Epidemiology and risk factors of periodontal diseases

Factors associated with toothbrushing performance among children: An observational cohort study

BACKGROUND

Effective removal of dental plaque is essential factor for prevention of caries, gingival, and periodontal diseases in children and adults.

AIM

To evaluate factors associated with improving toothbrushing performance (TB-P) among children.

DESIGN

An observational cohort study analyzed all paediatric patients receiving regular examinations in a single dental clinic between 2009 and 2017 and regularly brushing their teeth with a triple-headed toothbrush (TH-TB). At every periodic follow-up, the TB-P of the child/parent was evaluated using the TB-P Skill Index (TB-PS-I); that is, did the child reach all five teeth segments within each arch and did he/she perform 10 back-and-forth stocks in each segment. When not optimal, they received instructions for improving TB-P and subsequently were asked to re-demonstrate. TB-PS-I was calculated and analyzed for correlation with other explanatory variables.

RESULTS

A total of 1737 children with 7399 follow-up appointments were analyzed. Older age, female gender, higher number of follow-up appointments, and compliance with twice-daily toothbrushing significantly improved TB-P. The most typical mistakes in their performance were not reaching the canine segments and not performing enough strokes in each segment. Instructions given after imperfect TB-P significantly improved the TB-P. The magnitude of improvement, however, did not correlate with the performers' age, gender, or the number of follow-up visits.

CONCLUSIONS

A significant percentage of children >8 years did not perform optimal toothbrushing even when using TH-TB.

Emerging therapeutic strategies targeting bone signaling pathways in periodontitis

Periodontitis is a multifactorial immune-mediated disease exacerbated by dysregulated alveolar bone homeostasis. Timely intervention is crucial for disease management to prevent tooth loss. To successfully manage periodontitis, it is imperative to understand the cellular and molecular mechanisms involved in its pathogenesis to develop novel treatment modalities. Non-surgical periodontal therapy (NSPT) such as subgingival instrumentation/debridement has been the underlying treatment strategy over the past decades. However, new NSPT approaches that target key signaling pathways regulating alveolar bone homeostasis have shown positive clinical outcomes. This narrative review aims to discuss endogenous bone homeostasis mechanisms impaired in periodontitis and highlight the clinical outcomes of preventive periodontal therapy to avoid invasive periodontal therapies. Although the anti-resorptive therapeutic adjuncts have demonstrated beneficial outcomes, adverse events have been reported. Diverse immunomodulatory therapies targeting the osteoblast/osteoclast (OB/OC) axis have shown promising outcomes in vivo. Future controlled randomized clinical trials (RCT) would help clinicians and patients in the selection of novel preventing therapies targeting key molecules to effectively treat or prevent periodontitis.

Role of viruses in periodontitis: An extensive review of herpesviruses, human immunodeficiency virus, coronavirus-19, papillomavirus and hepatitis viruses

Periodontitis is the inflammation of the supporting structures around the dentition. Several microbial agents, mostly bacteria, have been identified as causative factors for periodontal disease. On the other hand, oral cavity is a rich reservoir for viruses since it contains a wide variety of cell types that can be targeted by viruses. Traditionally, the focus of research about the oral flora has been on bacteria because the most widespread oral diseases, like periodontitis and dental caries, are outcomes of bacterial infection. However, recently and especially after the emergence of coronavirus disease 2019, there is a growing tendency toward including viruses also into the scope of oral microbiome investigations. The global high prevalence of periodontitis and viral infections may point out to a concomitant or synergistic effect between the two. Although the exact nature of the mechanism still is not clearly understood, this could be speculated through the manipulation of the immune system by viruses; hence facilitating the furthermore colonization of the oral tissues by bacteria. This review provides an extensive and detailed update on the role of the most common viruses including herpes family (herpes simplex, varicella-zoster, Epstein-Barr, cytomegalovirus), Human papillomaviruses, Human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 in the initiation, progression and prognosis of periodontitis.

Thermosensitive Hydrogels for Periodontal Regeneration: A Systematic Review of the Evidence

OBJECTIVES

Thermosensitive hydrogels are now among the most commonly used biomaterials in tissue engineering. Due to their unique characteristics, this review aimed to evaluate the suitability of thermosensitive hydrogels in periodontal regeneration.

MATERIAL AND METHODS

PubMed, Scopus, and Web of Science databases were searched until March 25, 2024, to retrieve relevant articles. The eligibility criteria for the included studies were determined by the designed PICO elements. Results from each included study were extracted, focusing on the three main areas: thermosensitivity, cellular characteristics, and in vivo characteristics.

RESULTS

Nineteen studies were included in our study. The thermosensitivity assessment of the hydrogels indicated a range of sol-gel transition times from 40 s to 20 min based on the type of polymers and the fabrication process. The cellular characterization was assessed based on three main cellular behaviors: cellular viability/proliferation, differentiation, and migration. The in vivo characterization was performed based on two main approaches: radiographic and histologic evaluation.

CONCLUSIONS

The results indicated that the addition of bioactive agents could enhance the in vivo efficacy of thermosensitive hydrogels in periodontal regeneration through three main areas: antimicrobial, anti-inflammatory, and regenerative effects.

Circulating interleukin-27 is associated with the risk of chronic periodontitis and allergic rhinitis: A Mendelian randomization analysis

BACKGROUND

Chronic periodontitis (CP) and allergic rhinitis (AR) have attracted wide attention as global public health problems with high incidence. Recent studies have shown that circulating interleukin-27 (IL-27) is associated with the risk of CP and AR. The aim of this study is to analyze the causal effect between them using Mendelian randomization (MR).

METHODS

Bidirectional MR analyses were performed with the use of publicly available genome-wide association study (GWAS) data. Summary data on circulating IL-27, CP, and AR published in genome-wide association studies were collected. Instrumental variables (IV) were extracted using assumptions of correlation, independence and exclusivity as criteria. Inverse variance weighting (IVW) was used as the main method, combined with weighted median method (WM) and MR-Egger and other MR Analysis methods for causal inference of exposure and outcome. Cochran's Q and MR-Egger intercept were used for sensitivity analysis.

RESULTS

The IVW study showed a causal effect between increased circulating IL-27 levels and increased risk of CP (OR = 1.14, 95%CI = 1.02-1.26, p = .020). Similarly, the increase of circulating IL-27 level had a causal effect on the decreased risk of AR (OR = 0.88, 95%CI = 0.80-0.97, p = .012). In addition, IVW study found that there was a causal between the increased risk of CP and circulating IL-27 level (OR = 1.05, 95%CI = 1.01-1.10, p = .016). However, there was no significant causal relationship between the risk of AR and circulating IL-27 levels (OR = 0.97, 95%CI = 0.91-1.02, p = .209). no significant heterogeneity or horizontal pleiotropy was found in sensitivity analysis.

CONCLUSIONS

There is a causal effect between circulating IL-27 level and CP, AR, which will help to find new ideas and methods for the diagnosis and treatment of CP and AR.

Periodontal Molecular Diagnostics: State of Knowledge and Future Prospects for Clinical Application

Periodontitis leads to immunologically mediated loss of periodontium and, if untreated, can result in tooth loss. Periodontal diseases are the most prevalent in the world and have a very strong impact on patients' well-being and general health. Their treatment generates enormous costs. Given the above, precise, prompt, and predictive diagnosis of periodontal disease is of paramount importance for clinicians. The aim of the study was to summarize the state-of-the-art knowledge of molecular periodontal diagnostics and the utility of its clinical application. There is a great need to have diagnostic tests that not only describe the periodontal destruction that has occurred in the tissues but also allow clinicians to detect disease at a subclinical level before the changes occur. A test that would enable clinicians to follow the course of the disease and detect areas prone to exacerbation could be used to evaluate the effectiveness of ongoing periodontal therapies. Unfortunately, there is no such diagnostic method yet. A hopeful prospect is molecular diagnostics. There are numerous studies on biomarkers of periodontal disease. Point-of-care tests are also emerging. There are possibilities for processing large biological datasets (omics data). However, all of the above have a minor role in the overall single-patient diagnostics process. Despite advances in microbiological, molecular, and genetic research, the basis of periodontal diagnosis is still clinical examination enriched by the evaluation of radiological images.

