Parameters of oxidative stress in saliva from patients with aggressive and chronic periodontitis

E-Cigarette effects on oral health: A molecular perspective

Electronic cigarettes (e-cigarettes) have emerged as a potential alternative to traditional smoking and may aid in tobacco harm reduction and smoking cessation. E-cigarette use has notably increased, especially among young non-tobacco users, raising concerns due to the unknown long-term health effects. The oral cavity is the first and one of the most crucial anatomical sites for the deposition of e-cigarette aerosols. E-cigarette aerosols contain nicotine, flavors, volatile organic compounds, heavy metals, carcinogens, and other hazardous substances. These aerosols impact the oral cavity, disrupting host-microbial interactions and triggering gingivitis and systemic diseases. Furthermore, oral inflammation and periodontitis can be caused by proinflammatory cytokines induced by e-cigarette aerosols. The toxic components of e-cigarette aerosols increase the cellular reactive oxygen species (ROS) levels, reduce antioxidant capacity, increase DNA damage, and disrupt repair processes, which may further contribute to harmful effects on oral epithelum, leading to inflammatory and pre-malignant oral epithelial lesions. In this review, we analyze the toxicological properties of compounds in e-cigarette aerosols, exploring their cytotoxic, genotoxic, and inflammatory effects on oral health and delving into the underlying molecular mechanisms. Further research is essential to understand the impact of e-cigarettes on oral health and make informed regulatory decisions based on reliable scientific evidence.

Analysis of protein interaction network in obesity linked with periodontitis

The clinical link between obesity and periodontitis by investigating the potential interaction among proteins is of interest. A protein-protein interaction (PPI) network analysis using STRING was conducted on novel proteins identified from saliva samples through quantitative proteomics and mass spectrometry. Twenty proteins were involved in molecular process, cellular components and biological functions focusing on proteins with variants closely associated with obesity and periodontitis. Analysis revealed that PPI network exhibited a high degree of interactions, indicating a biological connection with a significant p value 4.8*105. These PPIs discuss the interplay between obesity and periodontitis, require further experimental validation, unravel new clues for downstream studies and propose biological mechanisms through which these two conditions may interact.

Considerations for oral and dental tissues in holistic care during long-haul space flights

The health of astronauts during and after the return from long-haul space missions is paramount. There is plethora of research in the literature about the medical side of astronauts' health, however, the dental and oral health of the space crew seem to be overlooked with limited information in the literature about the effects of the space environment and microgravity on the oral and dental tissues. In this article, we shed some light on the latest available research related to space dentistry and provide some hypotheses that could guide the directions of future research and help maintain the oral health of space crews. We also promote for the importance of regenerative medicine and dentistry as well highlight the opportunities available in the expanding field of bioprinting/biomanufacturing through utilizing the effects of microgravity on stem cells culture techniques. Finally, we provide recommendations for adopting a multidisciplinary approach for oral healthcare during long-haul space flights.

Age-related bone diseases: Role of inflammaging

Bone aging is characterized by an imbalance in the physiological and pathological processes of osteogenesis, osteoclastogenesis, adipogenesis, and chondrogenesis, resulting in exacerbated bone loss and the development of age-related bone diseases, including osteoporosis, osteoarthritis, rheumatoid arthritis, and periodontitis. Inflammaging, a novel concept in the field of aging research, pertains to the persistent and gradual escalation of pro-inflammatory reactions during the aging process. This phenomenon is distinguished by its low intensity, systemic nature, absence of symptoms, and potential for management. The mechanisms by which inflammaging contribute to age-related chronic diseases, particularly in the context of age-related bone diseases, remain unclear. The precise manner in which systemic inflammation induces bone aging and consequently contributes to the development of age-related bone diseases has yet to be fully elucidated. This article primarily examines the mechanisms underlying inflammaging and its association with age-related bone diseases, to elucidate the potential mechanisms of inflammaging in age-related bone diseases and offer insights for developing preventive and therapeutic strategies for such conditions.

