Risk factors for periodontal disease

Association of smokeless tobacco with periodontal health of patients seeking treatment at a Dental Hospital setting in Sri Lanka

Introduction

Betel chewing has indeed been an integral part of many cultures in South Asia and beyond for centuries. The practice involves the combination of various ingredients, including areca nut (also known as betel nut), slaked lime, and often tobacco, all wrapped in a betel leaf. This mixture is chewed for its stimulating and psychoactive effects. In addition to its widespread cultural significance, betel chewing has been linked to social rituals, celebrations, and even medical practices in some regions. Despite its cultural importance, it's important to note the health concerns associated with betel chewing. The use of areca nut has been linked to an increased risk of oral cancers, gum disease, and other health issues. Some studies also indicate that the combination of areca nut and tobacco significantly raises the risk of developing these conditions.

Main objective

To assess any association of smokeless tobacco (SLT) with periodontal health of patients seeking dental treatment.

Specific objectives

To assess the association of periodontal status with oral hygiene habits of patients seeking dental treatment.To assess the association between smokeless tobacco use with plaque score, bleeding score, BPE (Basic Periodontal Examination) scores and pocket depth measurements.

Materials and method

This was a cross sectional descriptive study, conducted among adult patients above the age of 18 years, randomly selected from the daily diagnostic clinic of the Dental (Teaching) Hospital, Peradeniya (DTHP), Sri Lanka. The sample size was calculated by using Lawanga and Lamshow sample size calculation method (Lwanga & Lemeshow, 1991) ensuring a 95 % confidence level and 80 % power and a systematic sampling technique. The study instrument was a check-list to obtain socio demographic information and periodontal health status.

Results

A total of 355 adult patients were included in the study, with a mean age of 38 (SD ± 15.2 years) and the age range between 18 and75 years. Out of the total study sample, 120 (34 %) were male and 235 (66 %) were female.It was identified that age is significantly associated with severe periodontal disease (p < 0.001, OR = 1.043 per year increase) and Plaque score percentile is a strong predictor (p < 0.001, OR = 1.87), indicating a higher plaque score is linked to severe periodontal destruction.The inferential statistics revealed that there was a statistically significant increase in the plaque scores (P = 0.007), bleeding scores (P = 0.007) and BPE scores (P = 0.003) in smokeless tobacco users when compared with those who do not use smokeless tobacco. Moreover, the periodontal pocket depths (PPD) of smokeless tobacco (SLT) users were significantly greater (P = 0.023) than those of tobacco nonusers (NSLT). Among the SLT users, and those who had good oral health habits which was assessed in related to their brushing frequency, showed no significant association across their periodontal (PDD) pocket depths resembling their PDD health.

Conclusion

The results indicated that smokeless tobacco is detrimental to periodontal health. Habit intervention and reduction in the consumption of smokeless tobacco may significantly reduce periodontal disease, and therefore, these preventive measures should be encouraged in SLT users.

Association between social determinants of health and periodontitis: a population-based study

BACKGROUND

The association between socioeconomic status and periodontitis is intricate. This research examines how social determinants of health relate to periodontitis in U.S. adults, an area that has not been thoroughly studied.

METHODS

This study utilized data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). During each survey cycle, data on self-reported Social Determinants of Health (SDoH) were collected, encompassing employment, family income, food security, education, healthcare access, health insurance, housing instability, and marital status (married or cohabiting). Periodontitis was classified based on Eke's 2012 criteria. The relationship between SDoH and periodontitis was examined using multivariable logistic regression models.

RESULTS

This study involved 10,714 participants (mean age 52.01 ± 14.30 years), with 49.37% male and 50.63% female. The average SDoH score was 2.64 ± 2.00, and the prevalence of periodontitis was 46.60%. The fully adjusted logistic regression model revealed a positive association between SDoH and periodontitis (OR = 1.28; 95% CI, 1.24-1.32, P < 0.001).

CONCLUSIONS

Adverse social determinants of health are associated with an increased risk of periodontitis among US adults.

Hepcidin-regulated iron metabolism disorders in patients with stage III/IV periodontitis

Background

/purposeThe disorders of iron metabolism in periodontal diseases have been reported, however, there is still lack of comprehensive and thorough analyses about the association between periodontitis and iron metabolism disorders. This study aimed to examine the association between periodontitis and iron metabolism disorders, and to analyze the characteristic changes of iron metabolism in periodontitis patients.