Microbiota-immune-brain interactions: A new vision in the understanding of periodontal health and disease

This review highlights the significance of interactions between the microbiota, immune system, nervous and hormonal systems, and the brain on periodontal health and disease. Microorganisms in the microbiota, immune cells, and neurons communicate via homeostatic nervous and hormonal systems, regulating vital body functions. By modulating pro-inflammatory and anti-inflammatory adaptive immune responses, these systems control the composition and number of microorganisms in the microbiota. The strength of these brain-controlled responses is genetically determined but is sensitive to early childhood stressors, which can permanently alter their responsiveness via epigenetic mechanisms, and to adult stressors, causing temporary changes. Clinical evidence and research with humans and animal models indicate that factors linked to severe periodontitis enhance the responsiveness of these homeostatic systems, leading to persistent hyperactivation. This weakens the immune defense against invasive symbiotic microorganisms (pathobionts) while strengthening the defense against non-invasive symbionts at the gingival margin. The result is an increased gingival tissue load of pathobionts, including Gram-negative bacteria, followed by an excessive innate immune response, which prevents infection but simultaneously destroys gingival and periodontal tissues. Thus, the balance between pro-inflammatory and anti-inflammatory adaptive immunity is crucial in controlling the microbiota, and the responsiveness of brain-controlled homeostatic systems determines periodontal health.

Periodontal Patients' Perceptions and Knowledge of Dental Implants-A Questionnaire Study

Background: Highly prevalent tooth loss is observed among populations around the world. To restore masticatory function and satisfactory aesthetics, missing teeth must be replaced. Dental implants are increasingly used for this purpose. This study aimed to assess periodontal patients' knowledge and attitudes towards dental implants. Methods: 467 anonymous questionnaires of periodontal patients were analyzed. The population participants were divided according to gender, age, education and place of residence. In the statistical analysis, the chi-squared test of independence was used (p < 0.05). The main questions addressed patients' knowledge about dental implants and the factors influencing their decision to undergo implantation. Results: The majority of periodontal patients were aware of dental implants and the importance of oral hygiene in their maintenance. However, the population studied had many knowledge deficits, especially on the technical and biological aspects of implants. The lack of knowledge about peri-implantitis was surprising in the group seeking professional periodontal care. Patients obtained information mainly from the internet and from family and friends, with their dentists being the third source. Good functional and aesthetic outcomes would encourage them to undergo the implantation procedure, and high cost and the possibility of complications were the most discouraging factors. Conclusions: Given the growing popularity of implant treatment, patients should be provided with evidence-based knowledge about indications and possible contraindications to implants to make informed decisions.

Professional dental care and survival rates in long-term care recipients: A cohort study of 1 459 163 individuals in South Korea

OBJECTIVES

To determine the dental care pattern and survival rates of participants who received long-term care (LTC) and a matched control cohort in South Korea.

BACKGROUND

Global ageing trends and the development of superaged societies pose healthcare challenges. South Korea's LTC system aids those with chronic illnesses and disabilities. Despite the link between oral health and systemic diseases, providing dental care in LTC facilities often reflects social neglect.

METHODS

We identified 1 459 163 individuals eligible for LTC insurance in the Korean National Health Insurance Service database from July 2008 to 2015 (LTC cohort) and 1 459 544 individuals matched through propensity-score matching (matched cohort). The LTC recipients were further categorised into subgroups based on their care type (institutional, home or mixed care). Population of utilising dental services and the average number of dental visits were counted in each cohort, and the survival rate of the LTC cohort was determined according to dental utilisation.

RESULTS

Population of utilising dental services increased steadily in all cohorts except for institutional care, with the highest utilisation (around 30%) observed in the matched cohort. Lower independence in LTC cohorts was associated with lower dental utilisation: 18-27% for home care, 12-18% for mixed care, and 10% for institutional care. The survival rates in the LTC cohort were significantly lower than in the matched cohort (P < .0001), with 28.1% survival in LTC vs 59.3% in the matched cohort.

CONCLUSION

Long-term care recipients experience social neglect for oral care, while higher survival rates were observed in those utilised dental services.

Oral and Intestinal Bacterial Flora in Patients with Increased Periodontal Inflamed Surface Area: A Cross-Sectional Study

Background/Objectives: Periodontitis is caused by bacterial plaque. The oral microflora may interact with the intestinal microflora and play a role in the development of periodontitis. The periodontal inflamed surface area (PISA) has been shown to be a useful indicator of periodontal disease related to systemic diseases; however, few studies have shown an association between PISA and the bacterial flora. This study aimed to determine the association between PISA and oral and intestinal bacteria. Methods: Participants were recruited between 2018 and 2021 at the Medical and Dental Collaboration Center of Kanagawa Dental University Hospital. A periodontal clinical examination was performed, and the PISA was calculated. Salivary tests were conducted, and leukocyte scores in the saliva were calculated. Moreover, 16S rRNA amplicon sequencing was performed using saliva and stool samples to analyze oral and intestinal bacteria, respectively. Results: Higher PISA levels resulted in an increased presence of Bacteroides and a decreased presence of Proteobacteria and Actinobacteria in the saliva. An increase in Bacteroides was detected in the saliva of patients with high leukocyte scores. No correlation was observed between PISA and intestinal bacteria. Conclusions: Bacteroides was highly abundant in the saliva of patients with worsened periodontal conditions, as indicated by PISA. No association was found between PISA and intestinal bacteria.

Disparities and social determinants of periodontal diseases

Periodontal diseases are highly prevalent in populations worldwide and are a major global public health problem, with major negative impacts on individuals and communities. This study investigates evidence of disparities in periodontal diseases by age groups, gender, and socioeconomic factors. There is ample evidence that these diseases disproportionally affect poorer and marginalized groups and are closely associated with certain demographics and socioeconomic status. Disparities in periodontal health are associated with social inequalities, which in turn are caused by old age, gender inequality, income and education gaps, access to health care, social class, and other factors. In health care, these factors may result in some individuals receiving better and more professional care compared to others. This study also reviews the potential causes of these disparities and the means to bridge the gap in disease prevalence. Identifying and implementing effective strategies to eliminate inequities among minorities and marginalized groups in oral health status and dental care should be prioritized in populations globally.

Demystifying the connection between periodontal disease and chronic kidney disease - An umbrella review

Chronic kidney disease (CKD) and poor oral health are inter-related and their significant impact on each other is well established in the literature. Many systematic reviews and meta-analyses have demonstrated a strong relationship between CKD and periodontitis, where periodontal treatment has shown potential in improving CKD outcomes. However, the quality of the studies and heterogeneity of the results show variation. The aim of this umbrella review was to review the quality of the current systematic reviews on the relationship between CKD and oral health with an emphasis on periodontal disease and to generate clinically relevant guidelines to maintain periodontal health in patients with CKD. This umbrella review was conducted and reported in alignment with the Joanna Briggs Institute and the PRISMA 2020 guidelines. The review protocol was established prior to commencing the review and registered on JBI and PROSPERO (CRD42022335209). Search strings were established for PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Dentistry & Oral Science Source up to April 2022. All systematic reviews and meta-analyses that considered the relationship between CKD and periodontitis or periodontal treatment were included. Of 371 studies identified through the systematic search, 18 systematic reviews met the inclusion criteria. Ten studies assessed the relationship between oral health status and CKD with a focus on periodontitis and CKD, five reviewed the impact of periodontal treatment on CKD outcomes, two included both relationship and effectiveness of periodontal treatment and one qualitatively reviewed oral health-related quality of life in patients with kidney failure. Findings indicate there is a bidirectional relationship between CKD and periodontal disease. In view of the heterogeneity of the existing literature on CKD and periodontal disease, specific recommendations for the management of periodontitis among patients with CKD are proposed for medical professionals, dental professionals, and aged care workers based on the evidence collated in this review.