Validation of assays for measurement of oxidant compounds in saliva of pigs: Thiobarbituric acid reactive substances (TBARS), carbonyl, and reactive oxygen species (ROS)

Thiobarbituric acid reactive substances (TBARS), carbonyls and reactive oxygen species (ROS) are oxidant compounds that can provide useful information on the oxidative status. Pigs can be affected by oxidative stress in different situations including physiological conditions such as lactation and also in different diseases, and the measurement of these three analytes in saliva could be potentially useful as biomarkers of the redox status in this species. Assays for the measurement of TBARS and carbonyls by spectrophotometry and ROS by luminol-based chemiluminescence in pigs' saliva were analytically validated and were applied in saliva of pigs after an in vitro incubation with different doses of ascorbic acid (AA). All the assays showed a satisfactory analytical precision and accuracy. The 240 h-incubation of saliva samples with 60 mM of AA induced to an increased TBARS and carbonyls production. TBARS, carbonyls and ROS can be estimated in saliva of pigs by the assays validated in this report. In addition, these assays can detect changes in the concentration of these analytes associated to incubation of saliva samples with AA.

Infrared laser therapy decreases systemic oxidative stress and inflammation in hypercholesterolemic mice with periodontitis

BACKGROUND

Near-infrared irradiation photobiomodulation (NIR-PBM) has been successfully used in periodontal treatment as an adjuvant tool to locally improve cell function and regeneration. Although the relationship between periodontitis and systemic disease constitutes an important aspect of periodontal clinical research, the systemic effects of NIR-PBM in periodontitis are not well known. In this study, we aimed to investigate the effects of NIR-PBM on systemic oxidative stress and inflammation in an apolipoprotein E (ApoE) knockout mouse model of periodontal disease (PD).

METHODS

We evaluated alveolar bone loss by measuring the distance from the cementoenamel junction (CEJ) to the alveolar bone crest (ABC), reactive oxygen species (ROS) production in blood cells, inflammatory activity, plasma cholesterol levels, and lipid peroxidation levels in three experimental groups: (1) ApoEC, control group without intervention; (2) ApoEP, first molar ligation-induced periodontitis for 4 weeks; and (3) ApoEP + PBM, exposed to 808 nm continuous wave, ø ~ 3 mm2, 100 mW, 60 s of NIR-PBM for 7 consecutive days after 4 weeks of periodontitis. At the end of the experimental protocols, ApoEP mice presented significantly increased alveolar bone loss, ROS production, inflammatory activity, plasma cholesterol, and lipid peroxidation levels compared to the ApoEC group (P < 0.05). NIR-PBM for 7 days in the ApoEP + PBM mice significantly decreased systemic ROS production, inflammatory response, plasma cholesterol, and lipid peroxidation levels, similar to those found in the ApoEC group (P > 0.05). However, it was not capable of preventing alveolar bone loss (P > 0.05 compared to ApoEP mice).

CONCLUSION

A 7-day treatment with NIR-PBM effectively reduces systemic oxidative stress and inflammatory parameters in hypercholesterolemic mice with PD. However, more studies with longer evaluation times are needed to confirm the systemic effects of locally applied NIR-PBM on PD associated with hypercholesterolemia.

Biomarkers for diagnosis of stage III, grade C with molar incisor pattern periodontitis in children and young adults: a systematic review and meta-analysis

AIM

To explore the existing salivary, gingival crevicular fluid (GCF), blood, and serum biomarkers associated with grade C molar-incisor pattern (C/MIP) periodontitis in systemically healthy children and young adults.

MATERIALS AND METHODS

Cross-sectional, case-control, and cohort studies on stage III grade C periodontitis or former equivalent diagnosis with analysis of molecular biomarkers in saliva, GCF, blood, or serum were retrieved from six databases and screened based on the eligibility criteria. The risk of bias in included studies was evaluated. Meta-analysis was planned for biomarkers assessed using the same detection methods and sample type in at least two papers.

