Periodontal inflamed surface area: quantifying inflammatory burden

The impact of periodontitis and periodontal treatment on rheumatoid arthritis outcomes: an exploratory clinical trial

OBJECTIVE

Studies suggest RA patients could benefit from periodontal treatment. However, published data are inconsistent, and there is a need for better-controlled research. Our study aims to address these limitations.

METHODS

In this exploratory randomized delayed-start study, 22 RA patients with moderate/severe periodontitis were subjected to full-mouth debridement. Periodontal and rheumatological assessments, including measuring anti-cyclic citrullinated peptide 2 (CCP2) IgG levels, were performed at baseline (V1), 2 months (V2) and 6 months (V3) after steps 1 and 2 of periodontal therapy. Primary outcome was changes in DAS for 28 joints (DAS28) between V2 and V1. Secondary outcomes were changes in other rheumatological or periodontal clinical parameters (V2 or V3-V1).

RESULTS

RA disease activity was significantly higher in RA patients with severe periodontitis compared with moderate periodontitis at baseline, with significant positive correlations between several rheumatological and periodontal parameters. After periodontal treatment, RA patients with severe, but not moderate, periodontitis demonstrated significant improvements in DAS28 (ΔV2-V1, P = 0.042; ΔV3-V1, P = 0.001) and significant reduction in anti-CCP2 IgG levels at V3 (P = 0.032).

CONCLUSION

Periodontal treatment is locally effective in patients with RA and impacts RA disease activity and anti-CCP2 antibody levels in patients with severe periodontitis. Hence, our data suggest that periodontal assessment and treatment should be integrated in the management of RA patients within a treat-to-target strategy.

TRIAL REGISTRATION

isrctn.com, http://www.isrctn.com, ISRCTN 17950307.

Atrial Translocation of Porphyromonas gingivalis Exacerbates Atrial Fibrosis and Atrial Fibrillation

BACKGROUND

Recent studies have indicated an association between periodontitis and atrial fibrillation (AF), although the underlying mechanisms remain unclear. Porphyromonas gingivalis is a causative agent of periodontal disease and is highly pathogenic. This study focused on P gingivalis and aimed to investigate the relationship among periodontitis, atrial translocation of P gingivalis, and atrial fibrosis and AF.

METHODS

An experiment was conducted using P gingivalis-infected C57BL/6J mice, in which P gingivalis was inoculated into the pulp of the molars. Immunohistochemistry was used to visualize the localization of P gingivalis, and loop-mediated isothermal amplification was employed to detect P gingivalis DNA in the left atrium. AF inducibility was examined by intracardiac stimulation. Moreover, left atrial appendage specimens were obtained from 68 patients with AF. A periodontal examination was conducted before the surgery, and the periodontal epithelial surface area and periodontal inflamed surface area, which are quantitative indices used to determine the clinical severity of periodontitis, were measured. The bacterial number of P gingivalis in human atrial tissue was analyzed via quantitative polymerase chain reaction. Atrial fibrosis was assessed using Azan-Mallory staining.

RESULTS

The translocation path of P gingivalis from the dental granuloma to the left atrium via the circulatory system was demonstrated by immunohistochemistry and loop-mediated isothermal amplification in P gingivalis-infected mice, which showed a higher degree of atrial fibrosis (21.9% versus 16.3%; P=0.0003) and a higher AF inducibility (30.0% versus 5.0%; P=0.04) than the control mice. Upregulation of GAL3 (galectin 3) and transforming growth factor-beta 1 in the left atrium was observed in P gingivalis-infected mice. Moreover, immunohistochemistry revealed that P gingivalis was also present in human atrial tissue. The number of P gingivalis in the human atrial tissue was positively correlated with periodontal epithelial surface area (ρ=0.35; P=0.004), periodontal inflamed surface area (ρ=0.52, P<0.0001), and the degree of atrial fibrosis (ρ=0.38; P=0.002).

CONCLUSIONS

P gingivalis translocation to the left atrium correlates with the clinical severity of periodontitis, which may exacerbate atrial fibrosis and AF. Atrial translocation of P gingivalis is a potential pathway explaining the causal relationship between periodontitis and AF.

Efficacy of Oral Intake of Hydrogen-Rich Jelly Intake on Gingival Inflammation: A Double-Blind, Placebo-Controlled and Exploratory Randomized Clinical Trial

Background/Objectives: Initiation and progression of periodontal disease include oxidative stress. Systemic application of antioxidants may provide clinical benefits against periodontal disease including gingivitis. Recently, a jelly containing a high concentration of hydrogen (40 ppm) was developed. We hypothesized that oral intake of this hydrogen-rich jelly may be safe and effective on gingivitis. This clinical trial was designed to investigate the safety and efficacy of oral intake of hydrogen-rich jelly against gingival inflammation. Methods: Participants with gingivitis were instructed to orally ingest 30 g of hydrogen-rich jelly (experimental group) or placebo jelly (control group) three times a day for 14 consecutive days. The primary outcome of this trial was the percentage of bleeding on probing (BOP) sites. Secondary outcomes were oral parameters, serum reactive oxygen metabolites, antioxidant capacity, oxidative index, concentrations of cytokine (interleukin [IL]-1β, IL-6, IL-10, IL-17, and tumor necrosis factor-alpha) in gingival crevicular fluid, and adverse events. For all parameters, Mann-Whitney U test was used for comparison between experimental and control groups. Analysis of covariance, controlling for baseline periodontal inflamed surface area, was performed to evaluate the association between the effect of the hydrogen-rich jelly and gingival inflammation. Results: In the experiment and control groups, the percentage of sites with BOP and PISA significantly decreased at the end of the experiment compared to the baseline. However, no significant differences were found between groups (p > 0.05). Conclusions: Administration of hydrogen-rich jelly for 14 days decreased gingival inflammation. However, no significant differences were identified compared to the control group.

Treatment of periodontitis ameliorates the severity and extent of psoriasis-A randomized clinical trial

AIM

To assess the impact of non-surgical periodontitis treatment over conventional dermatological treatment on the severity and extent of psoriasis in patients affected by comorbid psoriasis and periodontitis.

METHODS

Seventy-four patients affected by both psoriasis and Stages I-IV periodontitis were randomized to receive either Steps 1-2 (non-surgical) of periodontal therapy (test group; n = 37) or no treatment (control group; n = 37). The two groups were balanced in terms of psoriasis medications, with the majority of the included patients undergoing biologics (74.0%) as monotherapy, while minor proportions were under systemic medications (13.7%) or none/topical/phototherapy (12.3%). The psoriasis area severity index (PASI) was regarded as the primary outcome. The Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI) were additionally considered as dermatological outcomes. Probing pocket depth, recession depth, clinical attachment level, periodontal inflamed surface area, and full-mouth plaque and bleeding scores were also measured. [Correction added on July 5, 2024, after first online publication: The preceding sentence has been revised].

RESULTS

Periodontal therapy in the test group led to statistically significant lower PASI scores at 10 weeks (mean = 3.15; standard deviation [SD] = 3.78) compared to the control group (mean = 7.11; SD = 6.09) (mean difference [MD] = -4.0; 95% confidence interval [CI]: -6.3, -1.6; p = .001). The test group also showed improvements in BSA (MD = -4.3) and periodontal parameters compared to the control group. DLQI only showed a non-statistically significant tendency (MD = -2.0).

CONCLUSION

Steps 1-2 of periodontal therapy showed an additional effect over conventional dermatological treatment in reducing the severity and extent of psoriasis (Clinicaltrials.gov: NCT05311501).

Full-Mouth Disinfection Using Oral Sitafloxacin for Stage III and IV Grade C Periodontitis With High Bacterial Load: A Case Series

This case series presents a novel treatment approach for severe periodontitis with high bacterial loads in four patients (aged 32-47 years), including three cases of stage III and one case of stage IV, grade C periodontitis. After conventional scaling and root planing failed in one case, we developed a protocol combining full-mouth disinfection (FMD) with oral sitafloxacin (STFX) for cases with high levels of subgingival periodontal pathogens. FMD involved thorough debridement within 1 week, with STFX (100 mg/day) administered for 7 days. Clinical and microbiological parameters were evaluated before and after treatment. The results showed marked improvements in probing pocket depth, bleeding on probing, and inflamed periodontal surface area, with substantial reductions in red complex bacteria. This approach often eliminates the need for periodontal surgery, even in deep pockets, suggesting FMD with STFX as an effective nonsurgical alternative for severe periodontitis with significant bacterial load.

Galectin-3 as a possible link between periodontitis and chronic kidney disease: a cross-sectional study

BACKGROUND

Chronic periodontitis is associated with various systemic inflammatory diseases; however, research on its association with chronic kidney disease (CKD) is relatively limited. Because both conditions share common risk factors, systemic inflammation plays a key role in the progression of these diseases. Galectin-3 (Gal-3) is a proinflammatory cytokine that plays an important role in chronic inflammatory diseases and is a potential biomarker. This study aimed to measure salivary Gal-3 levels in patients with periodontitis and CKD to better understand their association and evaluate Gal-3 as a diagnostic biomarker for these conditions.

METHODS

Seventy-five patients were categorized into three groups: Group I, patients with CKD and periodontitis (n=25); Group II, patients with chronic periodontitis who were systemically healthy (n=25); and Group III, patients with CKD without chronic periodontitis (n=25). Demographic characteristics and periodontal and renal parameters were recorded for each patient. Saliva samples were collected to evaluate Gal-3 levels using an enzyme-linked immunosorbent assay.

RESULTS

Patients with chronic periodontitis and CKD and those with chronic periodontitis alone (Groups I and II, respectively) showed significantly higher salivary Gal-3 levels than patients with CKD alone (Group III) (p<0.001). Bivariate correlation analysis indicated a strong relationship between clinical parameters and Gal-3 levels across all three groups.

CONCLUSION

Salivary Gal-3 level is a valuable early diagnostic marker of chronic periodontitis and CKD.

