to Post-Adolescent Transition Period-A Cross-Sectional Exploratory Study

Background: The relevance of growth determination in orthodontics is driving the search for the most precise and least invasive way of tracking the pubertal growth spurt. Objectives: The aim was to explore whether minimally invasive salivary estimation of biomarkers Insulin-like growth factor (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) could be used to estimate skeletal maturity with diagnostic accuracy, especially in children and adolescent age groups. Subjects and methods: The cross-sectional study was conducted on 105 participants aged 6−25 years from the out-patient Department of Preventive Dental Science at Majmaah University between the period 2 January 2021 and 12 July 2021. Each subject’s lateral cephalogram radiograph was categorized based on skeletal maturity, and saliva samples were estimated for IGF-1 and IGFBP-3 using the respective ELISA kits. Two-way ANOVA with interaction was applied to examine the main effects due to cervical vertebral maturation staging (CVS), Sex and interaction effect due to CVS, and Sex on study parameters. Karl Pearson’s Product Moment Correlation Coefficient was calculated for finding a significant association between IGF, IGFBP3, and the IGF-1/IGFBP3 molar ratio. Results: Highest mean salivary IGF-1 was observed in the pubertal peak stage, which coincides with cervical vertebral maturity stages 3 and 4 (CVS3 and CVS4) for both males (2.57 ng/mL) and females (1.57 ng/mL) and the lowest mean level of IGF-1 for females (0.85 ng/mL) and males (1.22 ng/mL) was observed during the prepubertal stage. There exists a significant variation in IGF-1 between males and females in the pubertal stage (p < 0.01), but the difference is very narrow in the prepubertal and post-pubertal groups (p > 0.05). There was no significant interaction effect of different skeletal stages and gender on the IGFBP3 and the IGF-1/IGFBP3 molar ratio (p > 0.05), but there exists a significant interaction effect on IGF-1 (p < 0.05). Conclusion: Estimation of the IGF-1 and the IGF-1/IGFBP3 molar ratio in saliva, being a non-invasive biological marker, could serve as an adjunctive tool along with radiographic assessment in estimating growth maturity in the adolescence age group. By initiating orthodontic treatment during the mandibular growth peak in adolescence, a positive outcome is ensured in managing skeletal deformities within the craniofacial complex.

Permeability of P. gingivalis or its metabolic products through collagen and dPTFE membranes and their effects on the viability of osteoblast-like cells: an in vitro study

Membrane exposure is a widely reported and relatively common complication in Guided Bone Regeneration (GBR) procedures. The introduction of micro-porous dPTFE barriers, which are impervious to bacterial cells, could reduce the technique sensitivity to membrane exposure, even if there are no studies investigating the potential passage of bacterial metabolites through the barrier. Aim of this study was the in vitro evaluation of the permeability of three different GBR membranes (dPTFE, native and cross-linked collagen membranes) to Porphyromonas gingivalis; in those cases, where bacterial penetration could not be observed, another purpose was the analysis of the viability and differentiation capability of an osteosarcoma (U2OS) cell line in presence of bacteria eluate obtained through membrane percolation. A system leading to the percolation of P. gingivalis broth culture through the experimental membranes was arranged to assess the permeability to bacteria after 24 and 72 h of incubation. The obtained solution was then added to U2OS cell cultures which underwent, after 10 days of incubation, MTT and red alizarin essays. The dPTFE membrane showed resistance to bacterial penetration, while both types of collagen membranes were crossed by P. gingivalis after 24 h. The bacteria eluate filtered through dPTFE membrane didn't show any toxicity on U2OS cells. Results of this study demonstrate that dPTFE membranes can contrast the penetration of both P. gingivalis and its metabolites toxic for osteoblast-like cells. The toxicity analysis was not possible for the collagen membranes, since permeability to bacterial cells was observed within the first period of incubation.