Effect of psoralen on the regulation of osteogenic differentiation induced by periodontal stem cell-derived exosomes

Periodontitis is a chronic inflammatory disease that is the main cause of tooth loss in adults, and the key to periodontitis treatment is the repair and regenerate of periodontal bone tissue. Psoralen is the main component of the Psoralea corylifolia Linn, which shows antibacterial, anti-inflammatoryand osteogenic activities. It promotes the differentiation of periodontal ligament stem cells toward osteogenesis. Exosomes secreted by stem cells play important roles in information transmission during the osteogenic differentiation process. The aim of this paper was to investigate the role of psoralen in regulating osteogenic miRNA information in periodontal stem cells and in periodontal stem cells exosomes and the specific mechanism of its action. Experimental results show that exosomes of human periodontal ligament stem cell origin treated with psoralen (hPDLSCs + Pso-Exos) were not significantly different from untreated exosomes (hPDLSC-Exos) in terms of size and morphology. Thirty-five differentially expressed miRNAs were found to be upregulated and 58 differentially expressed miRNAs were found to be downregulated in the hPDLSCs + Pso-Exos compared to the hPDLSC-Exos (P < 0.05). hsa-miR-125b-5p was associated with osteogenic differentiation. Among them, hsa-miR-125b-5p was associated with osteogenic differentiation. After hsa-miR-125b-5p was inhibited, the osteogenesis level of hPDLSCs was enhanced. In summary, the osteogenic differentiation of hPDLSCs was promoted by psoralen through the downregulation of hsa-miR-125b-5p gene expression in hPDLSCs, and the expression of the hsa-miR-125b-5p gene was also downregulated in exosomes. This finding provides a new therapeutic idea for using psoralen to promote periodontal tissue regeneration.

Minimally invasive non-surgical therapy (MINST) in stage III periodontitis patients: 6-month results of a split-mouth, randomised controlled clinical trial

OBJECTIVES

To determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects.

MATERIALS AND METHODS

In a split-mouth randomised controlled trial, 20 patients' dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model.

RESULTS

After 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group's deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP.

CONCLUSIONS

MINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects.

CLINICAL RELEVANCE

MINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT04036513) on June 29, 2019.

Is periodontal infection a risk factor for thromboembolic disease? A systematic review

Background

Venous thromboembolism (VTE) is a rising major health problem comprising pulmonary embolism (PE) and deep vein thrombosis. It is of concern due to premature mortality, increased morbidity, and associated healthcare costs and hospitalization. Periodontitis can increase the risk of VTE by way of systemic inflammation induced by infection that can contribute to hypercoagulability and platelet aggregation. This systematic review aims to synthesize all the evidence concerning periodontal infection as a risk factor for thromboembolic disease.

Materials and Methods

A search for articles published from 1967 till December 2020 was conducted in the PubMed (MEDLINE), Scopus, and EMBASE data bases.

Results

Five hundred and five articles were retrieved after running search strategies in PubMed, Scopus, and EMBASE search databases. Based on the inclusion criteria, three clinical studies, two case series, and ten case reports were included for qualitative analysis. The presence of periodontal disease was reported to influence the occurrence of venous thromboembolic disease with a statistical significance of <0.010. Case series and case reports of septic PE due to periodontal disease showed complete resolution of lung lesions and subsiding of symptoms after dental treatment and antimicrobial therapy.

Conclusions

The results of this systematic review suggested for an association between periodontal disease and the incidence of thromboembolic disease. As most of the included/available studies are case series and case reports, the strength of evidence is weak. Evidence generated from well-designed longitudinal controlled clinical trials may be helpful to further assess the strength of the association.

Developing Automated Computer Algorithms to Phenotype Periodontal Disease Diagnoses in Electronic Dental Records

OBJECTIVE

 Our objective was to phenotype periodontal disease (PD) diagnoses from three different sections (diagnosis codes, clinical notes, and periodontal charting) of the electronic dental records (EDR) by developing two automated computer algorithms.

METHODS

 We conducted a retrospective study using EDR data of patients (n = 27,138) who received care at Temple University Maurice H. Kornberg School of Dentistry from January 1, 2017 to August 31, 2021. We determined the completeness of patient demographics, periodontal charting, and PD diagnoses information in the EDR. Next, we developed two automated computer algorithms to automatically diagnose patients' PD statuses from clinical notes and periodontal charting data. Last, we phenotyped PD diagnoses using automated computer algorithms and reported the improved completeness of diagnosis.

RESULTS

 The completeness of PD diagnosis from the EDR was as follows: periodontal diagnosis codes 36% (n = 9,834), diagnoses in clinical notes 18% (n = 4,867), and charting information 80% (n = 21,710). After phenotyping, the completeness of PD diagnoses improved to 100%. Eleven percent of patients had healthy periodontium, 43% were with gingivitis, 3% with stage I, 36% with stage II, and 7% with stage III/IV periodontitis.

CONCLUSIONS

 We successfully developed, tested, and deployed two automated algorithms on big EDR datasets to improve the completeness of PD diagnoses. After phenotyping, EDR provided 100% completeness of PD diagnoses of 27,138 unique patients for research purposes. This approach is recommended for use in other large databases for the evaluation of their EDR data quality and for phenotyping PD diagnoses and other relevant variables.

Periodontal Therapy Using Bioactive Glasses: A Review

This paper reviews the use of bioactive glasses as materials for periodontal repair. Periodontal disease causes bone loss, resulting in tooth loosening and eventual tooth loss. However, it can be reversed using bioactive glass, typically the original 45S5 formulation (Bioglass®) at the defect site. This is done either by plcing bioactive glass granules or a bioactive glass putty at the defect. This stimulates bone repair and causes the defect to disappear. Another use of bioactive glass in periodontics is to repair so-called furcation defects, i.e., bone loss due to infection at the intersection of the roots in multi-rooted teeth. This treatment also gives good clinical outcomes. Finally, bioactive glass has been used to improve outcomes with metallic implants. This involves either placing bioactive glass granules into the defect prior to inserting the metal implant, or coating the implant with bioactive glass to improve the likelihood of osseointegration. This needs the glass to be formulated so that it does not crack or debond from the metal. This approach has been very successful, and bioactive glass coatings perform better than those made from hydroxyapatite.

Engaging patients to develop a customized digital health companion for periodontitis: Study protocol

Periodontitis is a chronic inflammatory disease resulting in the destruction of tooth-supporting tissues. It affects billions of people around the globe and substantiates an enormous economic burden to society. Digital tools such as mobile Health (mHealth) applications have the potential to increase patient engagement, knowledge about the disease, and adherence to treatment recommendations. Digital health companions represent a new kind of digital tool aiming to support patients throughout their course of periodontal care. This paper presents the study protocol of the Paro-ComPas project which aims to co-develop and evaluate a digital patient companion application (“app”) to empower patients along their journey with periodontitis. As a first step, a qualitative study design encompassing semi-structured interviews with patients and experts as well as focus group discussions (FGD) will be used. Patients in different stages of periodontal care will be recruited from dental practices across Germany and are invited to share their experiences and opinions about their care and potential areas for support. Experts from relevant areas (e.g., mHealth, behavior change psychology, oral health, and dental hygiene) will be interviewed to map a holistic view on the current delivery of care and best practices of mHealth development. After setting up a minimal viable product (MVP) based on a requirements analysis, FGDs with patients will take place to incorporate user feedback and finalize the development of the prototypic app. The prototypic app will then be evaluated in a randomized, multi-center clinical trial in comparison with the current standard of care. Finally, a comprehensive implementation roadmap will be developed together with all relevant stakeholders. This comprehensive approach will allow us to map the patient journey and develop a digital health companion tailored to the needs of patients with periodontitis using an already existing indication independent medical companion toolbox. Novel insights into patients’ knowledge and perception of periodontal disease as well as barriers in adherence to periodontal care pathways will be provided. This knowledge will be converted in a systematically tailored companion app to serve the needs and preferences of people to better address periodontitis. The results from the clinical trial will provide unique insights into the extent to which the patient companion app contributes to adherence to periodontal care. Although mHealth applications have become popular in recent years, only few apps focusing on promotion of oral health have been released so far. Our study presents a novel and comprehensive approach to both co-developing and evaluating a proof of concept for a digital health companion for patients with periodontitis.