Effects of initial periodontal therapy on leucine-rich alpha-2 glycoprotein levels in saliva from Japanese patients with chronic periodontitis

PURPOSE

Examination of patients to detect periodontal disease is important for diagnosis and treatment planning, and accuracy of examination may be improved if salivary components can be applied for diagnosis. Leucine-rich α2 glycoprotein (LRG) is expressed in the serum of patients with inflammatory diseases, and salivary LRG may be applicable to the diagnosis of periodontal disease.

METHODS

To evaluate the effect of initial periodontal therapy (IPT) on clinical periodontal parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), periodontal inflamed surface area (PISA), periodontal epithelial surface area (PESA), saliva samples were collected before and after IPT from 63 patients with chronic periodontitis. The amount of LRG protein in saliva was measured by enzyme-linked immunosorbent assay.

RESULTS

Salivary LRG levels of 30 patients with Stage III, Grade B or C periodontitis (Severe group) were higher than the LRG levels of 33 patients with Stage Ⅰ or Ⅱ, Grade A periodontitis (Mild group). LRG levels in the Severe group significantly decreased after IPT. Positive correlations were found between salivary LRG levels and mean PD, CAL, BOP rate, PISA and PESA.

CONCLUSION

These results suggest that there is an association between salivary LRG levels and severity of periodontitis.

Exploring the Changes in Mild Cognitive Impairment Blood-Based Biomarkers after Local Antibiotic Periodontal Treatment in Diabetic Patients: Secondary Analysis of Data from a Randomized Controlled Trial

OBJECTIVES

 This article investigates the changes in blood-based biomarkers associated with mild cognitive impairment (MCI) risk in type 2 diabetic patients following local antibiotic periodontal treatment.

MATERIALS AND METHODS

 A secondary analysis of data from a 24-week randomized controlled trial was conducted, involving 27 patients with type 2 diabetes mellitus and periodontitis. Participants received periodontal treatment biweekly from baseline until the 6th week of the study. Sixteen patients were assigned to an intervention group and received local antibiotic periodontal treatment (Periofol 2%). The outcomes were periodontal inflammation score, which was measured using periodontal inflamed surface area, the inflammation markers levels (tumor necrosis factor-α, C-reactive protein, and interleukin [IL]-6), and MCI risk score, which was assessed using protein plasma analysis through blood test. The evaluations were performed at baseline and week 24th in both groups. The changes in periodontal inflammation scores, inflammation parameters, and MCI risk in baseline and week 24th were analyzed.

STATISTICAL ANALYSIS

 The Wilcoxon signed-rank test was used for within-group analysis and the Mann-Whitney U test was utilized for between-group analysis.

RESULTS

 Periodontal parameters were improved in both groups (p < 0.05). IL-6, complement C3, and alpha-2-antiplasmin levels were significantly decreased in the intervention group (p < 0.05). In between-group comparisons, there was a significant difference between the control and intervention groups in apolipoprotein A1, apolipoprotein C1, and alpha-1-B glycoprotein levels in week 24th (p < 0.05).

CONCLUSION

 Even though the periodontal status showed significant improvement after being given local antibiotic periodontal treatment, the changes in MCI risk proteins plasma remained unclear.

The Association Between Periodontal Inflamed Surface Area (PISA), Inflammatory Biomarkers, and Mitochondrial DNA Copy Number

Background/Objectives: Periodontitis is an inflammatory disease induced by bacteria in dental plaque that can activate the host's immune-inflammatory response and invade the bloodstream. We hypothesized that a higher periodontal inflamed surface area (PISA) is associated with higher levels of inflammatory biomarkers, lower levels of antioxidants, and mitochondrial DNA copy number (mtDNAcn). Methods: Using periodontal parameters, we calculated the PISA score, measured the levels of inflammatory biomarkers and antioxidants in the serum, and took buccal swabs for mtDNA and nuclear DNA (nDNA) extraction. Results: Higher PISA was associated with higher CRP levels, higher leukocyte, neutrophil, and erythrocyte counts, and lower magnesium-to-calcium ratio, but not with mtDNAcn. A higher number of deep pockets was associated with higher leukocytes and neutrophil counts and higher uric acid levels. Conclusions: The PISA score might be an appropriate parameter to assess the inflammatory burden of periodontitis, but not to assess mitochondrial dysfunction after mtDNA isolation from buccal swabs.

Periodontal disease and serum uric acid levels in the absence of metabolic syndrome: is there a link? A study on a sample of Cameroonian adults

BACKGROUND

The relationship between serum uric acid level (SUA) and periodontal diseases (PD) is still controversial, and few studies have been carried out in population with no element of metabolic syndrome especially in sub-Saharan Africa. The aim of this study was to assess the relationship between PD and SUA in Cameroonian adults not suffering from metabolic syndrome.

METHODS

We carried out a cross-sectional study including Cameroonians aged over 18 years recruited in the general population and free of metabolic syndrome elements. They were assessed for frequency of consumption of purine-rich foods, periodontal indices (plaque index, gingival index, calculus index, pocket depth and clinical loss of attachment), and SUA. The diagnosis of PD was based on the American Academy of Periodontology criteria revised in 2015, and hyperuricemia was defined for values exceeding 70 and 60mg/L in men and women respectively. Comparison of SUA means was performed with the ANOVA test. Association between hyperuricemia and PD were evaluated using Fischer's exact test. The threshold of significance was 0.05.

RESULTS

One hundred and seventy-four participants were included (57.5% women, mean age 29 (10.39) years). The frequencies of PD were 75.9%, gingivitis (59.1%) and periodontitis (40.1%). Hyperuricemia was found in 20.45% of people with PD, with no difference in frequency comparing with those without PD. The frequency of consumption of purine-rich foods was similar in individuals with and without PD. Serum uric acid levels were not different in individuals with and without PD, and differed among periodontal indices only for calculus index, where SUA were higher in participants with the highest score (p=0.026). We found no association between hyperuricemia and PD.

CONCLUSION

In individuals without elements of metabolic syndrome, hyperuricemia affects one in five people with PD. There appears to be no link between SUA and overall periodontal status in this population. Further studies are needed to better understand the salivary interaction between uric acid and periodontium in our population.

Effect of Daily Vitamin C Supplementation with or Without Flavonoids on Periodontal, Microbial, and Systemic Conditions Before and After Periodontal Therapy: A Case Series from an RCT

Purpose: To investigate the effect of vitamin C supplementation with or without flavonoids on periodontal conditions, and microbial and systemic variables before and after non-surgical periodontal treatment (NSPT). Materials and Methods: A case series derived from a randomized controlled trial was conducted to explore the effects of daily vitamin C supplementation, with or without flavonoids, on periodontal conditions. The study population was recruited from patients with periodontitis who had been referred to the Department of Periodontology at the Academic Centre for Dentistry Amsterdam (ACTA). The study consisted of a 2-month observation of untreated periodontitis followed by a 3-month period after NSPT. Descriptive statistics, correlation and clustering analyses, and dimensionality reduction methods were used to evaluate the interventions' impact. Results: Due to COVID-19, the study was prematurely terminated and reported findings from 13 patients. Results indicate a correlation between higher plasma vitamin C levels and reduced gingival inflammation, suggesting benefits for untreated periodontal conditions. Clustering analysis showed no differences based on supplementation type, indicating it did not affect outcomes, and microbiological data had limited effects. Principal Component Analysis visualized clusters and illustrated no distinct groups corresponding to supplementation types. Violin plots highlighted variability, with one cluster comprising individuals with more severe periodontal conditions. Conclusions: Higher plasma vitamin C levels were associated with lower gingival inflammation. However, daily vitamin C supplementation, with or without flavonoids, did not show additional benefits on periodontal conditions before or after treatment. Clustering suggests that periodontal severity, rather than supplementation, influenced patient profiles. The study's small sample size limits the generalizability of the findings.

The Prevalence of Comorbidities in Individuals with Periodontitis in a Private Periodontal Referral Practice

Objectives: Periodontitis (PD) patients frequently suffer from comorbidities, necessitating increased attention to disease management and monitoring. The aim of this study is to describe the prevalence and patterns of comorbidities among patients with PD in a private periodontal referral practice. Methods: This study involved 3171 adults with PD. Data on demographics, lifestyle, number of teeth, pockets of size ≥ 6 mm, bleeding on probing, periodontal inflammatory surface area, and comorbidities were extracted from electronic patient records. Descriptive and statistical analyses, including t-tests, chi-square tests, cluster analysis, binomial logistic regression analysis, and hypergraph network analysis, were performed. Results: Among this PD population, 47% had a comorbidity, and 20% had multimorbidity (≥2 diseases). Based on the disease patterns, two distinct clusters emerged: Cluster 1 was dominated by respiratory tract conditions (asthma, lung disease, and allergic rhinitis), allergies, and hypothyroidism, while Cluster 2 primarily included cardiometabolic diseases (angina pectoris, hypertension, diabetes mellitus (DM), and hyperthyroidism). The hypergraph network analysis for those with multimorbidity identified two main groups: (i) pulmonary conditions (lung disease, asthma, allergic rhinitis, and allergies) and (ii) cardiometabolic disorders (hypertension, myocardial infarction, cerebrovascular disease, and DM). Hypertension, allergies, and allergic rhinitis showed high centrality, serving as central nodes frequently co-occurring with other diseases. Conclusions: Nearly half of the PD patients in a private periodontal referral practice were found to have comorbidities, primarily clustering into cardiometabolic and respiratory tract diseases. These findings, based on real-world data, should encourage dental professionals to integrate systemic conditions into their care strategies. They could also guide policymakers and practitioners in developing evidence-based approaches to mitigate the reciprocal negative effects of PD and comorbidities.

Association of Periodontal Condition With Impaired Glucose Tolerance: Results of a 15-Year Follow-Up Study

OBJECTIVES

The aim of this study was to investigate whether periodontal condition is associated with the development of impaired glucose tolerance (IGT).

MATERIAL AND METHODS

This study was based on a subpopulation of a cohort of persons born in 1935 and living in Oulu, Finland, on October 1, 1990. The participants were normoglycemic (no previously diagnosed diabetes mellitus and a 2-h oral glucose tolerance test [OGTT] blood glucose < 7.8 mmol/L) in the baseline examinations (1990-1992) and had fasting blood glucose < 7.0 mmol/L in the follow-up examinations (2007-2008) (n = 225). The outcome was IGT on follow-up, measured by a blood glucose level of ≥ 7.8 mmol/L after OGTT. The exposure was the periodontal condition at baseline categorized into four groups: 0, 1-6, ≥ 7 sites with deepened (≥ 4 mm) periodontal pockets, and edentulousness.