Materials and methods

79 Stage III/IV periodontitis patients and 79 healthy controls were enrolled in this study. Periodontal clinical parameters, system inflammation markers, iron metabolism parameters and hematological parameters were collected and compared at baseline and 3 months after non-surgical periodontal therapy.

Results

Stage III/IV periodontitis patients exhibited higher levels of systemic inflammatory markers including white blood cell (WBC) counts and high-sensitivity C-reactive protein (hs- CRP). Serum hepcidin and ferritin were significantly increased in the periodontitis group, meanwhile serum iron and transferrin were significantly decreased. Periodontal therapy attenuated the higher levels of hepcidin and ferritin, and the lower levels of Fe and transferrin in periodontitis patients at 3 months after therapy. Probing depth (PD), bleeding index (BI) and clinical attachment loss (CAL) were positively correlated with hepcidin and ferritin, and negatively correlated with Fe and transferrin respectively. Hepcidin was significantly negatively correlated with Fe and positively correlated with ferritin in periodontitis patients.

Conclusion

Our findings suggest the association between periodontitis and iron metabolism disorders and indicate that periodontitis-activated host responses may increase the risk of iron metabolism disorders, while meaningfully provide new insights into the systemic effects of periodontitis.

IL-35 May Prevent the Exacerbation of Aspiration Pneumonia Involving Porphyromonas gingivalis by Suppressing IL-17 Production

Periodontitis is associated with aspiration pneumonia. However, the relationship between periodontitis and aspiration pneumonia remains unclear. This study investigated the virulence factor of Porphyromonas gingivalis, which exacerbates aspiration pneumonia, and the role of IL-35, an inhibitory heterodimeric cytokine of Epstein-Barr virus-induced gene 3 (EBI3) and p35, in aspiration pneumonia using Ebi3 knockout (KO) mice. Aspiration pneumonia was induced by the intratracheal injection of Streptococcus pneumoniae and P. gingivalis culture supernatant (mixed infection). Leupeptin was used to inhibit gingipain, a virulence factor of P. gingivalis. Four days after infection, lung tissues were collected for analyses. The percentage of interstitium in the group with mixed infection and leupeptin treatment was significantly reduced compared with the nonleupeptin administration group. Additionally, the percentage of interstitium in the field of Ebi3 KO mice was significantly increased compared with wild-type (WT) mice in mixed infection. IL-35 production in WT mice with mixed infection was significantly increased compared with the control group. IL-17 production in Ebi3 KO mice was significantly increased compared with WT mice with mixed infection. These findings suggest that gingipain exacerbates aspiration pneumonia and that IL-35 may contribute to suppressing the exacerbation of aspiration pneumonia.

The Role of Vitamin B Complex in Periodontal Disease: A Systematic Review Examining Supplementation Outcomes, Age Differences in Children and Adults, and Aesthetic Changes

Background and Objectives: Among nutritional factors implicated in periodontal health, the vitamin B complex-particularly folate (vitamin B9), cobalamin (B12), thiamine (B1), and riboflavin (B2)-has gained attention for its role in immunomodulation and tissue repair. This systematic review aims to synthesize current evidence on whether adequate vitamin B complex intake or status is associated with improved periodontal outcomes. Methods: A systematic search was performed in PubMed, Scopus, and Web of Science for observational studies investigating vitamin B complex intake or status in relation to periodontal disease indicators. Articles were screened according to PRISMA guidelines, and five studies met inclusion criteria. Results: Five observational studies were included. In older adults, each standard deviation increase in serum folate was associated with an approximate 26% reduction in periodontal disease odds ratio (OR = 0.74, 95% confidence interval (CI) 0.58-0.93). Among young adult women, inadequate riboflavin (B2) and pyridoxine (B6) intake correlated with higher community periodontal index (CPI) scores (p < 0.05). In a large NHANES-based cohort, insufficient thiamine (B1) intake yielded a 33% higher likelihood of severe periodontitis (p < 0.05), while adequate riboflavin was protective (OR = 0.90). Another dose-response analysis (n = 8959) indicated up to a 30% risk reduction for moderate folate or B1 intake, but no extra benefit with excessive intake. Finally, a UK Biobank analysis (n = 9476) showed that those in the highest quartile of a "high micronutrient" dietary pattern-including vitamins B6 and folate-had a 24% lower risk of self-reported periodontal disease (OR = 0.76, 95% CI 0.65-0.90) compared to the lowest quartile. Conclusions: Across diverse populations, inadequate vitamin B complex intake-especially folate-was consistently linked to worse periodontal outcomes.