Polymeric Nanotechnologies for the Treatment of Periodontitis: A Chronological Review

Periodontitis is a chronic infectious and inflammatory disease of periodontal tissues estimated to affect 70 - 80 % of all adults. At the same time, periodontium, the site of periodontal pathologies, is an extraordinarily complex plexus of soft and hard tissues, the regeneration of which using even the most advanced forms of tissue engineering continues to be a challenge. Nanotechnologies, meanwhile, have provided exquisite tools for producing biomaterials and pharmaceutical formulations capable of elevating the efficacies of standard pharmacotherapies and surgical approaches to whole new levels. A bibliographic analysis provided here demonstrates a continuously increasing research output of studies on the use of nanotechnologies in the management of periodontal disease, even when they are normalized to the total output of studies on periodontitis. The great majority of biomaterials used to tackle periodontitis, including those that pioneered this interesting field, have been polymeric. In this article, a chronological review of polymeric nanotechnologies for the treatment of periodontitis is provided, focusing on the major conceptual innovations since the late 1990s, when the first nanostructures for the treatment of periodontal diseases were fabricated. In the opening sections, the etiology and pathogenesis of periodontitis and the anatomical and histological characteristics of the periodontium are being described, along with the general clinical manifestations of the disease and the standard means of its therapy. The most prospective chemistries in the design of polymers for these applications are also elaborated. It is concluded that the amount of innovation in this field is on the rise, despite the fact that most studies are focused on the refinement of already established paradigms in tissue engineering rather than on the development of revolutionary new concepts.

Prevalence and risk indicators for severe periodontitis in Côte d'Ivoire

Background

The present study evaluated the prevalence of severe periodontitis (SP) and determined the possible relevant risk factors among patients referred to the Periodontology Department at the Dental Care Center of the Odontostomatology Training and Research Unit of Abidjan, in Côte d'Ivoire.

Methods

This retrospective observational study was based on 1087 patients data aged 18‒80 years, who were treated in the periodontology department from December 2008 to December 2018. Severe periodontitis (stages III or IV) was defined as interdental clinical attachment loss (CAL)>5 mm at two non-adjacent teeth. Two groups were considered: patients with severe periodontitis (test) or without severe periodontitis (control). Differences between the two groups were tested using the chi-squared test and ANOVA. Furthermore, logistic regression analysis was used to model the relationship between the severity of periodontitis and covariables as potential risk indicators.

Results

43.4% of patients had severe periodontitis with a mean CAL of 6.89 mm. SP was associated with age (P=0.004), socioeconomic status (P=0.005), smoking habits (P=0.000), brushing frequency (P=0.000), the number of mobile teeth (P<0.001), and the number of lost teeth (P<0.001). Logistic regression analysis showed that having at least five mobile teeth (OR= 4.11, 95% CI: 2.95‒5.73) and/or five missing teeth (OR=2.60, 95% CI: 1.85‒3.66) were independent risk indicators for severe periodontal disease.

Conclusion

This Ivorian sample presented a high prevalence of severe periodontal diseases. Therefore, proper public health measures would allow early detection, with targeted and effective treatment of the Ivorian population.

National survey of periodontal diseases in adolescents and young adults in Morocco

AIM

National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population.

MATERIALS AND METHODS

This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed.

RESULTS

Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco.

CONCLUSIONS

The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.

Periodontitis-Related Knowledge and Its Relationship with Oral Health Behavior among Adult Patients Seeking Professional Periodontal Care

Background: Periodontitis is a chronic inflammatory disease that not only damages the stomatognathic system, but may also adversely influence other systems and organs. Patients with low oral health literacy levels are more prone to gingivitis/periodontitis and have a more severe disease course. Methods: A written questionnaire was carried out to assess the knowledge of patients of the Outpatient Clinic of Department of Periodontal and Oral Mucosa Diseases, Medical University of Bialystok, Poland. The questions concerned knowledge regarding the causes of periodontal disease, its risk factors, and the connection between periodontal disease and general health status. To analyze the population, patients were divided according to gender, age and if they were first-time or regular outpatients. Results: Written questionnaires were completed by a total of 302 patients. In the studied population, we noted knowledge deficits, particularly related to weaker periodontal disease risk factors (stress, diabetes, osteoporosis, obesity) and the genetic factor, which is the determinant of periodontitis. The patients’ awareness of the role of plaque bacteria and the effect of smoking on the periodontium was at a relatively high level. The respondents were also aware of the impact of periodontal disease on general health as well as the role of oral hygiene in preventing the disease. At the same time, few of them (26%) used interdental brushes or an irrigator (8%). Conclusions: We demonstrated that patients have an insufficient level of knowledge related to risk factors as well as the prevention of periodontal disease. Awareness of the extent of oral health literacy among patients will help to identify key issues connected with health education interventions

Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review

Dental health is often neglected among the elderly because of the numerous comorbidities in this population, such as cardiovascular diseases. However, dental health influences general health and quality of life by impacting both the general health and the psychological state of the individual. The present review highlights the main dental comorbidities in the elderly population, their impact on the quality of life, the barriers towards access to dental care in the elderly and methods to improve their dental health. Information related to dental care and its importance must be provided both to older individuals and their caregivers in order to detect dental pathology and treat it adequately. Ensuring dental health involves the whole society of elders, caregivers, dental care providers, the public sector, health policymakers, and the private sector.

Periodontal and Peri-Implant Microbiome Dysbiosis Is Associated With Alterations in the Microbial Community Structure and Local Stability

Periodontitis and peri-implantitis are common biofilm-mediated infectious diseases affecting teeth and dental implants and have been considered to be initiated with microbial dysbiosis. To further understand the essence of oral microbiome dysbiosis in terms of bacterial interactions, community structure, and microbial stability, we analyzed 64 plaque samples from 34 participants with teeth or implants under different health conditions using metagenomic sequencing. After taxonomical annotation, we computed the inter-species correlations, analyzed the bacterial community structure, and calculated the microbial stability in supra- and subgingival plaques from hosts with different health conditions. The results showed that when inflammation arose, the subgingival communities became less connective and competitive with fewer hub species. In contrast, the supragingival communities tended to be more connective and competitive with an increased number of hub species. Besides, periodontitis and peri-implantitis were associated with significantly increased microbial stability in subgingival microbiome. These findings indicated that the periodontal and peri-implant dysbiosis is associated with aberrant alterations in the bacterial correlations, community structures, and local stability. The highly connected hub species, as well as the major contributing species of negative correlations, should also be given more concern in future studies.

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Interdental plaque reduction after use of different devices in patients with periodontitis and interdental recession: A randomized clinical trial

OBJECTIVES

To determine the efficacy of four different oral hygiene protocols involving adjunctive interdental devices in terms of plaque and bleeding scores in periodontitis-affected patients.

MATERIAL AND METHODS

This was a randomized clinical trial with a 5-week follow-up, including previously treated periodontitis-patients not undergoing any supportive care. Patients were randomly allocated to 4 groups: manual toothbrush (group TB); toothbrush plus dental floss (group TB/F); toothbrush plus interdental brushes (group TB/IDB); toothbrush plus rubber interdental picks (group TB/RIDB). Oral hygiene instructions (OHI) were provided at baseline (T-7) and at T0 (1-week) then bi-weekly (T14/T28). At T0 (supragingival professional cleaning was delivered. Plaque and bleeding indexes were taken at all time-points by a single calibrated examiner, blind to group allocation.

RESULTS

At T-7 patients were comparable for age, body mass index (BMI), and all clinical parameters, exceptions for the Interdental Angulated Bleeding Index. At T28, significant reductions of plaque and gingival inflammation were noted in all groups (p<0.001) and within the expected ranges. Intergroup comparisons identified that group TB/IDB and group TB/RIDB achieved lower levels of plaque and inflammation than group TB (p<0.05). Group TB/IDB and group TB/RIDB showed lower levels of plaque and lower inflammation as measured by angulated bleeding index than group TB/RIDB (p<0.05).

CONCLUSION

Interdental brushes and rubber interdental picks were more efficient than toothbrushing alone and toothbrushing and floss in reducing plaque and gingival inflammation measured in a periodontitis-affected population.