RESULTS

A total of 23% of the participants developed IGT. The adjusted incidence rate ratios with 95% confidence intervals (CI) for dentate participants with 1-6 sites and ≥ 7 sites with deepened periodontal pockets, and edentate participants (reference category dentate participants without deepened periodontal pockets) were 1.5 (95% CI, 0.6-4.0), 1.8 (95% CI, 0.7-4.4), and 1.6 (95% CI, 0.6-4.0), respectively.

CONCLUSIONS

Poor periodontal condition may predispose individuals to IGT; however, further studies on this matter are warranted.

Annexin levels in GCF determine the imbalance of periodontal inflammatory regulation

OBJECTIVE

Annexin-1 (ANXA1), a member of the annexin family, plays a role in the resolution of inflammation and the regulation of anti-inflammatory responses, while annexin-2 (ANXA2) is involved in the initiation of the inflammatory responses. The aim of this study was to determine the effects of annexin family (ANXA1 and ANXA2) in periodontal disease.

METHODS

Healthy participants (n:25) and stage III, grade B periodontitis (n:25) patients enrolled for this study. Clinical periodontal parameters and the periodontal inflamed surface area (PISA) levels were noted. Serum, saliva, and gingival crevicular fluid (GCF) samples were collected to measure the ANXA1, ANXA2 and IL-1β levels.

RESULTS

Salivary and serum concentrations of ANXA1 was significantly lower in the periodontitis group than in the control group (respectively, p = 0.0177 and p = < 0.0001). Periodontitis patients demonstrated higher serum ANXA2 and IL-1β concentrations compared to controls (respectively, p = 0.0002 and p = 0.0017). As an inflammatory index; saliva, serum and GCF ANXA1/ANXA2 ratio were significantly lower in the periodontitis group compared to healthy controls.

CONCLUSIONS

The data suggest that periodontitis is associated with a disruption of the balance between pro-inflammatory mechanisms (ANXA2 and IL-1beta) and inflammation resolution (ANXA1), in parallel with PISA levels.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT06554756 (15/08/2024).

The oral cavity is a potential reservoir of gram-negative antimicrobial-resistant bacteria, which are correlated with ageing and the number of teeth

Objectives

The suppression of antimicrobial-resistant bacteria (ARB) is an important issue worldwide. In recent years, the presence of various ARB in the oral cavity has been reported, but the details remain unclear. Therefore, we aimed to isolate ARB from the oral cavity and investigate the factors affecting ARB colonization.

Methods

Third-generation cephalosporin- or carbapenem-resistant gram-negative bacteria (GN-ARB) were isolated from the oral and nasal cavities of 514 participants who visited the dental clinic, and the whole-genome sequences of all the isolates were obtained. Additionally, the tongue microbiota was analysed by 16S rRNA sequencing. The correlations of GN-ARB isolation with clinical status and the tongue microbiota were subsequently investigated.

Results

Among 514 participants, 131 and 13 GN-ARB strains were isolated from the oral cavities of 93 participants (18.1 %) and from the nasal cavities of 12 participants (2.3 %). The ARB were mainly affiliated with Acinetobacter spp. (39.7 %), Pseudomonas spp. (14.5 %) and Stenotrophomonas maltophilia (18.3 %). We found a correlation between the isolation of oral GN-ARB and ageing/the number of teeth. There were no significant correlations between the presence of GN-ARB and tongue microbiota composition.

Conclusions

Our results suggest that the oral cavity is an important potential reservoir of GN-ARB and that ageing and tooth loss are risk factors for the presence of GN-ARB in the oral cavity.

Metabolic syndrome promotes resistance to aspirin in mitigating bone loss in murine periodontal disease

AIMS

This study aimed to investigate the protective effects of aspirin (ASA) on alveolar bone loss in a mouse model with metabolic syndrome (MetS) and concurrent periodontal disease (PD). Specifically, the study sought to determine whether ASA could mitigate bone loss in MetS and non-MetS animals with PD and explore the correlation between gingival nitric oxide (NO) levels and bone resorption.

MAIN METHODS

Newborn female Swiss mice were administered monosodium glutamate (MSG) (4 mg/g) during the initial 5 days of life to induce MetS (MetS group), while the control group (SAL) was administered saline. On the 60th day, PD was induced in both groups. Half of the animals were treated daily with ASA (40 mg/kg). MetS was characterized by the Lee index, blood glucose, and cardiovascular parameters. Maxillae were evaluated by microtomography and histopathology, showing significant bone loss after PD induction.

KEY FINDINGS

Animals with MetS exhibited higher alveolar bone loss than controls. SAL animals treated with ASA had less bone loss than their MetS counterparts. Gingival NO levels were elevated in animals with PD, and a strong correlation was found between NO levels and bone resorption. ASA reduced NO in non-MetS animals, but MetS animals were resistant to this effect.

SIGNIFICANCE

These findings suggest a protective mechanism of ASA against bone loss in non-MetS animals with PD, an effect that was not observed in MetS animals. Consequently, this study provides novel insights into the intricate relationship between MetS and PD in mice.

Reliability and utility of blood glucose levels in the periodontal pockets of patients with type 2 diabetes mellitus: a cross-sectional study

Background

Several studies have measured gingival blood glucose (GBG) levels, but few have confirmed systematic bias using Bland-Altman analysis. This study compared the effectiveness of GBG levels with that of fingertip blood glucose (FTBG) levels using Bland-Altman and receiver operating characteristic (ROC) analyses.

Methods

A total of 15 healthy volunteers and 15 patients with type 2 diabetes were selected according to inclusion and exclusion criteria. Each group comprised eight male and seven female participants. The GBG and FTBG levels were measured using a self-monitoring blood glucose device after periodontal examination. Pearson's product‒moment correlation and simple linear regression analyses were performed. In addition, Bland‒Altman analysis was also performed to assess the degree of agreement between the two methods. ROC analysis was conducted to determine the sensitivity, specificity, and cutoff values for patients with diabetes. The area under the ROC curve (AUC) was used to identify significant differences.

Results

The mean GBG and FTBG levels were 120 ± 44.8 mg/dL and 137 ± 45.1, respectively, for the whole sample. The mean GBG and FTBG levels were 145 ± 47.2 mg/dL and 163 ± 49.1, respectively, in the diabetes group. The mean GBG and FTBG levels in the nondiabetes group were 95.3 ± 25.2 and 111 ± 18.8, respectively. Patients with diabetes were more likely to have a probing pocket depth (PPD) of ≥4 mm at the sampled site. Pearson's product‒moment correlation and simple linear regression analyses revealed a significant correlation between the GBG and FTBG measurements. Bland-Altman analysis revealed that GBG and FTBG measurements differed significantly among all participants; however, no significant differences were observed among the patients with diabetes (mean difference (MD) ± standard deviation (SD) = -18.1 ± 34.2, 95% confidence interval (CI) [-37.0 to 0.88]) or among the participants with a PPD of ≥4 mm (MD ± SD = -15.2 ± 30.4, 95% CI [-30.8 to 0.43]). The sensitivity, specificity, and cutoff values of the GBG measurements for detecting diabetes were 80%, 93%, and 123.5 mg/dL, respectively. The sensitivity, specificity, and cutoff values of the FTBG measurements for detecting diabetes were 73%, 87%, and 134.0 mg/dL, respectively. No significant differences were observed between the AUCs (0.078, 95% CI [-0.006 to 0.161]).

Conclusions

The GBG measurements aligned with the FTBG measurements in the patients with diabetes and among the participants with a PPD of ≥4 mm. Patients with diabetes were more likely to have a PPD of ≥4 mm at the sampled site, GBG levels can be used to screen for type 2 diabetes in dental clinics.

Association between total functional tooth unit score and hemoglobin A1c levels in Japanese community-dwelling individuals: the Nagasaki Islands study

BACKGROUND

It is widely recognized that periodontal disease is associated with diabetes mellitus. Periodontal disease is accompanied by inflammation of the periodontal tissue, impaired masticatory function, and the presence of periodontopathic bacteria, all of which may affect glycemic control. However, the exact relationship between these factors and glycemic control has not yet been established. In this study, we aimed to investigate the relationship between periodontal disease-related factors and glycemic control in Japanese community-dwelling individuals.

METHODS

We conducted a cross-sectional study involving 671 participants aged 29-92 (65.3 ± 12.1) years, using data from the Nagasaki Islands Study. Participants underwent routine medical examinations, including body mass index (BMI) and hemoglobin A1c (HbA1c) levels. Information on the participants' demographics (age and sex) and whether they were on diabetes medications, had an exercise habit, consumed alcohol, engaged in late-night eating, had regular dental checkups, and smoked was obtained using a self-administered questionnaire. Dental examinations were performed to examine dentition status, probing pocket depth, clinical attachment level (CAL), and bleeding on probing. Functional tooth units (FTUs), defined as pairs of occluding posterior teeth, were used as an indicator of occlusal support area. Saliva samples were collected and levels of two species of periodontopathic bacteria (Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans) were determined using real-time polymerase chain reaction. We analyzed the association between HbA1c levels and variables related to periodontal status, masticatory function, and salivary levels of periodontopathic bacteria.

RESULTS

Bivariate analysis showed that HbA1c levels were significantly associated with age, sex, exercise habit, BMI, diabetes medications, CAL, salivary P. gingivalis level, number of teeth, and three FTU subcategories. In the multiple regression analysis, age, BMI, diabetes medications, and total FTU score (i.e., including natural teeth, implant-supported artificial teeth, fixed prostheses, and removable dentures) remained associated with HbA1c levels (B = 0.23, 0.14, 0.52, and - 0.12; p < 0.001, p < 0.001, p < 0.001, and p = 0.008, respectively).