RESULTS

Out of 5621 studies identified at initial screening, 28 papers were included in the qualitative analysis of which 2 were eligible for meta-analysis for IgG in serum samples. Eighty-seven biomarkers were assessed with the majority being higher in cases than in controls. Only the meta-analysis of total serum IgG with low heterogeneity value revealed a significant increase in its levels in C/MIPs compared to controls (standardised mean difference: 1.08; 95% CI: 0.76, 1.40).

CONCLUSION

There is a paucity of data on biomarkers associated with molar-incisor pattern periodontitis. Although serum IgG levels are raised, other more specific biomarkers in saliva, GCF, and blood/serum may be promising but require further investigation.

Assessment of Oxidative Stress by the Estimation of Lipid Peroxidation Marker Malondialdehyde (MDA) in Patients with Chronic Periodontitis: A Systematic Review and Meta-Analysis

OBJECTIVE

The present systematic review and meta-analysis aimed to assess the oxidative stress-mediated lipid peroxidation end product malondialdehyde (MDA) in periodontitis using the available literature.

MATERIALS AND METHODS

An electronic literature search was performed for the published articles from 2000 to 2022 in PubMed (MeSH), Science Direct, Wiley Online library, and cross-reference using specific keywords.

RESULTS

The literature search identified 1,166 articles. After analyzing the abstracts of the obtained articles, the articles were excluded for the following reasons: duplicate studies (n = 395) and not relevant to the research question (n = 726). The remaining 45 articles were chosen for full-text evaluation. Finally, the present qualitative synthesis selected 34 articles that met the inclusion criteria for evaluation and removed the articles which did not meet the required criteria (n = 11). Out of these, 16 articles had coherent data for quantitative synthesis. The meta-analysis used the standardized mean differences method at a 95% confidence interval by random-effects model. The periodontitis group displayed significantly higher MDA levels (P < 0.001) in gingival crevicular fluid, saliva, and serum samples of the studies analyzed than the healthy control.

CONCLUSION

The analyzed studies showed significantly higher MDA levels in various biological samples of patients with periodontitis, supporting the role of elevated oxidative stress and consequent lipid peroxidation in periodontitis.

Membrane Fluidity and Oxidative Stress in Patients with Periodontitis

Periodontitis leads to the destruction of dental tissue through polymicrobial interactions, inflammation, and increased oxidative stress. The aim of this study was to measure the levels of nitrates (NO3−), malondialdehyde (MDA), and membranal fluidity (MF) in the gingival tissue of subjects with or without periodontitis. A total of 120 participants from the Dentistry School of the University of Guadalajara were investigated. The study was approved by the ethics committee of our institution, with the registration number of CI-01221. The clinical parameters measured were probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP). NO3− was measured using the Greiss reaction, while MDA was determined colorimetrically with the FR12 Kit (Oxford Biomedical Research). Membrane fluidity (MF) was measured using the quotient Ie/Im according to the method of Ortiz and collaborators. The Student t-test, Spearman correlation, and chi-square are used to calculate the results. The results showed higher levels of PD, CAL, and BoP in patients. There was a positive correlation between MF and PD. Moreover, MDA was positively correlated with PD and CAL. Increases in PD resulted in higher levels of NO3−, MDA, and MF. Similarly, increases in CAL resulted in higher levels of MDA and MF in patients. We conclude that PD and CAL facilitated the progression of periodontitis through increases in MDA and MF.

The Emerging Role of Salivary Oxidative Stress Biomarkers as Prognostic Markers of Periodontitis: New Insights for a Personalized Approach in Dentistry