The relationship between inflammatory dietary pattern and incidence of periodontitis

The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food-based, reduced rank regression (RRR)-derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34 940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years and dietary data through validated semi-quantitative FFQ every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) with the lowest quintile was 0·99 (95 % CI 0·89, 1·10, P-value for trend = 0·97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile with the lowest was 1·39 (95 % CI 0·98, 1·96, P-value for trend = 0·03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated, EDIP was significantly associated with increased risk of periodontitis only among non-smokers who were obese. Hence, this association must be interpreted with caution.

Application of Selected Biomaterials and Stem Cells in the Regeneration of Hard Dental Tissue in Paediatric Dentistry-Based on the Current Literature

Currently, the development of the use of biomaterials and their application in medicine is causing rapid changes in the fields of regenerative dentistry. Each year, new research studies allow for the discovery of additional possibilities of dental tissue restoration. The structure and functions of teeth are complex. They consist of several diverse tissues that need to act together to ensure the tooth’s function and durability. The integrity of a tooth’s enamel, dentin, cementum, and pulp tissue allows for successful mastication. Biomaterials that are needed in dentistry must withstand excessive loading forces, be biocompatible with the hosts’ tissues, and stable in the oral cavity environment. Moreover, each tooth’s tissue, as well as aesthetic qualities in most cases, should closely resemble the natural dental tissues. This is why tissue regeneration in dentistry is such a challenge. This scientific research focuses on paediatric dentistry, its classification of caries, and the use of biomaterials in rebuilding hard dental tissues. There are several methods described in the study, including classical conservative methods such as caries infiltration or stainless-steel crowns. Several clinical cases are present, allowing a reader to better understand the described methods. Although the biomaterials mentioned in this work are artificial, there is currently ongoing research regarding clinical stem cell applications, which have a high potential for becoming one of the most common techniques of lost dental-tissue regeneration in the near future. The current state of stem cell development is mentioned, as well as the various methods of its possible application in dentistry.

Prevalence and severity of periodontitis among adults in Côte d'Ivoire according to the new EFP/AAP periodontal disease classification

Background

To describe the prevalence and severity of periodontitis in patients attending the Periodontics Service of the Cocody University Hospital at Abidjan.

Methods

This retrospective observational study reviewed records of patients aged 20-80 years who attended the Periodontics Service between January 2014 and December 2018. Periodontitis was diagnosed, according to the 2018 EFP/AAP new classification of Periodontal and Peri-Implant Diseases and Conditions. Chi-square test, 1-factor Anova test, and logistic regression were performed for analysis.

Results

A total number of 596 patients were included. The mean age was 44.94 ± 14.34 years and 59.20% of were males. 2 (0.40%) patients were classified as Stage I, 221 (37.08%) as Stage II, and 373 (62.58%) as Stage III/V; the extent of periodontitis was generalized in 39.77% of patients. PD ≥ 6 mm, missing teeth ≥ 5 and mobile teeth were present in 47.15%, 26.35% and 25.50% of the sample, respectively.Severity of periodontitis were associated with age (p < 0.001), socio-economic status (p=0.001), diabetes (p < 0.001), missing teeth (p < 0.001) and smoking (p=0.009). Age (OR= 1.59, 95% CI: 1.11-2.26) and missing teeth (OR= 2.31, 95% CI: 1.08-4.89) were identified as independent risks indicators.

Conclusion

The prevalence and severity of periodontitis were high. Risks indicators identified may allow early detection and management of groups at high risk in Côte d'Ivoire.

The relationship between COVID-19 and the dental damage stage determined by radiological examination

OBJECTIVE

COVID-19 causes severe complications particularly in respiratory system especially in the elderly and those with poor general health. General and oral health are closely related to the course of such viral diseases. This study aims to reveal the relationship between the Dental Damage Stage (DD Stg) and the severity of COVID-19 disease.

MATERIALS AND METHODS

The study included 137 patients (20-65 years) based on oral examination records and panoramic X-rays of 1516 COVID-19 patients diagnosed through real time PCR tests. DD Stg were determined according to data of Apical Periodontitis Grading Scale, Radiologic Alveolar Bone Loss and Pathophysiological Process of Dental Caries obtained from dental radiological images. DD Stg were determined according to the severity of dental pathology and compared in terms of age, gender, numbers of dental caries (NDC), dental implants (NDI), root canal treatment (NRCT), tooth fillings (NTF), missing teeth (NMT) and hospitalization due to COVID-19 (NHC), presence of chronic disease (CD), and symptom associated with COVID-19 (SAC) RESULTS: Patients in DD Stg 3 had significantly higher age and mortality. CD, NDC and NHC values were higher in DD Stg 2 and 3 than in DD Stg 0 and 1. NHCs were higher in DD Stg 3 than in DD Stg 2. NMTs were higher in DD Stg 3 than other stages. SACs were significantly lower in DD Stg 0 than in DD Stg 1, 2 and 3. NDC, NHC, SAC and CD were effective on DD staging; they were moderately positively related.

CONCLUSIONS

The relationship detected between DD stage and the severity and prognosis of viral disease such as COVID-19 was found to be remerkable for extensive studies.

COVID-19 and oral diseases: Assessing manifestations of a new pathogen in oral infections

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a recently identified virus responsible for life-threatening coronavirus disease 19 (COVID-19). The SARS-CoV-2 infected subjects can be asymptomatic or symptomatic; the later may present a wide spectrum of clinical manifestations. However, the impact of SARS-CoV-2 on oral diseases remain poorly studied. Detection of SARS-CoV-2 in saliva indicates existence of virus in the oral cavity. Recent studies demonstrating the expression of ACE-2, a SARS-CoV-2 entry receptor, in oral tissues further strengthens this observation. Cytokine storm in severe COVID-19 patients and copious secretion of pro-inflammatory cytokines (IL-6, IL-1β and TNF-α) in multiple symptomatic oral pathologies including periodontitis and periapical periodontitis suggests that inflammatory microenvironment is a hallmark of both COVID-19 and oral diseases. Hyperinflammation may provide conducive microenvironment for the growth of local oral pathogens or opportunistic microbes and exert detrimental impact on the oral tissue integrity. Multiple case reports have indicated uncharacterized oral lesions, symptomatic irreversible pulpitis, higher plaque index, necrotizing/desquamative gingivitis in COVID-19 patients suggesting that SARS-CoV-2 may worsen the manifestations of oral infections. However, the underlying factors and pathways remain elusive. Here we summarize current literature and suggest mechanisms for viral pathogenesis of oral dental pathology derived from oral microbiome and oral mucosa-dental tissue interactions. Longitudinal studies will reveal how the virus impairs disease progression and resolution post-therapy. Some relationships we suggest provide the basis for novel monitoring and treatment of oral viral disease in the era of SARS-CoV-2 pandemic, promoting evidence-based dentistry guidelines to diagnose virus-infected patients to improve oral health.

Characterization of the Subgingival Cultivable Microbiota in Patients with Different Stages of Periodontitis in Spain and Colombia. A Cross-Sectional Study

The objective was to characterize and compare the subgingival microbiota in patients diagnosed according to the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions 2018. For this cross-sectional study, Spanish and Colombian subjects (characterized as health/gingivitis, periodontitis in stages I-II or stages III-IV) were clinically assessed, and subgingival samples were taken and processed by culture. The comparisons among patients with periodontal status (and between countries) was made using Mann–Whitney, Kruskal–Wallis, ANOVA and chi-square tests. The final sample consisted of 167 subjects. Eikenella corrodens and Parvimonas micra were more frequently detected in health/gingivitis and Porphyromonas gingivalis in periodontitis (p < 0.05). Higher total counts were observed in Colombia (p = 0.036). In Spain, significantly higher levels of P. gingivalis and Campylobacter rectus were observed, and of Tannerella forsythia, P. micra, Prevotella intermedia, Fusobacterium nucleatum, Actinomyces odontolyticus and Capnocytophaga spp. in Colombia (p < 0.001). P. micra was more prevalent in health/gingivitis and stage I-II periodontitis in Colombia, and P. gingivalis in all periodontitis groups in Spain (p < 0.05). As conclusions, significant differences were detected in the microbiota between health/gingivitis and periodontitis, with minor differences between stages of periodontitis. Differences were also relevant between countries, with Colombia showing larger counts and variability of bacterial species.