Correlation between Salivary Levels of IGF-1, IGFBP-3, IGF-1/IGFBP3 Ratio with Skeletal Maturity Using Hand-Wrist Radiographs

Objective: The relevance of growth determination in orthodontics is driving the search for the most precise and least invasive way of tracking the pubertal growth spurt. Our aim was to explore whether minimally invasive salivary estimation of biomarkers Insulin-like growth factor (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) could be used to estimate skeletal maturity for clinical convenience, especially in children and adolescent age groups. Materials and Method: The cross-sectional study was conducted on 90 participants (56 girls and 34 males) with ages ranging from 6 to 25 years. Each subject’s hand-wrist radiograph was categorized based on skeletal maturity, and saliva samples were estimated for IGF-1 and IGFBP-3 using the respective ELISA kits. Kruskal−Wallis nonparametric ANOVA was applied to compare different skeletal stages. Results: The study demonstrated low salivary IGF-1 levels at the prepubertal stage, with increase during pubertal onset and peak pubertal stage followed by a decline during pubertal deceleration to growth completion. Spearman’s correlation coefficient demonstrated a strong positive association (r = 0.98 p < 0.01) between salivary IGF/IGFBP-3 ratio and different stages of skeletal maturity. Conclusion: Salivary IGF-1, IGFBP-3, and IGF/IGFBP-3 ratio could serve as a potential biochemical marker for predicting the completion of skeletal maturity.

Association of the CD14 -260C/T polymorphism with plaque-induced gingivitis depends on the presence of Porphyromonas gingivalis

BACKGROUND

Plaque-induced gingivitis is the most prevalent periodontal disease associated with pathogenic biofilms. The host immune system responds to pathogens through pattern recognition receptors (PRRs), such as Toll-like receptors (TLRs) and their co-receptor cluster of differentiation 14 (CD14).

AIM

This study investigated the association between the functional polymorphism in the CD14 gene and the dental plaque microbiota in children with gingivitis.

DESIGN

A total of 590 unrelated children (307 with plaque-induced gingivitis and 283 controls, aged 13-15 years) were enrolled in this case-control study. Dental plaque was processed using a ParoCheck^® 20 detection kit. The CD14 -260C/T (rs2569190) polymorphism was determined with the PCR-RFLP method.

RESULTS

Gingivitis was detected in 64.2% of boys and 35.8% of girls (P < .001). Children with gingivitis had a significantly higher occurrence of dental caries (P < .001). No significant differences in the CD14 -260C/T allele and genotype distribution among individuals with or without gingivitis in the whole cohort were found. Children with gingivitis and P gingivalis, however, were significantly more frequent carriers of the CT and TT genotypes than children with gingivitis without P gingivalis or healthy controls (P < .05).

CONCLUSIONS

The CD14 -260C/T polymorphism acts in cooperation with P gingivalis to trigger plaque-induced gingivitis in Czech children.

Biological Anchorage and Canine Orthodontic Movement Rate with a New Technique for Micro-Osteoperforations

Introduction

The differential management of anchorage and the acceleration of tooth movement are some of the current greatest challenges for orthodontists. Diverse techniques and devices to reinforce anchorage and increase the rate of tooth movement have been proposed. Whether micro-osteoperforations (MOPs) can be used for both purposes is currently investigated.

Objectives

To propose and describe a new technique for biological anchorage, which involves six MOPs performed every four weeks, and to present its results in a clinical case of upper premolar extraction. Intervention. In a dental class II patient who met the selection criteria, three MOPs both on the buccal and palatine sides on the intervention side were performed on the extraction area following the protocol described. No MOPs were performed on the control side. The allocation of the intervention was randomised. The MOPs were performed three times at an interval of four weeks. A 0.019 × 0.025-inch stainless steel wire was activated with calibrated NiTi springs. The three-dimensional movement of the first molars and upper canines was evaluated. In addition, the comfort, periodontal status, and canine root resorption of the patient were evaluated.

Results

Clinical and radiographic results suggest that the MOPs had a positive effect in reducing the loss of biological anchorage of the posterior sector and in the rate of canine tooth movement, without damaging changes in the soft and hard tissues.

Conclusion

The proposed protocol involving six MOPs every four weeks improved the behaviour of biological anchorage and increased distalization on the intervention side in this clinical case.

The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents.

METHODS

The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496).

RESULTS

Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001).

CONCLUSIONS

Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

A survey of oral health status, subjective oral symptoms and oral health behaviors among first-year dental students at a Japanese university

PURPOSE

The rapid deterioration of oral health in young adults is an alarming problem in Japan. The aim of the present study is to investigate the oral health status, subjective oral symptoms and oral health behaviors of dental students.

METHODS

Participants were 108 first-year students attending dental school in 2018-2019. Oral examinations were performed to assess dental caries indices, oral hygiene status, gingival bleeding on probing (BOP) and pocket depth. A self-administered questionnaire was used to assess subjective oral symptoms and oral health behaviors.