Periodontitis is a multifactorial and infective oral disease that leads to the destruction of periodontal tissues and tooth loss. Although the treatment of periodontitis has improved recently, the effective treatment of periodontitis and the periodontitis-affected periodontal tissues is still a challenge. Therefore, exploring new therapeutic strategies for a personalized approach is urgent. For this reason, the aim of this study is to summarize recent advances and the potential of oxidative stress biomarkers in the early diagnosis and personalized therapeutic approaches in periodontitis. Recently, ROS metabolisms (ROMs) have been studied in the physiopathology of periodontitis. Different studies show that ROS plays a crucial role in periodontitis. In this regard, the reactive oxygen metabolites (ROMs) started to be searched for the measures of the oxidizing capacity of the plasma understood as the total content of oxygen free radicals (ROS). The oxidizing capacity of plasma is a significant indicator of the body's oxidant state as well as homocysteine (Hcy), sulfur amino acid, which has pro-oxidant effects as it favors the production of superoxide anion. More specifically, the thioredoxin (TRX) and peroxiredoxin (PRX) systems control reactive oxygen species (ROS), such as superoxide and hydroxyl species, to transduce redox signals and change the activities of antioxidant enzymes to remove free radicals. Superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx), among other antioxidant enzymes, change their activity when ROS are produced in order to neutralize free radicals. The TRX system is triggered and transduces redox signals to do this.

Determination of salivary cortisol and salivary pH level in gaming teenagers - A cross-sectional study

Introduction

Internet gaming disorder and cybervictimization has a disproportionate increase during the COVID 19 pandemic. Teenagers and adolescents have high risk for addiction to online gaming. Online gaming increases the stress level of the users affecting the general and the oral health. The study aims to determine the salivary cortisol and salivary pH among the gaming teenagers.

Materials and methods

The cross-sectional study recruited 45 gaming teenagers with the mean age of 15.5 years. The participants were stratified according to the type of online gaming played as mind, aggressive and betting gaming. Their salivary pH and salivary cortisol were assessed. The collected data was analyzed using SPSS version 23.

Results

The mean salivary pH was found to be less among females playing aggressive games (7.11 ± 0.30) and males playing mind games (7.24 ± 0.16). Salivary cortisol level was found to be statistically high in males (6.66 ± 1.33) and females (7.82 ± 0.66) playing aggressive games. The sub-group analysis of salivary pH and cortisol for gender showed a significant difference in the mean salivary cortisol level (p < 0.05) with no difference in the salivary pH (p > 0.05). Based on the number of hours spent in online gaming, there was a significant increase in the mean salivary cortisol level among the participants playing >3 h (p < 0.05).

Conclusion

Salivary cortisol is high among individuals playing aggressive games compared to mind and betting games. Also, salivary cortisol is high in females compared to males with no change in salivary pH.

Eriodictyol Suppresses Porphyromonas gingivalis-Induced Reactive Oxygen Species Production by Gingival Keratinocytes and the Inflammatory Response of Macrophages

Porphyromonas gingivalis is a key pathogen of periodontitis, an inflammatory disease that affects the tooth-supporting tissues. The aim of the present study was to investigate the effects of the flavanone eriodictyol on P. gingivalis-induced reactive oxygen species (ROS) production by gingival keratinocytes and the inflammatory response of macrophages. Porphyromonas gingivalis and H2O2 acted synergistically to induce ROS production by keratinocytes. The presence of eriodictyol significantly attenuated ROS production in a dose-dependent manner. We used a macrophage model to show that eriodictyol decreases the secretion of IL-1β, IL-6, IL-8, and TNF-α induced by P. gingivalis. Evidence has been brought that this anti-inflammatory property of eriodictyol may be related to its ability to prevent the activation of the NF-κB signaling pathway by P. gingivalis. This periodontal pathogen was also found to be a potent inducer of matrix metalloproteinase (MMP) production by macrophages, including MMP-2, MMP-8, and MMP-9. Eriodictyol dose-dependently inhibited the production of all three MMPs. Lastly, eriodictyol inhibited the catalytic activity of both MMP-9 and P. gingivalis collagenase. In conclusion, eriodictyol may be a potential therapeutic agent for preventing and/or treating periodontal disease due to its antioxidant, anti-inflammatory, and anti-proteinase properties.

Assessment of Levels of Plasma Oxidative Stress in Patient Having Aggressive Periodontitis before and after Full Mouth Disinfection

Aim:

The primary purpose of the study was to evaluate the levels of oxidative stress in plasma in patients with aggressive periodontitis (AgP) before and after full-mouth disinfection.