CONCLUSIONS

In this community-based cross-sectional study, total FTU was significantly associated with HbA1c levels, independent of other risk factors. This suggests that reconstructed occlusal support areas, including dentures, are associated with glycemic control in the older population.

Estimation of Periodontal Inflamed Surface Area by Salivary Lactate Dehydrogenase Level Using a Test Kit

Background: Salivary lactate dehydrogenase (LD) levels are a feasible and useful parameter for screening periodontal diseases. The periodontal inflamed surface area (PISA) is useful to clinically assess periodontal diseases. However, PISA is difficult to calculate and PISA-compatible screening kits are required. We aimed to investigate the association between salivary LD levels, using a test kit, and PISA and PISA-Japanese and determine the feasibility and reliability of the salivary LD test kit for evaluation of periodontal status. Methods: This study included 110 patients (66.4% female, median and 25-75 percentiles of age were 66.5 and 53.0-75.0 years, respectively) who visited the Dental University Clinic in Japan. Resting saliva samples were collected from each participant and LD levels were evaluated in real time using a kit featuring an integer scale ranging from 1 to 10. PISA and PISA-Japanese were calculated using periodontal parameters. Results: The median salivary LD level was 4.0. The medians of PISA and PISA-Japanese were 46.9 and 61.0, respectively. Salivary LD levels were positively correlated with the bleeding on probing rate (r = 0.626, p < 0.001), PISA (r = 0.560, p < 0.001), and PISA-Japanese (r = 0.581, p < 0.001). Conclusions: Our results suggest that salivary LD levels assessed using the salivary LD kit showed a significantly positive correlation with PISA and PISA-Japanese. In addition, we developed the PISA estimation formula using salivary LD levels measured with a test kit, sex, and age.

The role of viruses in oral mucosal lesions

The mucosa of the oral cavity is exposed to a large number of different microorganisms such as archaea, bacteria, fungi, parasites, and viruses. Among those, viruses cause specific infections, which can easily be transmitted from one person to another. The infectious route may not only include patients and their relatives but also the dental professional team. Thus, a wide knowledge regarding specific viral infections is crucial for the daily routine. Signs and symptoms of oral viral infections can be completely absent or develop into a pronounced clinical picture, so that early detection and information determine the further course of the infection and its influence on other inflammatory diseases, such as periodontitis, as well as the safety of family members and the social environment. As the clinical manifestation of viral infections may be highly variable leading to heterogenous mucosal lesions it is, in most cases, mandatory to differentiate them by specific microbiological tests in addition to clinical examination procedures. This article will give an overview of the role of viruses infecting the oral mucosa, and in addition, describe their clinical manifestation and management.

Periodontal tissue susceptibility to glycaemic control in type 2 diabetes

AIM

To assess the direct effect of intensive glycaemic control on periodontal tissues in patients with diabetes mellitus.

MATERIALS AND METHODS

Twenty-nine patients with type 2 diabetes were enrolled and hospitalized to receive a 2-week intensive glycaemic control regimen. We observed and analysed the systemic and oral disease indicators before and after treatment and clarified the indicators related to periodontal inflammation.

RESULTS

A significant reduction in glycaemic and periodontal parameters, including glycated albumin levels and periodontal inflamed surface area (PISA), was observed after treatment. The changes in PISA per tooth, indicative of periodontal healing, exhibited a bimodal distribution; the patients were divided into two groups on this basis. Correlations were observed between the changes in PISA per tooth and fasting plasma glucose, acetoacetic acid, and beta-hydroxybutyrate levels in the PISA-improved group. Significantly lower levels of C-peptide, coefficient of variation of R-R interval, and ankle-brachial pressure index were observed before treatment in the PISA non-improved group.

CONCLUSIONS

Glycaemic control treatment can effectively improve periodontitis in patients with type 2 diabetes, even in the absence of specific periodontal treatments. However, the periodontal responsiveness to glycaemic control treatment depends on the systemic condition of the patient.

Correlation of Stress and Oral Inflammatory Burden in Patients With Chronic Periodontitis in a Sample Population From Bhopal: A Randomized Clinical Study

Introduction Chronic periodontitis is a prevalent inflammatory disease that leads to the destruction of tooth-supporting structures. Psychological stress is a potential risk factor for periodontitis, potentially exacerbating inflammation and impairing treatment outcomes. This study aims to explore the correlation between chronic stress and oral inflammatory burden, as measured by the Periodontal Inflamed Surface Area (PISA), in a sample population from Bhopal, India. Methods This randomized clinical study included 1,250 participants, divided into three groups: Group A (control, n=250), Group B (chronic periodontitis, n=500), and Group C (post-treatment chronic periodontitis, n=500). Participants underwent a comprehensive periodontal examination, including the calculation of PISA, and completed the Perceived Stress Scale-10 (PSS-10) to assess stress levels. Statistical analysis included Pearson's correlation to assess the relationship between PSS-10 scores and PISA, with comparisons among groups using analysis of variance or Kruskal-Wallis tests. Results Group B exhibited significantly higher periodontal parameters and PSS-10 scores than Group A and Group C (p<0.001 for all comparisons). Group C showed significant improvements in both periodontal parameters and PSS-10 scores following treatment (p<0.001). A positive correlation was observed between PSS-10 scores and PISA in Group B (r=0.62, p<0.001), indicating that higher perceived stress was associated with increased oral inflammation in untreated chronic periodontitis. This correlation persisted after adjusting for confounders, including age, sex, and socioeconomic status. Conclusions Chronic stress is significantly associated with increased oral inflammatory burden in patients with chronic periodontitis, suggesting that stress may act as an independent risk factor for disease progression. Periodontal therapy reduces oral inflammation and alleviates psychological distress. Integrating stress management into periodontal treatment plans may enhance patient outcomes, highlighting the importance of a holistic approach to periodontal care.

Comparison of Dental Findings with Computed Tomographic and Clinical Examination in Patients with End-Stage Heart Failure

Background: This study aimed to evaluate the diagnostic value of pre-existing computed tomography (CT) examinations for the detection of dental pathologies compared with clinical dental examination in patients with end-stage heart failure. Methods: For this purpose, 59 patients with end-stage heart failure and pre-existing non-dental CT images of the craniofacial region were included. Virtual orthopantomograms (vOPG) were reconstructed. Dental pathologies were analyzed in vOPG and source-CT images. Imaging and clinical findings less than 6 months apart were compared (n = 24). Results: The subjective image quality of vOPG was more often rated as insufficient than CT (66%; 20%; p < 0.01). Depending on examination (CT, vOPG or clinic), between 33% and 92% of the patients could require dental intervention such as treatment of caries and periodontitis or tooth extraction. vOPG led to a higher (80%) prevalence of teeth requiring treatment than CT (39%; p < 0.01). The prevalence of teeth requiring treatment was similar in CT (29%) and clinic (29%; p = 1.00) but higher in vOPG (63%; p < 0.01). CT (stage 3 or 4: 42%) and vOPG (38%) underestimated the stage of periodontitis (clinic: 75%; p < 0.01). Conclusions: In conclusion, available CT images including the craniofacial region from patients with end-stage heart failure may contain valuable information regarding oral health status. The assessability of vOPGs might be insufficient and must be interpreted with caution.

Impaired Periodontitis-Induced Cytokine Production by Peripheral Blood Monocytes and Myeloid Dendritic Cells in Patients with Rheumatoid Arthritis: A Case-Control Study

Background: Immune cells from rheumatoid arthritis (RA) patients display a reduced in vitro response to Porphyromonas gingivalis (P. gingivalis), which may have functional immune consequences. The aim of this study was to characterize, by flow cytometry, the frequency/activity of monocytes and naturally occurring myeloid dendritic cells (mDCs) in peripheral blood samples from patients with periodontitis and patients with periodontitis and RA. Methods: The relative frequency of monocytes and mDCs in the whole blood, the frequency of these cells producing TNFα or IL-6 and the protein expression levels for each cytokine, before and after stimulation with lipopolysaccharide (LPS) from Escherichia coli plus interferon-γ (IFN-γ), were assessed by flow cytometry, in peripheral blood samples from 10 healthy individuals (HEALTHY), 10 patients with periodontitis (PERIO) and 17 patients with periodontitis and RA (PERIO+RA). Results: The frequency of monocytes and mDCs producing IL-6 or TNF-α and the expression of IL-6 and TNF-α in the PERIO group were generally higher. Within the PERIO+RA group, P. gingivalis and related antibodies were negatively correlated with the monocyte and mDC expression of IL-6. A subgroup of the PERIO+RA patients that displayed statistically significantly lower frequencies of monocytes producing IL-6 after activation presented statistically significantly higher peptidylarginine deiminase (PAD)2/4 activity, anti-arg-gingipain (RgpB) IgG levels, mean probing depth (PD), periodontal inflamed surface area (PISA) and bleeding on probing (BoP). Conclusions: In the patients with PERIO+RA, innate immune cells seemed to produce lower amounts of pro-inflammatory cytokines, which are correlated with worse periodontitis-related clinical and microbiological parameters.

Association of periodontitis with cardiometabolic and haemostatic parameters

OBJECTIVE

To investigate the association between periodontitis and cardiometabolic and haemostatic parameters.

MATERIALS AND METHODS

Between 2014 and 2019, 54 individuals needing full mouth extraction, and 50 control individuals, were recruited for a combined cross-sectional (individuals versus controls) and longitudinal (individuals before and after extraction) study. Periodontitis severity was measured using the periodontal inflamed surface area (PISA). Blood was drawn to measure the haemostatic (Factor VIII, von Willebrand factor [VWF], endogenous thrombin potential, d-dimer, clot lysis time) and cardiovascular risk (C-reactive protein [CRP], lipid profile) parameters, prior to and 12 weeks post-extraction. The results were analysed group-wise.

RESULTS

The mean VWF and CRP levels were higher and the high-density lipoprotein levels were lower in the individuals prior to extraction compared to the controls. The VWF was significantly correlated with the PISA (a 21% unit increase in VWF per 1000 mm2 increase in PISA, 95%CI: 6-36%, p = 0.01). The other analyses were comparable between the individuals and controls, and did not change in the individuals after the extraction.

