An Evaluation of Periodontal Status and Cytokine Levels in Saliva and Gingival Crevicular Fluid of Patients with Inflammatory Bowel Diseases

Stabilization Splint Therapy for Patients with Temporomandibular Disorders Improves Opening Movements and Jaw Limitation and Attenuates Pain by Influencing the Levels of IL-7, IL-8, and IL-13 in the Gingival Crevicular Fluid

Background and Objectives: In recent years, numerous studies have investigated and analyzed the levels of molecular biomarkers of temporomandibular disorders (TMD) from various tissue samples and body fluids. However, no study has investigated gingival crevicular fluid (GCF) in TMD patients. The purpose of this study was to determine the concentrations of pro-inflammatory cytokines in GCF before and after stabilization splint (SS) therapy in patients with painful TMD, to investigate whether SS administration causes changes in the concentrations of pro-inflammatory cytokines. An additional aim was to investigate the relationship of GCF cytokine levels with chronic pain intensity and clinical parameters. Materials and Methods: This prospective cohort study included 36 patients who were diagnosed with painful TMD using the Diagnostic Criteria for TMD (DC/TMD). GCF samples were collected at baseline before SS treatment (T0) and at one month (T1) and three months (T2) after the start of therapy. Customized ProcartaPlex Multiplex assays from eBioscience (Invitrogen™, Thermo Fisher Scientific, Viena, Austria) were used for the quantitative analysis of pro-inflammatory cytokines (IL-1β, IL-6, IL-7, IL-8, IL-13, and TNF-α). Patients filled out Croatian versions of questionnaires for self-assessment from Axis II DK/TMP: Graded Chronic Pain Scale (v2) (GCPSv2) and Jaw Function Limitation Scale-20 (JFLS-20). Results: The results showed that the GCF levels of IL-7 (Friedman's test, p = 0.008) and IL-13 (Friedman's test, p = 0.003) were significantly decreased at T2. The GCF level of IL-13 was in negative correlation with chronic pain grade score at T2 (Rho = -0.333), while the GCF level of IL-8 was in positive correlation with mobility limitation (Rho = 0.382) at T1. Conclusions: The results indicate that SS therapy might have a role in reducing inflammation and that the GCF could be a valuable medium for assessing molecular biomarkers.

Dental problems and oral microbiome alterations in ulcerative colitis

Ulcerative colitis is a chronic disease that has not well-established etiology. The role of microbial dysregulation in its pathogenesis has been recently highlighted. Overall, microbiome alterations concern the reduction of bacterial abundance and diversity, resulting in gut microbiome imbalance negatively affecting immunological aspects. There is a link between ulcerative colitis and the oral microbiome. The changes of oral microbiome are found at many levels, from gently dysbiotic composition to the presence of the main periodontal microbes. The analysis of oral microbiome can be a part of personalized medicine due to the fact that it is a potential biomarker. Patients with ulcerative colitis may manifest dental symptoms/problems, such as periodontitis (strongly related to the red-complex pathogens-Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and bacteria belonging to the other complexes, such as Fusobacterium nucleatum and Aggregatibacter actinomycetecomitans), dental caries, oral ulcerations, leukoplakia, halitosis, and others. Notably, the DMFT (Decayed, Missing, Filled Teeth) index is higher in these patients compared to healthy subjects. According to some data, oral lichen planus (which is a disease with an immunological background) can also be observed in ulcerative colitis patients. It seems that deep understanding of ulcerative colitis in association with oral microbiome, immunology, and dental manifestations may be crucial to provide complex treatment from a dental point of view.

Periodontitis and the Incidence of Inflammatory Bowel Diseases: A Nationwide Population-Based Cohort Study

INTRODUCTION

Periodontitis and other oral health indicators are reportedly related to systemic inflammation. Our study aimed to investigate a possible association of oral health status (periodontitis and number of missing teeth) and oral hygiene behaviors (frequency of tooth brushing, dental visit, and dental scaling) with the risk of inflammatory bowel disease (IBD) incidence.

METHODS

Using the Korean National Health Insurance Database, we conducted a nationwide, population-based cohort study involving participants from the 2003 national health screening program. We followed these individuals until December 2020 or the occurrence of censoring events. Crohn's disease (CD) and ulcerative colitis (UC) were defined by disease classification codes from the International Classification of Diseases-10 and national codes for rare intractable disease. The occurrence of IBD was analyzed using the Cox proportional hazard model, with propensity score matching performed to balance baseline characteristics between participants with and without periodontitis.

RESULTS

Our analysis involved a total of 2,272,012 participants with a median follow-up period of 17.0 years. The incidence rates for CD and UC were 11.6 and 32.4 per 100,000 person-years, respectively. In multivariable analysis after propensity score matching, the presence of periodontitis was associated with an increased risk of both CD (adjusted hazard ratio [aHR] 1.32, 95% confidence interval [CI] 1.14-1.52, P < 0.001) and UC (aHR 1.21, 95% CI 1.10-1.32, P < 0.001). Conversely, frequent tooth brushing ≥3 times a day was associated with a reduced risk of CD (aHR 0.81, 95% CI 0.65-0.99, P = 0.049), but no significant association was observed with UC.