RESULTS

The prevalence of decayed teeth (DT) and gingivitis (BOP ≥ 10%) were 43.5% and 50.0%, respectively. Having DT and gingivitis were significantly associated with poorer oral hygiene. No association was observed between DT and subjective symptoms. Having gingivitis was significantly associated with xerostomia, mouth-breathing and less use of interdental cleaning tools. Multiple logistic regression analysis for gingivitis yielded an odds ratio of 1.41 (95% confidence interval: 1.19-1.67) for plaque score, and 2.75 (1.27-5.98) for xerostomia.

CONCLUSION

Since a relatively high ratio of students had DT and gingivitis without clear subjective symptoms, they require regular dental visits for early treatment and oral hygiene maintenance from the start of their time at university.

Superparamagnetic Iron Oxide Nanoparticles Protect Human Gingival Fibroblasts from Porphyromonas gingivalis Invasion and Inflammatory Stimulation

Introduction

Modulating the inflammatory response of human gingival fibroblasts (hGFs) is important for the control of periodontal inflammation because it is a key event in the pathogenesis of periodontitis. Here, we aimed to determine whether polyglucose sorbitol carboxymethyl ether (PSC)-coated superparamagnetic iron oxide nanoparticles (SPIONs) protect hGFs against invasion and inflammatory stimulation by Porphyromonas gingivalis (P. gingivalis).

Methods

First, we determined the cytotoxicity and antimicrobial activity of PSC-SPIONs. Then, their effects on invasion of hGFs by P. gingivalis were evaluated by counting invading P. gingivalis, fluorescence staining, and transmission electron microscopy. The effect of PSC-SPIONs on inflammation in hGFs induced by P. gingivalis lipopolysaccharide was evaluated by measurement of reactive oxygen species (ROS), and enzyme-linked immunosorbent assays, quantitative reverse transcription-polymerase chain reaction, and Western blotting of key indicator molecules. The effects of dimercaptosuccinic acid (DMSA)-coated SPIONs and the free form of PSC alone were also tested and compared with those of PSC-SPIONs.

Results

PSC-SPIONs (25 μg/mL) are cytocompatible with hGFs and exhibit no antimicrobial effects on P. gingivalis. However, they inhibit invasion of hGFs by P. gingivalis at 15 μg/mL. They also decrease ROS production and inflammatory cytokine secretion by hGFs at 5, 15, and 25 μg/mL, by downregulating activation of the nuclear factor-kappa B signaling pathway. Furthermore, PSC alone does not inhibit inflammation, while DMSA-SPIONs do. This indicates that the nanosize effects of PSC-SPIONs, rather than their coating material, play the dominant role in their anti-inflammatory activity.

Conclusion

PSC-SPIONs protect hGFs against P. gingivalis invasion and inflammatory stimulation. Thus, they have potential for clinical application in control of periodontal inflammation.

Molar-incisor hypomineralization and dental caries: A hierarchical approach in a populational-based study

The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH) studies. Hypomineralized defects can have several consequences such as hypersensitivity, increased dental plaque accumulation, and consequently higher caries risk. This cross-sectional study aimed to investigate the prevalence of MIH and its association with dental caries in schoolchildren from a city in southern Brazil. A random cluster sample of schoolchildren was selected. Clinical examinations were carried out to collect information on MIH (following the European Academy of Pediatric Dentistry criteria), dental caries (using the DMF-T index) and gingivitis. Socioeconomic, demographic and behavior variables were collected using a standardized questionnaire answered by the children's parents/caregivers. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance through a hierarchical approach (p<0.05). A total of 513 schoolchildren were included in the study. MIH and caries prevalence was 19.7% and 31.6%, respectively. The mean age was 11.6 (+1.9) years. Dental caries was more prevalent in children with MIH (PR 1.39; 95% CI 1.05 - 1.85). Older children and children whose families were enrolled in conditional cash transference programs (PR 1.97 95% CI 1.47 - 2.64), and children who did not have their mother or father as the head of the family (PR 1.56 95% CI 1.06 - 2.30) presented a higher prevalence of dental caries. Our findings suggest that children with MIH are more likely to have dental caries.

Periodontal disease prevalence, extent, and risk associations in untreated individuals

Objectives

to examine the prevalence, extent, and risk associations of untreated periodontitis.

Materials and Methods

A purposive sample of subjects who were never treated for periodontal conditions was clinically examined after collecting information about their sociodemographic characteristics, medical conditions, oral health behaviors, perceived stress, and perceived social support.