CONCLUSION

VWF levels are associated with periodontitis severity; they do not improve after full-mouth extraction. Severe periodontitis in control individuals does not induce substantial changes in their haemostatic or inflammatory systems.

CLINICAL RELEVANCE

Treatment of periodontitis has been shown to improve the cardiometabolic blood profile of patients with established cardiometabolic disease. However, whether periodontitis treatment improves cardiometabolic and haemostatic profiles in people without cardiometabolic disease is uncertain.

"The effects of non-surgical periodontal treatment plus zinc and magnesium supplementation on oxidative stress and antioxidants enzymes in type 2 diabetes patients: a quasi-experimental study"

BACKGROUND

Periodontal Disease (PD) associated with Type 2 Diabetes Mellitus (T2DM) is a chronic condition that affects the oral cavity of people living with T2DM. The mechanisms of the interaction between type 2 Diabetes Mellitus and Periodontal diseases are complex and involve multiple pathophysiological pathways related to the systemic inflammatory process and oxidative stress. Non-surgical periodontal treatment (NSTP) is considered the standard for the management of this disease; however, patients with systemic conditions such as type 2 Diabetes Mellitus do not seem to respond adequately. For this reason, the use of complementary treatments has been suggested to support non-surgical periodontal treatment to reduce the clinical consequences of the disease and improve the systemic conditions of the patient. The use of zinc gluconate and magnesium oxide as an adjunct to non-surgical periodontal treatment and its effects on periodontal clinical features and oxidative stress in patients with Periodontal diseases -type 2 Diabetes Mellitus is poorly understood.

METHODS

A quasi-experimental study was performed in patients with periodontal diseases associated with T2DM. Initially, 45 subjects who met the selection criteria were included. 19 were assigned to a control group [non-surgical periodontal treatment] and 20 to the experimental group (non-surgical periodontal treatment + 500 mg of magnesium oxide and 50 mg of zinc gluconate for oral supplementation for 30 days) and the data of 6 patients were eliminated. Sociodemographic characteristics, physiological factors, biochemical parameters, and clinical features of periodontal diseases were assessed.

RESULTS

In this research a change in periodontal clinical characteristics was observed, which has been associated with disease remission. Additionally, a shift in MDA levels was presented for both groups. Furthermore, the supplementation group showed an increase in antioxidant enzymes when compared to the group that only received NSPT.

CONCLUSION

The use of Zinc gluconate and magnesium oxide can serve as a complementary treatment to non-surgical periodontal treatment, that supports the remission of PD as a result of regulation-reduction of oxidative biomarkers and increase in antioxidant enzymes activity.

TRIAL REGISTRATION

https://www.isrctn.com ISRCTN 14,092,381. September 13º 2023. Retrospective Registration.

Predictive factors of periodontal regeneration outcomes using rhFGF-2: A case-control study

OBJECTIVE

This study aimed to investigate the factors influencing the clinical outcomes of regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2).

BACKGROUND

rhFGF-2 promotes periodontal regeneration, and identifying the factors influencing this regeneration is important for optimizing the effectiveness of rhFGF-2.

METHODS AND MATERIALS

This study used a hospital information-integrated database to identify patients who underwent periodontal regenerative therapy with rhFGF-2. Factors included age, smoking status, diabetes mellitus (DM), periodontal inflamed surface area (PISA) at the initial visit, whether the most posterior tooth was involved or not, and preoperative radiological bone defect angle. Periodontal regenerative therapy outcomes were defined as good if radiographic bone fill ≥35% or periodontal pocket closure at 9-15 months after surgery. Bone fill rate (%) and periodontal pocket depth (mm) were also used as outcome measures. Factors were evaluated by simple regression analysis, and then the association between factors and the outcomes was determined by multivariate analysis.

RESULTS

PISA and age at the first visit did not significantly influence the success or failure of bone fill rate byrhFGF-2. However, DM, radiographic bone defect angle, and the most posterior tooth significantly influenced the regenerative effect (success/failure in bone fill) of rhFGF-2. The most posterior tooth was significantly associated with bone fill rate by rhFGF-2. Examination of the association between pocket closure and factors shows that the most posterior tooth significantly influenced. The most posterior tooth and preoperative PPD were significantly associated with pocket reduction depth. For the most posterior tooth, a significantly higher bone regeneration rate (p < .05) was observed with a combination of autologous bone graft and rhFGF-2 than with rhFGF-2 alone, and the effect was significant in multivariate analysis.

CONCLUSIONS

The radiographic bone defect angle, the involvement of most posterior teeth, and the presence of DM influenced the effectiveness of rhFGF-2 in periodontal regeneration. However, PISA values and age at the initial visit had no significant effect.

Evaluation of inflammasomes as biomarker following non-surgical periodontal treatment

OBJECTIVE

The purpose of this study was to investigate interleukin (IL)-1β, IL-18, nod-like receptor pyrin domain-containing protein 3 (NLRP3), apoptosis-related speck-like protein containing a caspase activation and recruitment domain (ASC), and caspase-1 levels in saliva and serum in different periodontal diseases and to evaluate the changes after non-surgical periodontal treatment (NSPT).

DESIGN

A total of 45 participants, 15 healthy, 15 gingivitis, and 15 stage III grade C (SIIIGC) periodontitis patients, were included in the study. Periodontal parameters were assessed, and salivary and serum samples were collected at baseline in all groups and one and three months after NSPT in gingivitis and periodontitis groups. An enzyme-linked immunosorbent assay was used to analyse IL-1β, IL-18, NLRP3, ASC, and caspase-1 levels.

RESULTS

After NSPT, improvement was observed in all clinical parameters, along with periodontal inflamed surface area (PISA) in gingivitis and periodontitis groups. PISA scores were positively correlated with IL-1β, NLRP3, and caspase-1 at baseline (p < 0.05). Salivary and serum IL-1β, NLRP3 levels were higher in periodontitis compared to healthy controls at baseline and reduced after treatment (p < 0.05). Receiver operating characteristic analysis revealed that salivary IL-1β, NLRP3, and caspase-1 had the ability to discriminate SIIIGC periodontitis patients from healthy subjects (p < 0.05).

CONCLUSION

In conclusion, salivary IL-1β, NLRP3, and caspase-1 are at aberrantly high levels in SIIIGC periodontitis and are remarkably decreased following NSPT; these inflammasome biomarkers may show potential utility in diagnosing and monitoring periodontitis.

Systematic review to evaluate accuracy studies of the diagnostic criteria for periodontitis in pregnant women

The diversity of criteria used in the diagnosis of periodontitis in pregnant women makes it difficult to define and compare the disease. Using a systematic review, this study evaluated the accuracy of criteria for diagnosing periodontitis in pregnant women. Searches were carried out in the databases: Medline/PubMed, Embase, Scopus, Web of Science, SciELO, Lilacs, ProQuest, and CINAHL. Validation studies of the criteria used for diagnosing periodontitis met the inclusion criteria. The study steps were performed by three independent reviewers. A qualitative synthesis of the included articles was carried out and the quality methodological analysis using the QUADAS-2 instrument. The assessment of the quality of the evidence was obtained through the GRADE tool. A total of 592 records were identified, of which only 6 made up this systematic review. The included studies analyzed different criteria for diagnosing periodontitis, evaluating 3,005 pregnant women. The criteria selected as a test presented results equivalent to the performance of those recognized as the gold standard. The self-reported criteria were of lower diagnostic accuracy. A major limitation of this review was the small number of primary studies that evaluated clinical diagnosis of periodontitis in pregnant women, which was highly heterogeneous, making it impossible to carry out accuracy meta-analysis and additional analyzes. There is a lack of consensus on the criteria for the diagnosis of periodontitis, with great variability in the accuracy and prevalence of the disease in pregnant women.

Multimodal inhibitory effect of matcha on Porphyromonas gingivalis

Porphyromonas gingivalis has been associated with progression of periodontitis, characterized by inflammation and destruction of periodontal tissues. Here, we report that matcha, a product of Camellia sinensis, hampers the adherence and survival of P. gingivalis through multiple tactics. Matcha extract (ME) inhibited the growth not only of P. gingivalis but also of Prevotella nigrescens and Fusobacterium nucleatum, while it did not inhibit growth of nine species of oral streptococci and Aggregatibacter actinomycetemcomitans. ME-mediated P. gingivalis growth inhibition was characterized by both morphological and physiological changes at the bacterial envelope, which were accompanied by nano-particle formation and decreased membrane fluidity/permeability without loss of membrane integrity. ME also triggered autoaggregation of P. gingivalis in a major fimbriae (FimA)-dependent manner. In addition, adherence of P. gingivalis was dramatically inhibited by ME, irrespective of fimbriae. Furthermore, a structure-activity relationship study tested a series of catechins isolated from ME and identified the pyrogallol-type B-ring of catechins as essential for P. gingivalis growth inhibition. In a clinical study to assess the microbiological and therapeutic effects of matcha mouthwash in patients with periodontitis, the P. gingivalis number in saliva was significantly reduced by matcha mouthwash compared to the pre-intervention level. A tendency toward improvement in probing pocket depth was observed in the matcha group, although the difference was not statistically significant. Taken together, we present a proof of concept, based on the multimodal inhibitory effect of matcha against P. gingivalis, and that matcha may have clinical applicability for prevention and treatment of periodontitis.

IMPORTANCE

Periodontitis, a multifactorial inflammatory disease of the oral cavity, results in alveolar bone destruction, and is a major cause of tooth loss of humans. In addition, emerging evidence has demonstrated associations between periodontitis and a wide range of other chronic inflammation-driven disorders, including diabetes mellitus, preterm birth, cardiovascular disease, aspiration pneumonia, rheumatoid arthritis, cognitive disorder, and cancer. In the present study, we report that matcha, a product of Camellia sinensis, hampers Porphyromonas gingivalis, a major periodontal pathobiont, in not only a series of in vitro experiments but also a pilot intervention clinical trial of patients with periodontitis, in which matcha mouthwash statistically significantly reduced the P. gingivalis number in saliva, as compared to the pre-intervention level. Taken together, we suggest that matcha may have clinical applicability for prevention and treatment of periodontitis.