DISCUSSION

Periodontitis may augment the risk of incidence for CD and UC. This association underscores the potential significance of periodontal health in the context of IBD, emphasizing the importance of comprehensive oral hygiene practices and potential preventive strategies to reduce the risk of CD and UC incidence.

Gut microbial dysbiosis and inflammation: Impact on periodontal health

Periodontitis is widely acknowledged as the most prevalent type of oral inflammation, arising from the dynamic interplay between oral pathogens and the host's immune responses. It is also recognized as a contributing factor to various systemic diseases. Dysbiosis of the oral microbiota can significantly alter the composition and diversity of the gut microbiota. Researchers have delved into the links between periodontitis and systemic diseases through the "oral-gut" axis. However, whether the associations between periodontitis and the gut microbiota are simply correlative or driven by causative mechanistic interactions remains uncertain. This review investigates how dysbiosis of the gut microbiota impacts periodontitis, drawing on existing preclinical and clinical data. This study highlights potential mechanisms of this interaction, including alterations in subgingival microbiota, oral mucosal barrier function, neutrophil activity, and abnormal T-cell recycling, and offers new perspectives for managing periodontitis, especially in cases linked to systemic diseases.

Unravelling the Oral-Gut Axis: Interconnection Between Periodontitis and Inflammatory Bowel Disease, Current Challenges, and Future Perspective

As the opposite ends of the orodigestive tract, the oral cavity and the intestine share anatomical, microbial, and immunological ties that have bidirectional health implications. A growing body of evidence suggests an interconnection between oral pathologies and inflammatory bowel disease [IBD], implying a shift from the traditional concept of independent diseases to a complex, reciprocal cycle. This review outlines the evidence supporting an 'oral-gut' axis, marked by a higher prevalence of periodontitis and other oral conditions in IBD patients and vice versa. We present an in-depth examination of the interconnection between oral pathologies and IBD, highlighting the shared microbiological and immunological pathways, and proposing a 'multi-hit' hypothesis in the pathogenesis of periodontitis-mediated intestinal inflammation. Furthermore, the review underscores the critical need for a collaborative approach between dentists and gastroenterologists to provide holistic oral-systemic healthcare.

The global burden of periodontal diseases in 204 countries and territories from 1990 to 2019

AIMS

The aim of this study was to report the incidence, prevalence, and disability-adjusted life-years (DALYs) of periodontal diseases during the period 1990-2019.

METHODS

Data on periodontal diseases were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. The estimated annual percentage changes were calculated to evaluate the changing trend of age-standardized incidence, prevalence, and DALY rates related to periodontal diseases.

RESULTS

Globally, there were 1,087,367,744.0 cases with 91,518,820.6 new incidence and 7,090,390.3 DALYs of periodontal diseases in 2019, almost twice as many as in 1990. Moreover, the pace of increase in age-standardized incidence, age-standardized prevalence, and age-standardized DALY rates had accelerated during the 1990-2019 time period, with EAPC of 0.29 (95% CI, 0.22 to 0.35), 0.34 (95% CI, 0.26 to 0.43), and 0.35 (95% CI, 0.27 to 0.44) separately. The corresponding age-standardized percentage changes were more pronounced in females, Southeast Asia, and low-middle SDI regions. Western Sub-Saharan Africa was the high-risk area of standardized periodontal diseases burden in 2019, among which Gambia was the country with the heaviest burden.

CONCLUSION

The globally incidence, prevalence, and DALYs of periodontal diseases are substantially increased from 1990 to 2019, which highlights the importance and urgency of periodontal care.

Salivary Th17 cytokine, human β-defensin 1-3, and salivary scavenger and agglutinin levels in Crohn's disease

OBJECTIVES

Crohn's disease patients, who are prone to develop periodontal diseases, may carry genetic defects in their Th17 cytokine, human beta-defensin (hBD) 1-3, and salivary and scavenger agglutinin (SALSA) expressions. Biochemical composition of saliva reflects the oral consequences of systemic immune response modifications. Our aim was to evaluate the salivary Th17 cytokine, epithelial hBD 1-3, and SALSA levels in relation to Crohn's disease.

MATERIALS AND METHODS

This cross-sectional study included 42 Crohn's disease patients and 34 systemically healthy controls. Periodontal and dental indexes were measured, and stimulated saliva samples were collected. Salivary Th17 cytokine levels were analyzed by multiplex technique, and hBD 1-3 and SALSA levels by enzyme-linked immunosorbent assay.

RESULTS

There were 19 gingivitis and 11 initial periodontitis patients in the Crohn's disease group, and 15 gingivitis and 4 initial periodontitis in the control group. In comparison to controls, higher salivary Th17 cytokine levels were observed in Crohn's disease patients. No statistical difference was observed between Crohn's disease and control groups in terms of their salivary hBD 1-3 and SALSA levels. Based on the regression analysis, there is no independent association between Crohn's disease and salivary Th17 cytokine levels.