Results

A total of 431 subjects were recruited (response rate, 97.0%), and their mean age (SD) was 35.4 (13.3) years. Overall, high plaque levels were observed in all untreated individuals. The prevalence of periodontitis and severe (stage III/IV) periodontitis using the American Academy of Periodontology and European Federation of Periodontology (AAP/EFP) classification were 85.4% and 48.5%, respectively. The prevalence of moderate‐severe and severe periodontitis using the definitions of the Centers for Disease Control and Prevention (CDC) and AAP were 78.4% and 31.1%, respectively. The extent of periodontitis expressed as mean% of clinical attachment loss (CAL) ≥ 3 mm and CAL ≥ 5 mm were 34.9% and 14.4%, respectively, while the mean% of a periodontal probing depth (PPD) ≥4 mm and PPD ≥6 mm were 22.0% and 9.2%, respectively. Risk determinants associated with AAP/EFP periodontitis after the adjustment for other variables were age ≥35 years (odds ratio [OR] = 11.5) and lower income (OR = 2.5). Adjusted risk associations with stage II/IV periodontitis included age ≥35 years (OR = 8.2), males (OR = 2.5), lower income (OR = 2.3), and lower perceived stress (OR = 2.0). Adjusted risk associations with CDC/AAP moderate‐severe periodontitis included age ≥35 years (OR = 12.0), lower income (OR = 2.1), and current cigarette smoking (OR = 4.2). Adjusted risk associations with CDC/AAP severe periodontitis included age ≥35 years (OR = 4.5), males (OR = 1.9), lower education (OR = 2.0), lower income (OR = 1.7), uncontrolled diabetes mellitus (OR = 2.0), and current cigarette smoking (OR = 2.3).

Conclusions

The prevalence and extent of periodontitis were high in untreated subjects. Risk associations with untreated periodontitis included age ≥35 years, males, lower income, lower education, current cigarette smoking, uncontrolled diabetes mellitus, and lower perceived stress.

The frequency of periodontitis in end-stage renal disease on hemodialysis in a sample of Egyptian population: multi-center clinical cross-sectional study

BACKGROUND

There is a general assumption that periodontal disease is highly prevalent among patients with chronic renal failure undergoing hemodialysis. The aim of the study to estimate the frequency of periodontitis in patients on hemodialysis among a sample of the Egyptian population, as well as the correlation between different clinical parameters of periodontal status with serum creatinine and blood urea. This may rule out the bidirectional relationship between periodontitis and renal failure in patients on hemodialysis.

METHODS

The study was conducted on 263 hemodialysis patients (165 males and 98 females) at three dialysis centers in Benha Governorate, Egypt (Benha Hospital, Tukh hospital, Qalyub hospital). Periodontal parameters including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD) had been recorded in these patients. Serum urea and creatinine levels had been measured, the data had been collected and undergone statistical analysis.

RESULTS

Frequency of periodontitis was 85.6% with stage III is the most prevalent stage. There was a significant positive strong correlation between age and periodontitis stage (rs = 0.707, p < 0.001). There was a positive correlation between clinical parameters and serum creatinine level.

CONCLUSION

In the present study, a high frequency of periodontitis had been found among ESRD patients on hemodialysis in the severe form (stage III) periodontitis. There was a significant direct correlation between the severity of periodontitis and CAL with a duration of hemodialysis. There was a weak insignificant association between periodontal indices (PD, BOP, and plaque score) and duration of hemodialysis.

Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury

Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).

Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.

Results: Dental plaque (P = 0.01) and total BOE score (P &lt; 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).

Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.

Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.

Oral Colonization by Entamoeba gingivalis and Trichomonas tenax: A PCR-Based Study in Health, Gingivitis, and Periodontitis

Background

The etiology of periodontitis remains unclear, as is the place of gingivitis in its pathophysiology. A few studies linked the colonization by oral parasites (Entamoeba gingivalis and Trichomonas tenax) to periodontal disease and its severity. The aim of the current study was to estimate the prevalence of these oral parasites among healthy individuals, and in patients with gingivitis and periodontitis in Jordan.

Methods

The study was conducted during July 2019–December 2019. Samples were composed of saliva and periodontal material including dental plaque sampled with probes. The detection of oral parasites was done using conventional polymerase chain reaction (PCR).