Materials and Methods:

Twenty-five healthy controls and 25 participants with aggressive periodontal were assessed for plaque index, probing pocket depth, papillary bleeding index, and clinical attachment level. Periodontal bone support was assessed by taking full mouth periapical radiographs. Full-mouth disinfection of the patient was done within 24 h of clinical assessment of AgP. These parameters were assessed at the baseline and after 8 weeks of initial periodontal therapy. Plasma samples were taken and evaluated for various oxidative stress markers.

Results:

Strong positive correlation was observed among periodontal parameters and levels of enzymatic/nonenzymatic biomarkers for oxidative stress (thiobarbituric acid-reactive substances [TBARS], glutathione peroxidase [GPX], and catalase [CAT]) (P < 0.05), before and after periodontal management. The patients with AgP had high levels of TBARS, GPX, and CAT levels in the plasma matched to the healthy individuals (P < 0.05).

Conclusion:

Enzymatic and nonenzymatic oxidative stress may have a role in the pathogenesis AP. Initial periodontal treatment can lead to the reduction of these stresses.

Salivary Redox Biomarkers in the Course of Caries and Periodontal Disease

Caries are a pathological process of extracorporeal nature, characterized by demineralization of inorganic substances as well as proteolysis triggered by acids produced by bacteria present in dental plaque, as a result of metabolism of sugars of both external and internal origin. Periodontal disease, on the other hand, is a multifactorial degenerative disease associated with inflammation, involving a group of tissues that surround the dental cervix and root of the tooth. It is believed that one of the mechanisms in the etiopathogenesis of caries and periodontitis are disorders of local and/or general oxidative stress (OS) parameters. Numerous clinical studies have confirmed the relationship between oxidative stress markers and oral diseases. In most analyzed studies, technical and biological variability was so high that none of the markers so far has proven suitable for routine clinical use. The aim of systematic reviews of the literature is to present the existing studies on OS parameters, mainly concerning the activity of antioxidant enzymes in saliva of patients with caries and periodontitis.

Total Oxidant and Antioxidant Capacity of Gingival Crevicular Fluid and Saliva in Patients with Periodontitis: Review and Clinical Study

Periodontitis is inextricably linked to oxidative-reductive (redox) imbalance. However, little is still known about the resultant ability to scavenge oxygen free radicals in saliva and gingival crevicular fluid in patients with periodontitis. The multitude of enzymatic and non-enzymatic antioxidants and their synergistic effects cause an interest in the evaluation of the total antioxidative capacity. Thus, our study aimed to evaluate the total oxidative and antioxidative activity of gingival crevicular fluid and saliva in the periodontitis, as well as to relate these biomarkers to clinical indices of periodontopathy. Additionally, by calculating the oxidative stress index (OSI), the intensity of redox disturbances was also evaluated. Fifty-eight periodontitis patients were included in the study and divided into two subgroups depending on the severity of the disease. In the non-stimulated/stimulated saliva as well as a gingival crevicular fluid of the study group, we found significantly higher OSI and total oxidant status (TOS) as well as lower total antioxidant capacity (TAC). However, the ability to reduce iron ions (FRAP) was significantly lower only in stimulated and non-stimulated saliva of patients with periodontitis. The examined parameters correlated with the periodontium’s clinical condition, which indicates the exacerbation of the inflammatory process. However, TAC, TOS, OSI, and FRAP did not differentiate individual stages of periodontitis.

DNA Laddering to Evaluate Cytogenetic Damage in Patients with Periodontitis

Background:

Inflammatory conditions show cytogenetic damage in peripheral blood leukocytes and this can be assessed using various tests. Cytogenetic damage as observed in the peripheral blood cells, is a marker of periodontal disease. DNA laddering is a sensitive assay which evaluates the cytogenetic damage. DNA laddering is a feature that can be observed when DNA fragments, resulting from apoptotic DNA fragmentation, are visualised after separation by gel electrophoresis which results in a characteristic “ladder” pattern.

Aim:

The aim of the present study is to investigate the cytogenetic damage in different forms of periodontitis in comparison with healthy controls.