Cross-sectional comparisons of subgingival microbiome and gingival fluid inflammatory cytokines in periodontally healthy vegetarians versus non-vegetarians

BACKGROUND

Vegetarian diets are known to reduce inflammation. The objective of this study was to test the hypothesis that reduced inflammation associated with a vegetarian diet would promote a more commensal subgingival bacterial profile.

METHODS

A total of 39 periodontally healthy subjects (PD ≤3 mm, bleeding on probing <10%) were enrolled. Dietary intake was assessed by a food frequency questionnaire. A comprehensive periodontal examination was performed. Gingival crevicular fluid (GCF) and subgingival plaque samples were collected. GCF samples were assessed for interleukin-1β, interleukin-6, interleukin-8, tumor necrosis factor-alpha, and interleukin-10. Plaque samples were analyzed for bacteria using 16S rDNA sequencing on an Illumina platform. GenBank database was used for taxonomy classification.

RESULTS

Twenty-three subjects were categorized as vegetarian and 16 non-vegetarians. Clinical periodontal measures and GCF cytokine levels were statistically comparable between the two groups. Measures of microbial richness and alpha diversity were also comparable between the two dietary groups. Vegetarians harbored higher levels of phyla associated with gingival health (Actinobacteria, and Proteobacteria). Two species known to be associated with periodontitis (Mogibacterium timidum and Veillonella rogosae) were prominent in non-vegetarians. Pearson's correlations between GCF inflammatory cytokines and microbial taxa differed between vegetarians and non-vegetarians. In vegetarians, the anti-inflammatory cytokine IL-10 positively correlated with two species known to be associated with periodontal health (Peptidiphaga sp. HMT183 and Rothia aeria).

CONCLUSIONS

Diet is directly and indirectly associated with the microbial composition of subgingival plaque. A vegetarian diet may promote a subgingival microbiota associated with periodontal health.

[Periodontitis-therapy of a widespread disease]

Parodontitis ist eine chronisch entzündliche nichtübertragbare Erkrankung, die alle Anteile des Zahnhalteapparates (Parodonts) betrifft und dort weitgehend irreversible Schäden verursacht. Schätzungen legen nahe, dass in Deutschland ca. 10 Mio. Menschen an einer schweren Parodontitis erkrankt sind. Parodontitis zeigt über viele Jahre zumeist wenige oder nur milde Symptome, die von den Patienten oft nicht wahrgenommen oder richtig eingeordnet werden. Fehlendes Bewusstsein kann dazu führen, dass zahnärztliche Behandlung erst in einem fortgeschrittenen Erkrankungsverlauf in Anspruch genommen wird, wenn umfangreiche Therapiemaßnahmen notwendig geworden sind und sich die Prognose für den Erhalt der Zähne verschlechtert hat. Der parodontale Screeningindex (PSI) ist ein einfaches und schnelles Instrument, mit dem die Notwendigkeit weiterführender diagnostischer Maßnahmen beurteilt werden kann. Der Index wird mittlerweile bei vielen Patienten durchgeführt. Trotzdem bleiben die Versorgungszahlen niedrig und hinter dem zurück, was für das Absenken der bestehenden Parodontitislast notwendig wäre. Jede Zahnarztpraxis muss in der Lage sein, Parodontitistherapie umzusetzen. Fachzahnärzte oder Spezialisten können die allgemeinzahnärztlichen Kollegen wesentlich bei der Behandlung von schweren Formen von Parodontitis unterstützen. Dazu ist eine Aufwertung des Faches in der universitären Ausbildung erforderlich, aber auch die zunehmende postgraduale Ausdifferenzierung von Spezialisten oder Fachzahnärzten für Parodontologie. Die neuen Behandlungsrichtlinien für die Parodontaltherapie (PAR-Therapie) erlauben die Versorgung der parodontal erkrankten Patienten auf Basis international anerkannter wissenschaftlicher Standards und verbessern damit die Rahmenbedingungen für die Parodontitistherapie in der zahnärztlichen Praxis.

Transcriptomic phases of periodontitis lesions using the nonhuman primate model

We used a nonhuman primate model of ligature-induced periodontitis to identify patterns of gingival transcriptomic after changes demarcating phases of periodontitis lesions (initiation, progression, resolution). A total of 18 adult Macaca mulatta (12-22 years) had ligatures placed (premolar, 1st molar teeth) in all 4 quadrants. Gingival tissue samples were obtained (baseline, 2 weeks, 1 and 3 months during periodontitis and at 5 months resolution). Gene expression was analyzed by microarray [Rhesus Gene 1.0 ST Array (Affymetrix)]. Compared to baseline, a large array of genes were significantly altered at initiation (n = 6049), early progression (n = 4893), and late progression (n = 5078) of disease, with the preponderance being up-regulated. Additionally, 1918 genes were altered in expression with disease resolution, skewed towards down-regulation. Assessment of the genes demonstrated specific profiles of epithelial, bone/connective tissue, apoptosis/autophagy, metabolism, regulatory, immune, and inflammatory responses that were related to health, stages of disease, and tissues with resolved lesions. Unique transcriptomic profiles occured during the kinetics of the periodontitis lesion exacerbation and remission. We delineated phase specific gene expression profiles of the disease lesion. Detection of these gene products in gingival crevicular fluid samples from human disease may contribute to a better understanding of the biological dynamics of the disease to improve patient management.

The Effect of Proximal Cleaning Devices on Periodontal Status in Korean Adults between 2016 and 2018

Removal of the biofilm from the proximal space is essential for preventing periodontal disease. This study aimed to prove the association between the use of proximal cleaning devices, such as dental floss and interdental brushes, and periodontal health among nationally representative Korean adults. Data collected from the 7th National Health Nutrition Survey (KNHANES VII: 2016-2018) were used for this purpose. A total of 11,359 participants aged 19 years or older who participated in KNHANES were reviewed. The response variable was the prevalence of high CPI (CPI of 3-4), and the explanatory variables were dental floss and interdental brush. A multivariable logistic regression analysis was performed to adjust for potential confounding factors and to analyze the association between periodontal disease and proximal cleaning devices. It was found that 63.1% of the participants did not use proximal cleaning devices at all, 17.5% used dental floss alone, 11.9% used an interdental brush, and 7.5% used both. Subjects who used both dental floss and interdental brush had a high CPI rate nearly half that of all the models for those who did not. In particular, for those using dental floss, the aOR of high CPI was 0.681 in Model 1, 0.714 in Model 2, and 0.737 in Model 3. Dental hygiene products for cleaning the proximal space, such as dental floss, are essential for removing the dental biofilm as a basic tool along with toothbrushes. Teaching and explaining the need to use these devices well are important for oral health care and maintenance.

Biological Aging and Periodontal Disease: Analysis of NHANES (2001-2002)

INTRODUCTION

Periodontitis is a chronic inflammatory disease caused by multiple potential contributing factors such as bacterial biofilm infection of the tissues surrounding the teeth and environmental determinants and a dysregulated host response for modifying and resolving the inflammation. Because periodontal disease is a major public health concern with substantial increases in the prevalence and severity in aging populations, previous studies of periodontitis tended to approach the disease as an age-associated outcome across the life span. However, few investigations have considered that, as a chronic noncommunicable disease, periodontitis may not simply be a disease that increases with age but may contribute to more rapid biologic aging.

OBJECTIVES

Increasing population data supports the potential disconnect between chronological aging and biologic aging, which would contribute to the heterogeneity of aging phenotypes within chronologic ages across populations. Thus, our aim was to test whether periodontal disease affects biological aging across the life span.

METHODS

The prevalence of periodontitis in the adult US population is a portion of the assessment of the National Health and Nutrition Examination Survey (NHANES), which has been ongoing since 1971 through 2-y cycles sampling populations across the country. We used NHANES 2001-2002 to test the hypothesis that the presence/severity of periodontal disease as an exposure variable would negatively affect telomere length, a measure of biological aging, and that this relationship is modified by factors that also affect the progression of periodontitis, such as sex, race/ethnicity, and smoking.