Results

The total number of study participants was 237: healthy (n=94), gingivitis (n=53) and periodontitis (n=90). The prevalence of E. gingivalis was 88.9% among the periodontitis patients, 84.9% among the gingivitis patients and 47.9% in the healthy group. For T. tenax, the prevalence was 25.6% among the periodontitis patients, 5.7% among the gingivitis patients and 3.2% in the heathy group. Positivity for E. gingivalis was significantly correlated with the presence of periodontal disease compared to the healthy group with odds ratio (OR) of 6.6. Periodontal disease was also correlated with lower monthly income (OR=8.2), lack of dental care (OR=4.8), and history of diabetes mellitus (OR=4.5). Colonization by E. gingivalis was correlated with gingivitis (OR=6.1) compared to the healthy group. Colonization by E. gingivalis and T. tenax were significantly correlated with periodontitis (OR=6.4 for E. gingivalis, and OR=4.7, for T. tenax) compared to the healthy group. T. tenax was only detected among individuals with generalized periodontal disease compared to its total absence among those with localized disease (19.6% vs. 0.0%; p=0.039). The co-infection rate by the two oral parasites was 11.0%.

Conclusions

The higher prevalence of human oral parasites in periodontal disease compared to healthy individuals appears to be more than a mere marker for the disease and might also be associated with disease severity and potential for progression. Thus, the dogmatic view of E. gingivalis and T. tenax as commensals needs to be re-evaluated and their contribution to pathophysiology of periodontal diseases cannot be neglected.

Preliminary Evaluation of a NitrAdine-Based Brushing Solution for Patients Suffering from Gingivitis: A Prospective Clinical Case-Control Study

Objectives  This article aimed to evaluate the clinical efficacy of a nonantibiotic biofilm-removal formulation based on NitrAdine (PerioTabs), combined with a regular home oral hygiene regimen, in Caucasian patients with gingivitis.

Materials and Methods  A sample of 60 patients were included in this clinical prospective study. All selected subjects underwent regular prophylaxis and professional oral hygiene at baseline; 30 days later, they were recalled for the measurements of the reference parameters about bleeding on probing (full-mouth bleeding upon probing score [FMBS]) and plaque index (full-mouth plaque score [FMPS]); no other clinical procedure was performed. Consequently, half of the patients ( n  = 30) were instructed to use PerioTabs for 10 days. The remaining patients ( n  = 30) were used as the negative control, only instructed to continue with their usual oral hygiene regimen. Fifteen days after, the clinical parameters of FMBS and FMPS were re-evaluated in both groups.

Results  Changes in the scores of clinical indices FMBS and FMPS were calculated and compared. A significant difference between pre- and post-values, for both FMBS and FMPS, was noticed in the test group; in particular, the bleeding index value demonstrated the more significant changes: 22 participants showed a clinically meaningful improvement, and 5 had a small improvement. Only three patients had no evidence of change. In addition, 50% of patients had a reduction in plaque levels. No side effects were reported.

Conclusions  The adjunctive use of 10-day PerioTabs treatment in the daily oral hygiene routine seemed to be efficient in reducing gingival bleeding and plaque accumulation, with absence of adverse effects. These results should be confirmed in studies with a larger number of participants following a controlled-blinded design.

Tumour necrosis factor-alpha polymorphism -308 G/a and its protein in subjects with gingivitis

OBJECTIVE

This study examined the association between tumour necrosis factor-alpha (TNF- α) (-308 G/A) polymorphism and gingivitis, and serum and salivary TNF- α levels, in a Mexican population.

MATERIAL AND METHODS

This study enrolled 171 subjects, divided into two groups: healthy subjects and gingivitis patients. TNF- α (-308 G/A) gene polymorphism was analyzed by PCR-RFLP assay. Salivary and serum samples were used to measure cytokine levels through the ELISA technique.

RESULTS

TNF- α (-308 G/A) polymorphism was shown to have a protective effect in carriers of the A/A genotype and allele A. The G/A genotype is associated with an increase in high-density lipoprotein cholesterol (HDL-C) levels in the gingivitis group. Healthy individuals had higher levels of salivary TNF- α and HDL-C, and increased salivary flow. Triglycerides, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol levels were increased in the gingivitis group. No statistical differences were found in serum TNF- α levels.

CONCLUSION

Our data demonstrate that the TNF- α -308 A/A genotype exerts a protective effect against gingivitis. Moreover, oral conditions are associated with some biochemical parameters.