Materials and Methods:

In this cross-sectional study, 15 systemically healthy subjects with moderate to severe chronic periodontitis (CGP), 15 systemically healthy subjects with generalised aggressive periodontitis(GAP) and 15 systemically healthy control subjects were recruited. Blood samples of the patients were drawn and evaluated for the cytogenetic damage by DNA laddering.

Results:

Apoptotic DNA fragmentation was observed as a “ladder” pattern at 180-200 BP intervals in both CGP and GAP groups indicating the DNA damage, in contrast with the healthy group where the ladder pattern was not observed suggesting of the healthy DNA.

Conclusion:

The results indicated that there are cytogenetic damages in both the chronic and aggressive periodontitis groups incontrast to the healthy controls.

The effects of cigarette smoking and exercise on total salivary antioxidant activity

Objectives

This study was conducted to determine the effects of both cigarette smoking and exercise on total salivary antioxidants and their impact on periodontal health status.

Material & methods

the study group consisted of 120 males, 20–25 years old selected from patients at the College of Dentistry/University of Baghdad. The sample was classified into four groups: cigarettes smokers who exercised, cigarettes smokers who did not exercise, non-smokers who exercised, and non-smokers who did not exercise. The smokers smoked 5–15 Oriental tobacco cigarettes daily for 3–5 years and did not use other types of tobacco. Physical exercises were performed for a half-hour to an hour daily either at home or the gym. Stimulated saliva was collected under standardised conditions and chemically analysed to determine the total salivary antioxidants concentration using a Total Antioxidant Capacity Assay Kit. The periodontal component of the Periodontal Disease Index (PDI) was applied to diagnose and record periodontal health status. Data were analysed using SPSS version 19.

Results

The total salivary antioxidant concentrations were significantly higher among the non-smokers than the smokers and were significantly higher among those who exercised compared to those who did not exercised (P < 0.01). The mean of the periodontal index was significantly higher in the group of smokers than the group of non-smokers and significantly higher among those who did not exercise compared to those who exercised (P < 0.01). Smoking and physical exercises recorded a significant effect on total salivary antioxidants and the mean of the periodontal index (p < 0.01), but there was no significant interaction between these two variables for total salivary antioxidants or the mean of the periodontal index (P > 0.05). Person's correlation coefficient indicated significant negative correlations between the mean of the periodontal index and the total salivary antioxidant concentrations among the four studied groups.

Conclusion

Cigarette smoking and physical exercise may alter total salivary antioxidants activity and the periodontal health status. However, there is no interaction between cigarette smoking and physical exercise regarding total salivary antioxidants and the periodontal health status. Total salivary antioxidants correlated inversely with the periodontal health status and this correlation was not affected by cigarette smoking or physical exercise.

Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies

OBJECTIVE

This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels.

DESIGN

The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst.

RESULTS

Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model.

CONCLUSION

Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.

Sources of free radicals and oxidative stress in the oral cavity

OBJECTIVE

An oral cavity is a place especially susceptible to oxidative damage. It is subjected to many environmental pro-oxidative factors or factors that have the ability to generate reactive oxygen species (ROS). The aim of this article is to present the main sources of ROS and oxidative stress in the oral environment.

DESIGN

A literature search was performed using the PubMed and Google Scholar databases.

RESULTS

One of the most important ROS sources in the oral cavity is periodontal inflammation. Other sources of ROS include: xenobiotics (ethanol, cigarette smoke, drugs), food (high-fat diet, high-protein diet, acrolein), dental treatment (ozone, ultrasound, non-thermal plasma, laser light, ultraviolet light), and dental materials (fluorides, dental composites, fixed orthodontic appliances, and titanium fixations). It has been shown that excessive production of ROS in the oral cavity may cause oxidative stress and oxidative damage to cellular DNA, lipids, and proteins, thus predisposing to many oral and systemic diseases.

CONCLUSIONS

Recognition of the exogenous sources of ROS and limitation of exposure to the ROS generating factors can be one of the prophylactic measures preventing oral and systemic diseases. It is suggested that antioxidant supplementation may be helpful in people exposed to excessive production of ROS in the oral cavity system.