RESULTS

The data demonstrated a significant impact of periodontitis on decreasing telomere lengths across the life span. These differences were modulated by age, sex, race/ethnicity, and smoking within the population.

CONCLUSION

The findings lay the groundwork for future studies documenting broader effects on biological aging parameters as well as potential intervention strategies for periodontitis in driving unhealthy aging processes.

KNOWLEDGE TRANSFER STATEMENT

Periodontitis is a chronic inflammatory disease and dysregulated host response. Shortening of telomeres is a reflection of biologic aging. Decreased telomere lengths with periodontitis are seemingly related to chronic infection and persistent local and systemic inflammation. These findings suggest that periodontitis is not simply a disease of aging but may also transmit chronic systemic signals that could affect more rapid biological aging. Clinicians can use this outcome to recognize the role of periodontitis in driving unhealthy aging processes in patients.

The Association of Oral Health Status and socio-economic determinants with Oral Health-Related Quality of Life among the elderly: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to determine the relationship between poor Oral Health-Related Quality of Life (OHRQoL) and oral health determinants (eg being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, decayed, missing filled teeth (DMFT) scores and periodontal diseases) among the elderly.

METHODS

Formal search strategies in PubMed, Scopus, Cochrane and Web of Science were performed to identify studies in English published before 1 December 2019. We assessed the impacts of the oral health determinants including being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, DMFT scores and periodontal diseases) on OHRQoL among elderly individuals. The data were analysed using Stata 12.0 software.

RESULTS

In total, 19 publications met the inclusion criteria of this meta-analysis. Findings indicate a positive association between low educational level (ie ≤8th grade), marital status, depression, smoking status, denture wearing, poor general health, tooth-induced pain, periodontal diseases and poor OHRQoL among the elderly. We also observed a negative association between DMFT, being older than 75 years of age on poor OHRQoL among the elderly.

CONCLUSIONS

This review identified that several oral health determinants were associated with poor OHRQoL. The efficacy of preventive measures and the economic aspects of tooth replacement approaches should be explored in the future. Developing oral healthcare plans and policies with the specific aim of improving OHRQoL among this group is essential.

A Case-Control Study of Type 2 Diabetes Mellitus and Periodontitis in Saudi Arabian Adults

Objective

The relationship between type 2 diabetes mellitus (T2DM) and periodontitis is bidirectional and has been investigated. However, the evidence from the middle-eastern region is sparse. The current report assessed the association between uncontrolled T2DM and periodontal status from a sample of the Saudi Arabian adult population.

Methods

A case–control study was carried out. Cases were adults diagnosed with periodontitis (clinical attachment loss ≥1 mm) and controls were patients from the same dental setting with no gum conditions matched with age, sex, and location. Diabetes was recorded using HbA1c readings. The other health conditions including hypertension, epilepsy, bronchitis, thyroid disorders, and arthritis were obtained from medical records. Data on the use of tobacco and related products (smoking, khat/qat, sheesha, shammah) were gathered using a self-perceived questionnaire. Frequencies, percentages, p-values, crude and adjusted odds ratios (OR) with 95% confidence intervals were computed.

Results

Overall sample comprises 166 cases and 332 controls with a mean age of 37.5 years. Multivariable analysis indicated uncontrolled T2DM as an important predictor for periodontitis among Saudi Arabian adults, and they had nearly three times greater odds (OR: 2.779; 95% CI: 1.425–5.419; p=0.003) of being diagnosed with periodontitis in contrast to non-diabetics. Secondary findings revealed that cigarette ever-users were two times more likely to be suffering from periodontitis than never-users, and those brushing once per day or less had five times greater odds of developing periodontitis as compared to those brushing twice daily.

Conclusion

To conclude, the current evidence from Saudi Arabia is supportive of earlier studies and an awareness of this association is warranted among all healthcare providers and patients in the region for early detection of periodontitis.

The associations between major dietary patterns and risk of periodontitis

AIM

To prospectively investigate the associations between major dietary patterns and incidence of periodontitis.

METHODS

We included 34,940 men from the Health Professionals Follow-Up Study, free of periodontal disease and major illnesses at baseline. Detailed medical and dental history was collected through biennial mailed questionnaires, and dietary information was provided through quadrennial food frequency questionnaires. Using principal component analysis, we identified two major dietary patterns ("prudent" and "Western"). We used Cox proportional hazard models to examine the associations between the two dietary patterns and self-reported incidence of periodontitis over a 24-year follow-up period. We investigated each pattern separately.

RESULTS

There was no overall association between Western or prudent dietary patterns and periodontitis. Among obese, however, the Western dietary pattern was significantly associated with incident periodontitis. The hazard ratio for those in the highest quintile of Western diet versus those in the lowest (reference) was 1.83 (95% confidence interval: 1.21-2.76).

CONCLUSIONS

There was no overall association between Western or prudent dietary patterns and periodontitis; however, in subgroups analysis, the Western diet was significantly associated with higher periodontitis risk only among obese men, a finding that requires replication and biological explication.

<i>In Vitro</i> Characterization of Polyurethane-Carbon Nanotube Drug Eluting Composite Scaffold for Dental Tissue Engineering Application

Tooth loss due to periodontal disease, dental caries, trauma or a variety of genetic disorders causes an adverse inability in adult’s lives. It is proved that biodegradable composite scaffolds in dental tissue engineering could play crucial role. To inhibit bacterial colonization in dental structure noticeable research concerning the drug delivery approach has been administrated. Nanostructures retain and release drug molecules more efficiently and continuously than other microstructure. In the present research, composite electrospun nanofibers of polyurethane-Single-walled carbon nanotube (SWNT) by the different mass ratios of metronidazole benzoate were prepared. Physico-chemical characterization of scaffolds including Scanning electron microscopy (SEM), uniaxial tensile testing and Ultraviolet-Visible (UV-Vis) spectroscopy analysis was operated. Culture of dental pulp stem cells (DPSCs) to evaluate cells behavior was carried out. The role of nanofiber diameters and drug content on releasing profile of the scaffolds was investigated. The median diameter of the nanofibrous scaffold was reduced from 330 ± 4 to 120 ± 4 nm. Ultimate stress and Young modulus of the scaffolds by enhancement of drug content increased from 0.28 ± 0.05 up to the 1.8 ± 0.05 MPa and 0.87 ± 0.05 up to the 4.4 ± 0.05 Mpa respectively. According to the result, prolonged and continuous releasing profile of the drug molecules was achieved. As the content of the drug increased, the drug was released continuously. It means that two parameters of fiber's diameter and drug ratio affected the releasing behavior of composite structures. Polyurethane-SWNT scaffolds contained metronidazole benzoate presented appropriate support of DPSCs adhesion and proliferation and biomimetic architecture like the structure of dental ECM.

Frequency of Porphyromonas gingivalis and fimA genotypes in patients with periodontitis and systemic lupus erythematosus

OBJECTIVE

The objective of this study was to determine and compare the distribution of fimA genotypes of Porphyromonas gingivalis (P. gingivalis) in systemic lupus erythematosus (SLE) patients compared with control subjects.

MATERIAL AND METHODS

This observational cross-sectional study included 281 patients divided into two groups. Group 1 (G1) consisted of 162 control subjects (30-54 years old) and, group 2 (G2) included 119 subjects (10-69 years old) diagnosed with SLE. The presence of P. gingivalis was detected by PCR. DNA sequences in acquired plaque samples were identified using P. gingivalis specific sequences and further analyzed to differentiate their fimA genotypes using six sets of fimA genotype-specific primers.

RESULTS

The presence of periodontitis (PE) was similar in both groups; similar measurements were obtained regarding clinical attachment loss (CAL) (G1 1.76 ± 0.72 vs. G2 1.95 ± 0.76). G2 showed the highest frequency of P. gingivalis (94.95%). FimA genotype II is considered the most virulent and, was the most frequently found in the SLE group (53.09%).