Severe periodontal disease in Japanese patients with high HbA1c levels: a cross-sectional study

Objective

This study aimed to investigate the relationship between plasma glucose profiles and periodontal disease (PD) severity in men and women.

Methods

We conducted a cross-sectional cohort study, enrolling all eligible patients with type 2 diabetes mellitus (T2DM) who regularly visited the outpatient department.

Results

Patients were divided into severe and non-severe PD groups. The severe PD group showed a male predominance and significantly higher hemoglobin A1c (HbA1c) levels than the non-severe PD group. The optimal HbA1c cutoff value on the receiver operating characteristic curve for predicting severe PD was 7.3% [56 mmol/mol] (sensitivity, 52%; specificity, 73%; P = 0.01). Multivariate logistic regression revealed that male sex (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.19-6.34; P = 0.01) and higher HbA1c levels (OR, 3.09; 95% CI, 1.42-6.70; P < 0 .01) were independently and significantly associated with the presence of severe PD. The prevalence rates of severe PD in patients with HbA1c levels < 7.3% [56 mmol/mol] and HbA1c levels ≥ 7.3% [56 mmol/mol] were 17.4% and 53.3% in women, and 50.0% and 66.7% in men, respectively.

Conclusions

Men with T2DM had a high risk of severe PD independent of HbA1c levels. Plasma glucose management may be crucial for maintaining periodontal health in T2DM patients, particularly in women.

The potential positive effect of periodontal treatment on brain function activity using functional magnetic resonance imaging analysis

Background/purpose

There are reports on the relationship between periodontal treatment and the whole body. The purpose of the present study was to investigate the effect of periodontal initial treatment on brain function activity by improving periodontal tissue and the occlusal status of subjects with periodontitis.

Materials and methods

The subjects were 13 patients with periodontitis. Following the patient's informed written consent, the periodontal initial treatment provided to the patient included tooth brushing instruction, scaling and root planning, however, occlusal adjustment was not performed at this stage. Periodontal examination, occlusal force examination and fMRI results were also evaluated at the initial and the reevaluation examinations.

Results

After the periodontal initial treatment had been performed, periodontal tissue had significantly improved. In addition, cerebral blood flow in the insula and primary motor cortex was also improved, as confirmed by fMRI.

Conclusion

This result suggests that the periodontal ligament has recovered and the periodontal ligament neuron have been further subjected to clenching in the insula.

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.

Non-Surgical Periodontal Therapy's Influence on Alpha-Synuclein and Inflammatory Marker Levels: A Pilot Study

Background: Microbial dysbiosis may contribute to alpha-synuclein (α-Syn) homeostasis disruption, yet the burden of inflammatory periodontal infection and its treatment have never been studied in this regard. We aimed to compare the cytokine and α-Syn levels in the saliva and blood of patients with periodontitis who underwent non-surgical periodontal therapy (NSPT) and those of their healthy counterparts. Methods: Periodontal examination and saliva and blood sample collection were carried out in incoming patients at a university clinic. The periodontitis group (PG) received NSPT. The sample collection and periodontal observation were repeated 30 days after. IL-6, IL1-β and total α-Syn were quantified using immunoassay methods. The periodontal inflamed surface area (PISA) was calculated as a proxy for periodontal inflammation. Results: Eleven participants formed the PG, and there were fifteen healthy controls (HC). At baseline, no correlation between salivary and plasma α-Syn was found. The salivary α-Syn levels revealed a tendency to decrease 30 days after, particularly in the PD cases. The variation in PISA and α-Syn showed significant correlation. Salivary α-Syn correlated negatively with salivary IL-6 levels at both timepoints in the total sample (rho = -0.394 and rho = -0.451) and in the HC (rho = -0.632 and rho = -0.561). Variations in plasma IL-6 and α-Syn were negatively correlated (rho = -0.518) in the healthy participants. Baseline plasma IL1-β negatively correlated with plasmatic α-Syn at 30 days in the HC (rho = -0.581). Conclusions: Salivary and plasma α-Syn bioavailability operate independently, and periodontal diagnosis was not a confounding factor. Salivary α-Syn levels were significantly affected by NSPT, contrary to plasma levels. These results should be confirmed in future larger and prospective studies.

Periodontal Inflammation and Dysbiosis Relate to Microbial Changes in the Gut

Periodontal disease (PerioD) is a chronic inflammatory disease of dysbiotic etiology. Animal models and few human data showed a relationship between oral bacteria and gut dysbiosis. However, the effect of periodontal inflammation and subgingival dysbiosis on the gut is unknown. We hypothesized that periodontal inflammation and its associated subgingival dysbiosis contribute to gut dysbiosis even in subjects free of known gut disorders. We evaluated and compared elderly subjects with Low and High periodontal inflammation (assessed by Periodontal Inflamed Surface Area (PISA)) for stool and subgingival derived bacteria (assayed by 16S rRNA sequencing). The associations between PISA/subgingival dysbiosis and gut dysbiosis and bacteria known to produce short-chain fatty acid (SCFA) were assessed. LEfSe analysis showed that, in Low PISA, species belonging to Lactobacillus, Roseburia, and Ruminococcus taxa and Lactobacillus zeae were enriched, while species belonging to Coprococcus, Clostridiales, and Atopobium were enriched in High PISA. Regression analyses showed that PISA associated with indicators of dysbiosis in the gut mainly reduced abundance of SCFA producing bacteria (Radj = -0.38, p = 0.03). Subgingival bacterial dysbiosis also associated with reduced levels of gut SCFA producing bacteria (Radj = -0.58, p = 0.002). These results suggest that periodontal inflammation and subgingival microbiota contribute to gut bacterial changes.

Periodontal inflammation as a potential driver of HIV low level viremia

HIV can be successfully suppressed to undetectable levels by antiretroviral therapy (ART) in most people with HIV (PWH). However, a small proportion continues to have persistent low-level viremia (LLV) during ART. A presumed source of LLV is production or replication from viral reservoirs, which are maintained in the presence of ART. It is unknown whether the oral cavity can be considered an HIV reservoir. As periodontal inflammation is a common problem in PWH, we hypothesize that periodontal inflammation in the oral cavity activates (latently) infected cells and thus might be associated with LLV. We included 11 individuals with HIV LLV, and compared HIV-RNA levels in saliva and plasma at baseline and at week 24 after switch of ART. We compared the LLV-group at baseline with 11 age-matched controls with suppressed viremia. To investigate the severity of periodontitis we used Periodontal Inflamed Surface Areas (PISA) by measuring probing depth, gingival recession, bleeding on probing and clinical attachment level. Severity of periodontitis was classified according to the CDC-AAP case definition. Additional insights in periodontal inflammation were obtained by comparing immune activation markers and the presence of periodontal pathogens. In four individuals of the LLV group, residual levels of HIV-RNA were detected in saliva at baseline (N = 1) or at week 24 (N = 2) or both (N = 1). Of the four individuals with LLV, three had residual levels of HIV-RNA in saliva. All 22 individuals had moderate to severe periodontitis. PISA was not significantly different between cases with LLV and controls. Similarly, periodontal pathogens were frequently observed in both groups. Total activated HLA-DR+CD38+ CD4+ cells and CD8+ cells were significantly higher in the LLV group than in the control group (p = <0.01). No immune markers were associated with LLV. In conclusion, periodontal inflammation is an unlikely driver of HIV LLV compared to HIV suppressed individuals.

Assessing the Correlation of Periodontal Inflamed Surface Area (PISA) With Systemic Inflammatory Markers

Background Periodontitis has a vital role in eliciting a cross-reactivity or systemic inflammatory response, making periodontal inflamed surface area (PISA) a primary contributor to the inflammatory burden posed by periodontitis. PISA helps in the quantification of the amount of inflamed periodontal tissue. However, the existing literature data concerning PISA as an indicator of inflammatory burden are scarce, with limited research on the relationship between systemic inflammatory markers and PISA. Aim The present clinic-hematological cross-sectional study aimed to correlate PISA with systemic inflammatory markers. The study also aimed to assess serum concentrations of inflammatory markers such as erythrocyte sedimentation rates (ESR), C-reactive protein (CRP), and peripheral blood markers such as neutrophils and monocytes and to correlate these markers with PISA. Methods The study assessed 62 subjects, who were divided into two groups of 31 subjects, each following bleeding on probing (BOP) criteria. Group I consisted of subjects with generalized chronic gingivitis, and Group II included subjects with generalized chronic periodontitis. In two groups, BOP, probing pocket depth, clinical attachment level, and gingival recession were assessed along with PISA by a custom-made R function derived from a pre-existing, freely available MS Excel spreadsheet (Microsoft Corporation, Redmond, Washington). The results of the assessment were then compared. Results A statistically highly significant positive correlation was seen in PISA and CRP with a correlation coefficient of 0.4875 and p-value of 0.000059. A similar statistically significant positive correlation was seen in ESR and PISA with a correlation coefficient of 0.4089 and p-value of 0.000968. A statistically non-significant correlation was seen in neutrophils and PISA with p=0.576018. However, a moderate and positive statistically significant association was seen in monocyte and PISA with a correlation coefficient of 0.3258 and p-value of 0.009956. Conclusions The present study concludes that most of the common systemic inflammatory markers have a positive correlation with PISA. However, more studies are required to establish this correlation.