[Effect of inflammaging on periodontitis]

Inflammaging is the chronic, systematic, and controllable upregulation of a pro-inflammation state with advancing age. Chronic low-grade inflammation accompanied by sustained stimuli is correlated with various age-related diseases (ARDs). Recent studies on ARDs have prompted further research interest in the inner mechanisms underlying inflammaging to establish prevention and treatment plans for inflammatory diseases. In this article, we discuss inflammaging and its significant role in periodontitis.

Oxidative Stress and Antioxidants in the Diagnosis and Therapy of Periodontitis

Oxidative stress has been implicated in the pathogenesis of numerous diseases. However, large interventional studies with antioxidants failed to show benefits in the prevention or treatment of cardiovascular diseases, cancer, or diabetes mellitus. Numerous clinical studies have confirmed the association of oxidative stress markers and periodontitis. Technical and biological variability is high for most of the analyzed markers and none of them seems to be optimal for routine clinical use. In a research setting, analysis of a palette of oxidative stress markers is needed to cover lipid peroxidation, protein oxidation, and the antioxidant status. The source of reactive oxygen species and their role in the pathogenesis of periodontitis remains unclear. Interventional experiments indicate that oxidative stress might be more than just a simple consequence of the inflammation. Small studies have confirmed that some antioxidants could have therapeutic value at least as an addition to the standard non-surgical treatment of periodontitis. A clear evidence for the efficiency of antioxidant treatment in large patient cohorts is lacking. Potentially, because lowering of oxidative stress markers might be a secondary effect of anti-inflammatory or antibacterial agents. As the field of research of oxidative stress in periodontitis gains attraction and the number of relevant published papers is increasing a systematic overview of the conducted observational and interventional studies is needed. This review summarizes the currently available literature linking oxidative stress and periodontitis and points toward the potential of adjuvant antioxidant treatment, especially in cases where standard treatment fails to improve the periodontal status.

Identification of a discriminative metabolomic fingerprint of potential clinical relevance in saliva of patients with periodontitis using 1H nuclear magnetic resonance (NMR) spectroscopy

Periodontitis is characterized by the loss of the supporting tissues of the teeth in an inflammatory-infectious context. The diagnosis relies on clinical and X-ray examination. Unfortunately, clinical signs of tissue destruction occur late in the disease progression. Therefore, it is mandatory to identify reliable biomarkers to facilitate a better and earlier management of this disease. To this end, saliva represents a promising fluid for identification of biomarkers as metabolomic fingerprints. The present study used high-resolution ¹H-nuclear magnetic resonance (NMR) spectroscopy coupled with multivariate statistical analysis to identify the metabolic signature of active periodontitis. The metabolome of stimulated saliva of 26 patients with generalized periodontitis (18 chronic and 8 aggressive) was compared to that of 25 healthy controls. Principal Components Analysis (PCA), performed with clinical variables, indicated that the patient population was homogeneous, demonstrating a strong correlation between the clinical and the radiological variables used to assess the loss of periodontal tissues and criteria of active disease. Orthogonal Projection to Latent Structure (OPLS) analysis showed that patients with periodontitis can be discriminated from controls on the basis of metabolite concentrations in saliva with satisfactory explained variance (R2X = 0.81 and R2Y = 0.61) and predictability (Q2Y = 0.49, CV-AUROC = 0.94). Interestingly, this discrimination was irrespective of the type of generalized periodontitis, i.e. chronic or aggressive. Among the main discriminating metabolites were short chain fatty acids as butyrate, observed in higher concentrations, and lactate, γ-amino-butyrate, methanol, and threonine observed in lower concentrations in periodontitis. The association of lactate, GABA, and butyrate to generate an aggregated variable reached the best positive predictive value for diagnosis of periodontitis. In conclusion, this pilot study showed that 1H-NMR spectroscopy analysis of saliva could differentiate patients with periodontitis from controls. Therefore, this simple, robust, non-invasive method, may offer a significant help for early diagnosis and follow-up of periodontitis.