CONCLUSION

The genotypes associated with PE are more frequently detected in SLE, which could make them susceptible to develop PE.

Differential immune cell infiltrations between healthy periodontal and chronic periodontitis tissues

Background

Host immunity plays an important role against oral microorganisms in periodontitis.

Methods

This study assessed the infiltrating immune cell subtypes in 133 healthy periodontal and 210 chronic periodontitis tissues from Gene Expression Omnibus (GEO) datasets using the CIBERSORT gene signature files.

Results

Plasma cells, naive B cells and neutrophils were all elevated in periodontitis tissues, when compared to those in healthy controls. In contrast, memory B cells, resting dendritic, mast cells and CD4 memory cells, as well as activated mast cells, M1 and M2 macrophages, and follicular helper T cells, were mainly present in healthy periodontal tissues. Furthermore, these periodontitis tissues generally contained a higher proportion of activated CD4 memory T cells, while the other subtypes of T cells, including resting CD4 memory T cells, CD8 T cells, follicular helper T cells (T_FH) and regulatory T cells (Tregs), were relatively lower in periodontitis tissues, when compared to healthy tissues. The ratio of dendritic and mast cells and macrophages was lower in periodontitis tissues, when compared to healthy tissues. In addition, there was a significant negative association of plasma cells with most of the other immune cells, such as plasma cells vs. memory B cells (γ = − 0.84), plasma cells vs. resting dendritic cells (γ = − 0.64), plasma cells vs. resting CD4 memory T cells (γ = 0.50), plasma cells versus activated dendritic cells (γ = − 0.46), plasma cells versus T_FH (γ = − 0.46), plasma cells versus macrophage M2 cells (γ = − 0.43), or plasma cells versus macrophage M1 cells (γ = − 0.40), between healthy control and periodontitis tissues.

Conclusion

Plasma cells, naive B cells and neutrophils were all elevated in periodontitis tissues. The infiltration of different immune cell subtypes in the periodontitis site could lead the host immunity against periodontitis.

Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study

BACKGROUND

Periodontitis is a chronic inflammation of periodontal tissues. The effect of periodontitis on the development of inflammatory bowel disease (IBD) remains unclear.

AIM

To assessed the risk of IBD among patients with periodontitis, and the risk factors for IBD related to periodontitis.

METHODS

A nationwide population-based cohort study was performed using claims data from the Korean National Healthcare Insurance Service. In total, 9950548 individuals aged ≥ 20 years who underwent national health screening in 2009 were included. Newly diagnosed IBD [Crohn’s disease (CD), ulcerative colitis (UC)] using the International Classification of Disease 10^th revision and rare intractable disease codes, was compared between the periodontitis and non-periodontitis groups until 2017.

RESULTS

A total of 1092825 individuals (11.0%) had periodontitis. Periodontitis was significantly associated with older age, male gender, higher body mass index, quitting smoking, not drinking alcohol, and regular exercise. The mean age was 51.4 ± 12.9 years in the periodontitis group and 46.6 ± 14.2 years in the non-periodontitis group (P < 0.01), respectively. The mean body mass index was 23.9 ± 3.1 and 23.7 ± 3.2 in the periodontitis and non-periodontitis groups, respectively (P < 0.01). Men were 604307 (55.3%) and 4844383 (54.7%) in the periodontitis and non-periodontitis groups, respectively. The mean follow-up duration was 7.26 years. Individuals with periodontitis had a significantly higher risk of UC than those without periodontitis [adjusted hazard ratio: 1.091; 95% confidence interval (CI): 1.008-1.182], but not CD (adjusted hazard ratio: 0.879; 95% confidence interval: 0.731-1.057). The risks for UC were significant in the subgroups of age ≥ 65 years, male gender, alcohol drinker, current smoker, and reduced physical activity. Current smokers aged ≥ 65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers aged ≥ 65 years without periodontitis.

CONCLUSION

Periodontitis was significantly associated with the risk of developing UC, but not CD, particularly in current smokers aged ≥ 65 years.

A public health approach for prevention of periodontal disease

Upwards of 1 in 10 adults worldwide may be affected by severe periodontitis, making the disease more prevalent than cardiovascular disease. Despite its global scope, its impact on pain, oral function, and the wellbeing of individuals, and the disproportionate burden of disease and the socioeconomic impact on communities, the perception that periodontal disease is a public health problem remains low. Although there have been substantial improvements in our understanding of the etiology of periodontal disease and how we can prevent and control it, these advances have been primarily focused on individual, patient-focused approaches. The prevention of periodontal disease depends on improving currently available individual interventions and on determining what public health interventions can be effective and sustainable under real-life conditions. Currently, public health approaches for periodontal disease prevention and control are lacking. This review traces the historical strategies for prevention of periodontal disease in an epidemiologic transition context, using a modified model developed for cardiovascular disease, and presents a possible public health approach. Improving periodontal disease prevention and control will need to take into consideration the core activities of a public health approach: assessment, policy development, and assurance.

Smoking reduces cathelicidin LL-37 and human neutrophil peptide 1-3 levels in the gingival crevicular fluid of patients with periodontitis

BACKGROUND

Antimicrobial peptides are components of innate immune response that have a key role on susceptibility and resistance of the oral cavity to diseases. This study aimed to investigate the influence of smoking on cathelicidin LL-37 and human neutrophil peptides 1 through 3 (HNP 1-3) levels in the gingival crevicular fluid (GCF) of patients with periodontitis. The relationship between levels of these peptides with the periodontal status and selected inflammatory mediators levels in smokers and non-smokers was also evaluated.

METHODS

Forty patients with periodontitis, 20 smokers and 20 non-smokers were recruited. After a full periodontal clinical assessment, GCF samples were collected from healthy (n = 5) and diseased (n = 5) sites of each patient. Peptides and inflammatory mediators in the GCF were quantitated by sandwich ELISAs and Multiplex assay, respectively.

RESULTS

Diseased sites had significantly (P <0.05) higher levels of LL-37 and lower levels of HNP 1-3 than healthy sites in both smokers and non-smokers. Diseased sites of smokers presented significantly lower levels of LL-37 and HNP 1-3 when compared with diseased sites of non-smokers. Concentration of LL-37 was directly correlated with the presence of proinflammatory mediators matrix metalloproteinase (MMP)-8 and interleukin (IL)-1β and inversely correlated with concentration of IL-10. HNP 1-3 concentration was positively correlated with IL-10 and negatively correlated with concentrations of MMP-8 and IL-1β.

CONCLUSIONS

Smoking was associated with reduced levels of LL-37 and HNP 1-3 in GCF of patients with periodontitis. LL-37 had a distinct expression pattern from HNP 1-3: LL-37 was upregulated in diseased sites, and HNP 1-3 was increased in periodontally healthy sites.1.

An Antibacterial Strategy of Mg-Cu Bone Grafting in Infection-Mediated Periodontics

Periodontal diseases are mainly the results of infections and inflammation of the gum and bone that surround and support the teeth. In this study, the alveolar bone destruction in periodontitis is hypothesized to be treated with novel Mg-Cu alloy grafts due to their antimicrobial and osteopromotive properties. In order to study this new strategy using Mg-Cu alloy grafts as a periodontal bone substitute, the in vitro degradation and antibacterial performance were examined. The pH variation and Mg²⁺ and Cu²⁺ release of Mg-Cu alloy extracts were measured. Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), two common bacteria associated with periodontal disease, were cultured in Mg-Cu alloy extracts, and bacterial survival rate was evaluated. The changes of bacterial biofilm and its structure were revealed by scanning electron microscopy (SEM) and transmission electronic microscopy (TEM), respectively. The results showed that the Mg-Cu alloy could significantly decrease the survival rates of both P. gingivalis and A. actinomycetemcomitans. Furthermore, the bacterial biofilms were completely destroyed in Mg-Cu alloy extracts, and the bacterial cell membranes were damaged, finally leading to bacterial apoptosis. These results indicate that the Mg-Cu alloy can effectively eliminate periodontal pathogens, and the use of Mg-Cu in periodontal bone grafts has a great potential to prevent infections after periodontal surgery.