Prevalence of oral Capnocytophaga species and their association with dental plaque accumulation and periodontal inflammation in middle‑aged and older people

Capnocytophaga species are commonly found in human oral microbiome. The aim of the present study was to understand the association of the prevalence of oral Capnocytophaga species with oral hygiene and periodontal inflammation. A total of 136 patients (median age 72 years) who visited the Hiroshima University Hospital (Hiroshima, Japan) between April 2021 and June 2023 were enrolled. Swab samples were obtained from the tongue surface. DNA from Capnocytophaga species (C. ochracea and C. sputigena) was detected by real-time PCR analysis. Dental plaque accumulation was observed to assess the oral hygiene condition of participants. Additionally, clinical periodontal inflammation was assessed with periodontal inflamed surface area (PISA) scores. Clinical confounding factors such as age, sex, lifestyle-related disease, remaining teeth and denture wearing between Capnocytophaga species-positive and -negative groups were adjusted with a propensity score matching method. Mann-Whitney U and χ2 or Fisher's exact test were employed for statistical analysis. The prevalence rate was 67.6% for oral C. ochracea and 83.1% for C. sputigena. C. ochracea-positive participants showed significantly higher plaque control record scores (an indicator of dental plaque accumulation) than C. ochracea-negative participants (P=0.03). Additionally, C. ochracea/C. sputigena dual-positive participants exhibited significantly higher plaque control record and PISA scores than non-dual-positive participants (P=0.01 and P=0.04, respectively). Propensity score matching was conducted in the C. ochracea/C. sputigena dual-positive group and the non-dual-positive group for adjustment of clinical factors, resulting in 51 matched patient pairs. C. ochracea/C. sputigena dual-positive participants had significantly higher plaque control record scores than non-dual-positive participants (P=0.02). The present results suggest that the prevalence of both oral C. ochracea and C. sputigena is associated with poor oral hygiene in middle-aged and older people.

Advanced machine learning for estimating vascular occlusion percentage in patients with ischemic heart disease and periodontitis

Objective

The study aimed to assess the efficacy of advanced machine learning algorithms in estimating the percentage of vascular occlusion in ischemic heart disease (IHD) cases with periodontitis.

Methods

This study involved 300 IHD patients aged 45 to 65 with stage III periodontitis undergoing coronary angiograms. Dental and periodontal examinations assessed various factors. Coronary angiograms categorized patients into three groups based on artery stenosis. Clinical data were processed, outliers were identified, and machine learning algorithms were applied for analysis using the orange tool, including confusion matrices and receiver operating characteristic (ROC) curves for assessment.

Results

The results showed that Random Forest, Naïve Bayes, and Neural Networks were 97 %, 84 %, and 92 % accurate, respectively. Random Forest did exceptionally well in identifying the severity of conditions, with 95.70 % accuracy for mild cases, 84.80 % for moderate cases, and a perfect 100.00 % for severe cases.

Conclusions

The current study, using Periodontal Inflammatory Surface Area (PISA) scores, revealed that the Random Forest model accurately predicted the percentage of vascular occlusion.

Update on Focal Infection Management: A Czech Interdisciplinary Consensus

BACKGROUND

The focal infection theory has been used to explain several chronic systemic diseases in the past. Systemic diseases were thought to be caused by focal infections, such as caries and periodontal diseases, and dentists were held responsible for these diseases due to the spread of oral infections. As knowledge of the interrelationship between oral microorganisms and the host immune response has evolved over the last few decades, the focal infection theory has been modified in various ways. The relationship between oral and systemic health appears to be more complex than that suggested by the classical theory of focal infections. Indeed, the contribution of the oral microbiota to some systemic diseases is gaining acceptance, as there are strong associations between periodontal disease and atherosclerotic vascular disease, diabetes, and hospital-associated pneumonia, amongst others. As many jurisdictions have various protocols for managing this oral-systemic axis of disease, we sought to provide a consensus on this notion with the help of a multidisciplinary team from the Czech Republic.

METHODS

A multidisciplinary team comprising physicians/surgeons in the specialities of dentistry, ear-nose and throat (ENT), cardiology, orthopaedics, oncology, and diabetology were quetioned with regard to their conceptual understanding of the focal infection theory particularly in relation to the oral-systemic axis. The team also established a protocol to determine the strength of these associations and to plan the therapeutic steps needed to treat focal odontogenic infections whenever possible.

RESULTS

Scoring algorithms were devised for odontogenic inflammatory diseases and systemic risks, and standardised procedures were developed for general use.

CONCLUSIONS

The designed algorithm of the oral-systemic axis will be helpful for all health care workers in guiding their patient management protocol.

Effectiveness of novel oral hygiene instruction avoiding inattentional blindness using an application for unique plaque control record calculation: A randomized clinical trial

OBJECTIVE

This study was performed to estimate the effectiveness of novel oral hygiene instruction (OHI) focusing on areas with deep periodontal pockets for reduction of periodontal inflammation.

BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD

Because stained areas on the plaque chart do not always correspond to the areas with deep periodontal pockets, conventional OHI based on O'Leary's plaque control record (PCR) often provides guidance inconsistent with the target area.

METHODS

This randomized clinical trial involved two groups: (1) OHI based on the PCR limited in deep pocket sites (novel OHI group) and (2) OHI based on O'Leary's PCR (conventional OHI group). The unique PCR (aggressive target for PCR [agPCR]; only counting the plaque-stained areas with PD at ≥4 mm sites) for the novel OHI was calculate by dedicated expression program. The probing depth (PD), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) were obtained at the baseline and 5 to 6 months later.

RESULTS

The approximation curve with PISA before and after instruction indicated that the PISA converged to a lower value after instruction in the novel OHI group. The approximation curve with the improvement rate of the PISA and agPCR showed a positive correlation in the novel OHI group but no correlation in the conventional OHI group.

CONCLUSION

Control of inflammation was more effective in the novel OHI group. These results suggest that this novel OHI technique using our developed application could be used as a strategy to improve the effectiveness of brushing instruction.

Improvement of periodontal parameters following intensive diabetes care and supragingival dental prophylaxis in patients with type 2 diabetes: A prospective cohort study

AIM

This study aimed to investigate the effects of diabetes care on periodontal inflammation.

MATERIALS AND METHODS

This prospective cohort study included 51 Japanese patients with type 2 diabetes who underwent intensive diabetes care including educational hospitalization and regular outpatient treatment for 6 months. Dental prophylaxis without subgingival scaling was provided three times during the observational period. Associations between changes in periodontal parameters and glycaemic control levels were evaluated using multiple regression analysis.

RESULTS

Overall, 33 participants (mean age: 58.7 ± 12.9) were followed up for 6 months. At baseline examination, 82% were diagnosed with Stage III or IV periodontitis. Haemoglobin A1c (HbA1c) level changed from 9.6 ± 1.8% at baseline to 7.4 ± 1.3% at 6 months. The ratio of probing pocket depth (PPD) ≥4 mm, bleeding on probing (BOP), full-mouth plaque control record (PCR), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) also significantly improved. The reduction in PPD and PESA was significantly associated with changes in both HbA1c and fasting plasma glucose (FPG) levels, and the reduction in PISA was significantly associated with an improvement in FPG after adjusting for smoking, change in body mass index and full-mouth PCR.

CONCLUSIONS

This is the first study to report a significant improvement in PPD and BOP after intensive diabetes care and dental prophylaxis without subgingival scaling.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000040218.

Periodontal Treatment During the Blanking Period Improves the Outcome of Atrial Fibrillation Ablation

BACKGROUND

Periodontitis has not been recognized as a modifiable risk factor for atrial fibrillation (AF). This prospective nonrandomized study investigated whether periodontal treatment improves the AF ablation outcome.

METHODS AND RESULTS

We prospectively enrolled 288 AF patients scheduled to undergo initial radiofrequency catheter ablation. Each patient underwent periodontal inflamed surface area (PISA; a quantitative index of periodontal inflammation) measurement. All eligible patients were recommended to receive periodontal treatment within the blanking period, and 97 consented. During the mean follow-up period of 507±256 days, 70 (24%) AF recurrences were documented. Patients who exhibited AF recurrences had a higher PISA than those who did not (456.8±403.5 versus 277.7±259.0 mm2, P=0.001). These patients were categorized into high-PISA (>615 mm2) and low-PISA (<615 mm2) groups according to the receiver operating characteristic analysis for AF recurrence (area under the curve, 0.611; sensitivity, 39%; specificity, 89%). A high PISA, as well as female sex, AF duration, and left atrial volume, were the statistically significant predicter for AF recurrence (hazard ratio [HR], 2.308 [95% CI, 1.234-4.315]; P=0.009). In patients with a high PISA, those who underwent periodontal treatment showed significantly fewer AF recurrences (P=0.01, log-rank test). The adjusted HR of periodontal treatment for AF recurrence was 0.393 (95% CI, 0.215-0.719; P=0.002).

CONCLUSIONS

Periodontitis may serve as a modifiable risk factor for AF. PISA is a hallmark of AF recurrence, and periodontal treatment improves the AF ablation outcome, especially for those with poor periodontal condition.

Correlation of periodontal inflamed surface area with glycated hemoglobin, interleukin-6 and lipoprotein(a) in type 2 diabetes with retinopathy

BACKGROUND

The two-way relationship between periodontitis and type 2 diabetes mellitus (T2DM) is well established. Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis, accentuating diabetic complications. An inflammatory link exists between diabetic retinopathy (DR) and periodontitis, but the studies regarding this association and the role of lipoprotein(a) [Lp(a)] and interleukin-6 (IL-6) in these conditions are scarce in the literature.

AIM

To determine the correlation of periodontal inflamed surface area (PISA) with glycated Hb (HbA1c), serum IL-6 and Lp(a) in T2DM subjects with retinopathy.

METHODS

This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR. All subjects were assessed for periodontal parameters [bleeding on probing (BOP), probing pocket depth, clinical attachment loss (CAL), oral hygiene index-simplified, plaque index (PI) and PISA], and systemic parameters [HbA1c, fasting plasma glucose and postprandial plasma glucose, fasting lipid profile, serum IL-6 and serum Lp(a)].

RESULTS

The proportion of periodontitis in T2DM with and without DR was 47.5% and 27.5% respectively. Severity of periodontitis, CAL, PISA, IL-6 and Lp(a) were higher in T2DM with DR group compared to T2DM without DR group. Sig-nificant difference was observed in the mean percentage of sites with BOP between T2DM with DR (69%) and T2DM without DR (41%), but there was no significant difference in PI (P > 0.05). HbA1c was positively correlated with CAL (r = 0.351, P = 0.001), and PISA (r = 0.393, P ≤ 0.001) in study subjects. A positive correlation was found between PISA and IL-6 (r = 0.651, P < 0.0001); PISA and Lp(a) (r = 0.59, P < 0.001); CAL and IL-6 (r = 0.527, P < 0.0001) and CAL and Lp(a) (r = 0.631, P < 0.001) among study subjects.