CONCLUSIONS

Crohn's disease does not relate to salivary antimicrobial hBD 1-3 or SALSA levels. While Crohn's disease patients have higher salivary Th17 cytokine levels in comparison to systemically healthy controls, an independent association between Crohn's disease and Th17 cytokine profile is still missing.

CLINICAL RELEVANCE

Diminished Th17 cytokine response in Crohn's disease, which might be related to genetic susceptibility, can be also visualized in saliva.

Immunoaffinity-enriched salivary small extracellular vesicles in periodontitis

Aim

aliva extracellular vesicles (EVs) serve as a significant reservoir of biomarkers that may be of clinical use in disease diagnosis. Saliva, however, contains EVs of both host- and bacterial- origin. Identifying suitable EVs for disease diagnosis involves enriching host EVs and limiting non-host contamination with effective isolation methods. The objectives of this research were: (1) to evaluate the salivary EVs enrichment in 12 periodontally healthy patients by two different methods: size exclusion chromatography (SEC) and bead-based immunoaffinity capture (EXO-NET®); (2) to analyze the variance expression of inflammatory cytokines in EXO-NET-enriched EVs, comparing individuals with periodontitis (n = 20) to non-periodontitis (n = 12).

Methods

Whole unstimulated saliva samples were collected from 12 periodontally healthy and 20 periodontitis patients. EVs were isolated from the 12 non-periodontitis patients using SEC (referred to as SEC-EVs) and EXO-NET (referred to as EXO-NET EVs), after which their total protein content, 37 EV surface markers, and bacterial pathogens expression were compared. Subsequently, the inflammatory cytokines expression levels (interleukin-IL-6, IL-1β, IL-8, and IL-10) in EXO-NET EVs were measured for non-periodontitis and periodontitis.

Results

EXO-NET EVs contained more EV-specific protein and substantially higher expression of EV surface markers (CD9, CD81, CD63), but less pathogenic DNA was detected compared to that in SEC-EVs. Additionally, EXO-NET EVs from periodontitis patients contained higher amounts of IL-6 and IL-8, and decreased IL-10, compared to those from non-periodontitis patients.

Conclusion

The findings suggest that immunoaffinity capture (EXO-NET) is a dependable method for salivary EVs enrichment, resulting in a higher yield of host EVs with reduced bacterial DNA detection compared to SEC. Furthermore, the research proposes that immunoaffinity capture enriched EVs can function as biomarkers for periodontitis, demonstrated by an increased expression of proinflammatory cytokines from periodontitis patients.

Unraveling the Link between Periodontitis and Inflammatory Bowel Disease: Challenges and Outlook

Periodontitis and Inflammatory Bowel Disease (IBD) are chronic inflammatory conditions, characterized by microbial dysbiosis and hyper-immunoinflammatory responses. Growing evidence suggest an interconnection between periodontitis and IBD, implying a shift from the traditional concept of independent diseases to a complex, reciprocal cycle. This review outlines the evidence supporting an "Oral-Gut" axis, marked by a higher prevalence of periodontitis in IBD patients and vice versa. The specific mechanisms linking periodontitis and IBD remain to be fully elucidated, but emerging evidence points to the ectopic colonization of the gut by oral bacteria, which promote intestinal inflammation by activating host immune responses. This review presents an in-depth examination of the interconnection between periodontitis and IBD, highlighting the shared microbiological and immunological pathways, and proposing a "multi-hit" hypothesis in the pathogenesis of periodontitis-mediated intestinal inflammation. Furthermore, the review underscores the critical need for a collaborative approach between dentists and gastroenterologists to provide holistic oral-systemic healthcare.

Oral manifestations serve as potential signs of ulcerative colitis: A review

As an immune dysregulation-related disease, although ulcerative colitis (UC) primarily affects the intestinal tract, extraintestinal manifestations of the disease are evident, particularly in the oral cavity. Herein, we have reviewed the various oral presentations, potential pathogenesis, and treatment of oral lesions related to UC. The oral manifestations of UC include specific and nonspecific manifestations, with the former including pyostomatitis vegetans and the latter encompassing recurrent aphthous ulcers, atrophic glossitis, burning mouth syndrome, angular cheilitis, dry mouth, taste change, halitosis, and periodontitis. Although the aetiology of UC has not been fully determined, the factors leading to its development include immune system dysregulation, dysbiosis, and malnutrition. The principle of treating oral lesions in UC is to relieve pain, accelerate the healing of lesions, and prevent secondary infection, and the primary procedure is to control intestinal diseases. Systemic corticosteroids are the preferred treatment options, besides, topical and systemic administration combined with dietary guidance can also be applied. Oral manifestations of UC might accompany or precede the diagnosis of UC, albeit with the absence of intestinal symptoms; therefore, oral lesions, especially pyostomatitis vegetans, recurrent aphthous ulcer and periodontitis, could be used as good mucocutaneous signs to judge the occurrence and severity of UC, thus facilitating the early diagnosis and treatment of UC and avoiding severe consequences, such as colon cancer.