CONCLUSION

Despite both groups having poor glycemic control and comparable plaque scores, the periodontal parameters were higher in DR as compared to T2DM without DR. Since a bidirectional link exists between periodontitis and DM, the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Effects of Rinsing with Povidone-Iodine during Step II Periodontal Therapy: A Systematic Review and Meta-Analysis

Background and Objectives: Antiseptics have been suggested to enhance the outcomes of non-surgical periodontal treatment (NSPT). Among these, povidone-iodine (PVP-iodine) was reported to significantly reduce periodontal pocket depths (PPDs). The aim of this study was to systematically re-assess the existing literature regarding the potential benefit of using PVP-iodine in step II periodontal therapy. Material and Methods: The scientific literature was systematically searched across electronic libraries for randomized controlled trials employing PVP-iodine during NSPT through to September 2023, using search items related to PVP-iodine and periodontitis. The selection process was performed by two independent reviewers. The primary outcomes were reductions in periodontal probing depth (PPD) and clinical attachment level (CAL). When reasonable, a meta-analysis of the included studies was performed. Results: Initially, 799 records were identified. After abstract and title screening and fulltext revision, 15 RCTs were included. The data from eight studies were merged in meta-analyses. The use of PVP-iodine had no significant effect on PPD reduction at 6 months (means [standard deviation]: -0.12 mm [-0.33; 0.09]) but it did at 12 months (-0.29 mm [-0.56; -0.02]). CAL was significantly better at 6 (-0.42 mm [-0.64; -0.20]) and 12 months (-0.39 mm [-0.66; -0.11]). Conclusions: PVP-iodine rinsing during NSPT may slightly improve patients' PPD and CAL.

The Impact of Periodontal Inflammation on the Severity of Coronary Atherosclerosis

Introduction Through plausible biological mechanisms, periodontitis causes systemic inflammatory burden and response, thus resulting in damage far beyond the oral cavity. Studies have demonstrated periodontitis to be a significant risk factor for coronary heart disease (CHD) and stroke. The larger the quantum of periodontal inflamed tissue, the greater the chances of periodontitis eliciting bacteremia and systemic inflammatory responses. Studies have reported that periodontitis and other common oral infections play an important role in the development of atherosclerosis. Therefore, the quantity of inflamed periodontal tissue assumes significance in determining the severity of atherosclerosis. Hence, this study investigates the impact of periodontal inflamed surface area (PISA) on the severity of coronary atherosclerosis. Materials and methods In this cross-sectional study, a total of 160 patients who presented at the department of periodontics of The British University in Egypt (BUE) from 1 January 2023 to 30 September 2023 were enrolled. Patients were only enrolled if they had undergone coronary angiography within the last six months, were less than 60 years of age, shared their previous medical history and coronary angiographic report, and gave informed written consent. Data on classic coronary risk factors and periodontal inflammatory status and angiographic findings were recorded and subjected to appropriate statistical analysis. Results The results revealed that the periodontal inflamed surface area (p = 0.002) apart from age (p < 0.047) and low-density lipoprotein cholesterol (LDL-C) (p < 0.001) is a significant independent predictor of the severity of coronary atherosclerosis. Conclusions The periodontal inflamed surface area is an independent predictor of the severity of coronary atherosclerosis.

Effects of amoxicillin and metronidazole as an adjunct to scaling and root planing on glycemic control in patients with periodontitis and type 2 diabetes: A short-term randomized controlled trial

OBJECTIVE

To assess the effects of amoxicillin and metronidazole with scaling and root planing (SRP) on periodontal parameters and glycemic control in patients with severe periodontitis and diabetes mellitus.

BACKGROUND

Adjunctive antibiotics use is advantageous for treating periodontitis in patients with severe periodontitis and diabetes. However, the effects of adjunctive antibiotic use on hemoglobin A1c (HbA1c) levels remain unclear.

METHODS

This short-term, randomized controlled trial enrolled patients with severe periodontitis and type 2 diabetes. The patients were randomly allocated to SPR only (i.e., control) or SPR + antibiotics (500 mg of amoxicillin and 200 mg of metronidazole, three times daily for 7 days) groups. Periodontal and hematological parameters were assessed at baseline and 3 months after treatment. Inter- and intra-group analyses were performed using Student's t-tests, Mann-Whitney U tests, and the binary logistic regression models. p-values of <.05 were considered statistically significant.

RESULTS

This study enrolled 49 patients, with 23 and 26 patients in the SRP-only and SRP + antibiotics groups, respectively. The periodontal parameters improved significantly and similarly in both groups after treatment (p < .05). The SRP + antibiotics group had more sites of improvement than the SRP-only group when the initial probing depth was >6 mm. (698 [78.96%] vs. 545 [73.35%], p = .008). The HbA1c levels decreased in the SRP-only and SRP + antibiotics groups after treatment (0.39% and 0.53%, respectively). The multivariable binary logistic regression model demonstrated that antibiotics administration and a high baseline HbA1c level were associated with a greater reduction in the HbA1c level (odds ratio = 4.551, 95% confidence interval: 1.012-20.463; odds ratio = 7.162, 95% confidence interval: 1.359-37.753, respectively).

CONCLUSIONS

SRP and SRP plus systemic antibiotics were beneficial for glycemic control. Adjunctive antibiotic use slightly improved the outcome for patients with severe periodontitis and poorly controlled diabetes.

Impact of COVID-19 spread on visit intervals and clinical parameters for patients with periodontitis in supportive periodontal therapy: a retrospective study

PURPOSE

This study investigated the relationship between the number of days that hospital visits were postponed and changes in clinical parameters due to the spread of coronavirus disease 2019 (COVID-19), after the Japanese government declared a state of emergency in April 2020.

METHODS

Regarding the status of postponement of appointments, we analyzed the patients who had visited the Nihon University Hospital at Matsudo for more than 1 year for supportive periodontal therapy (SPT) and classified them into low-, moderate- and high-risk subgroups according to the periodontal risk assessment (PRA). Clinical parameters for periodontal disease such as probing depth (PD), full-mouth bleeding score (FMBS), full-mouth plaque score, periodontal inflamed surface area (PISA), and periodontal epithelial surface area (PESA) were analyzed in 2 periods, from October 2019 to March 2020 and after April 2020. Correlation coefficients between days of deferral and the degree of changes in clinical parameters were calculated.

RESULTS

The mean age of the 749 patients was 67.56±10.85 years, and 63.82% were female. Out of 749 patients, 33.24% deferred their SPT appointments after April 2020. The average total of postponement days was 109.49±88.84. The number of postponement days was positively correlated with changes in average PD (rs=0.474) and PESA (rs=0.443) in the high-risk subgroup of FMBS, and average PD (rs=0.293) and PESA (rs=0.253) in the high-risk subgroup of tooth number (TN). Patients belonging to the high-risk subgroups for both FMBS and TN had a positive correlation between postponement days and PISA (rs=0.56).

CONCLUSIONS

The findings, the spread of COVID-19 appears to have extended the visit interval for some SPT patients. Moreover, longer visit intervals were correlated with the worsening of some clinical parameters for SPT patients with high PRA.

Cross-sectional analysis comparing prefabricated titanium to individualized hybrid zirconia abutments for cemented zirconia based fixed dental prostheses: a critical concept assessment

PURPOSE

Despite the differences in material properties and shapes among the different types of prefabricated titanium (pTiA) and individualized hybrid zirconia abutments (ihZiA), the biological and clinical relevance of materials and construction features remains vague. Yet, individualized ihZiA are increasingly implemented into daily routine aiming to satisfy rising expectations. The objective was to compare these two types of abutments in fixed dental prostheses (FDP).

METHODS

This cross-sectional study examined 462 implants in 102 patients comparing pTiA (52 patients) to ihZiA (50 patients) for FDP. These different treatment regimens were evaluated in terms of peri-implant health, radiographic bone loss, and oral-health related quality of life (OH-QoL) with special consideration of abutment type and superstructure design.

RESULTS

ihZiA showed significantly different design features than prefabricated pTiA, but the annual bone loss in both groups did not. Visible titanium in the esthetic zone negatively impacted OHIP 14 scores. The combination of an emergence angle (EA) of < 30° and a concave emergence profile (EP) as well as gingiva thickness (p = 0.002) at the time of the prosthetic restoration significantly improved the annual peri-implant bone loss, independently of the abutment type.

CONCLUSION

ihZiA showed comparable results to pTiA. To optimize the long-term outcome, not just material alone but generating adequate soft tissue thickness, minimizing the EA, and applying a concave EP seem to be the most relevant factors. To improve OH-QoL, particular attention must be paid to the esthetic zone.

Effect of Periodontal Treatment on Reducing Chronic Inflammation in Systemically Healthy Patients With Periodontal Disease

BACKGROUND

We determined the effects and an accurate marker of periodontal treatment on serum interleukin (IL)-6 and high-sensitivity C-reactive protein (HsCRP) levels in systemically healthy individuals with periodontal disease.

METHODS

This multicenter study included systemically healthy individuals with periodontal disease who received initial periodontal treatment and had no periodontal treatment history. Periodontal parameters, including periodontal inflamed surface area, masticatory efficiency, and periodontal disease classification; serum IL-6 and HsCRP levels; and serum immunoglobulin (Ig)G titers against periodontal pathogens were evaluated at baseline and after treatment. Subjects were classified as low or high responders (group) based on periodontal inflamed surface area changes.

RESULTS

There were 153 participants. Only periodontal inflamed surface area changes were markedly different between low and high responders. Periodontal treatment (time point) decreased both serum IL-6 and HsCRP levels. The interaction between group and time point was remarkable only for serum IL-6 levels. Changes in serum immunoglobulin (Ig)G titers against periodontal pathogens were not associated with IL-6 changes in high responders. We analyzed the indirect effect of serum anti-Porphyromonas gingivalis type 2 IgG titer changes using mediation analysis and found no significance. However, the direct effect of group (low or high responder) on IL-6 changes was considerable.

CONCLUSIONS

Periodontal treatment effectively decreased serum IL-6 levels, independent of periodontal pathogen infection, in systemically healthy individuals with periodontal disease.