Periodontal Disease in Saudi Arabia: A Systematic Review of Prevalence and Associated Risk Factors

Background/Objectives: The oral health disorder periodontal disease is widespread around the world and has a public health dimension. This study aimed to perform a systematic review and an appraised analysis that looks at both the prevalence and diversity of risk factors associated with periodontal disease in Saudi Arabia. It places a particular focus on subgroup analyses and pooled prevalence estimates to identify certain populations that could be described as high risk. Methods: Several databases, including PubMed, Scopus, and Google Scholar, were used to conduct the present systematic review. The search was designed to identify relevant studies published from 1980 to 2023. Both quantitative and qualitative studies were included. Subgroup analyses and meta-analyses were performed using a random-effects model to calculate pooled prevalence rates. The studies were evaluated using three criteria that focused on bias. Finally, the authors created a narrative synthesis of the review findings for ease of understanding. Results: The pooled overall prevalence of periodontal disease was 46.2% (95% CI: 40.5-51.8), with high heterogeneity (I2 = 85%). Subgroup analyses identified obese adults as having the highest prevalence of this condition (71.3%), and individuals diagnosed with diabetes also displayed a significantly high prevalence (52.1%). Adolescents aged 15-19 years had an age-specific prevalence of 8.6%, which was significantly lower than that of the other age groups analyzed. Poor oral hygiene, tobacco use, diabetes, and obesity have been recognized as risk factors for periodontal disease. Conclusions: The substantial burden of periodontal disease in Saudi Arabia, especially among high-risk groups, such as obese and diabetic adults, cannot be overstated. Our public health initiatives need to focus on these high-risk individuals, who are likely to be both periodontally and systemically compromised, to provide lifestyle modification counseling and oral hygiene education for them, as well as to routinize their dental care in a way that minimizes the chances of becoming periodontally compromised.

Association between adjustable dietary factors and periodontitis: NHANES 2009-2014 and Mendelian randomization

BACKGROUND

Periodontitis is the major cause of tooth loss in adults and one of the most common non-communicable diseases. Clinically, periodontitis impairs oral health and associated with various systemic diseases. Maintaining a healthy diet is considered risk reduction of periodontitis. To explore the causal effect between dietary data and periodontitis by Mendelian randomization (MR) analyses.

METHODS

A total of 11,704 participants and 21 dietary variables from the NHANES were in random forest to rank the importance in predicting periodontitis. Data were from the genome wide association studies (GWASs) database to estimate causal relationships between diet data and periodontitis. Two-sample MR analyses were conducted by using the inverse-variance weighted (IVW) method.

RESULTS

The MR showed alcohol consumption and sugars intake increased the risk of chronic periodontitis with odds ratio (OR) 2.768 (95% CI: 1.03e + 00-7.42e + 00) and 2.123 (95% CI: 1.06e + 00-4.26e + 00) respectively. Vitamins and minerals, including folic acid and folate, magnesium, vitamin A, vitamin E, vitamin C, calcium, vitamin D and zinc, were not causally associated with chronic periodontitis. Alcohol consumption greater than 2.5 drinks per day and sugar intake more than 4.88 g increased the risk of periodontitis, with a calculated relative risk of 1.33 and 1.61, respectively.

CONCLUSION

It is suggested to drink alcohol less than 2.5 drinks/day and consume sugar less than 4.88 g/day to avoid alcohol and sugar consumption promoting the development of periodontitis. Establishing a dietary pattern conducive to periodontal health may be the focus of further clinical research.

Identification of key genes in periodontitis

Periodontitis, a prevalent global oral health issue, is primarily characterized by chronic inflammation resulting from bacterial infection. Periodontitis primarily affects the tissues surrounding and supporting the teeth, encompassing the gingival tissue, periodontal attachment apparatus, and the bony socket. The disease mechanism results from intricate interactions between hereditary factors, the body's defense mechanisms, and shifts in the composition of oral microbiota, with each element playing a crucial role in the initiation and advancement of the pathological process. The early symptoms of periodontitis are often not obvious, resulting in patients often not seeking medical attention until they are seriously ill, so finding biomarkers for periodontitis is essential for timely diagnosis and treatment. In this study, we selected two datasets (GSE10334 and GSE16134) by in-depth analysis of publicly available sequencing data of affected and unaffected gum tissue in periodontitis patients in the GEO database. To identify key genes associated with periodontitis pathogenesis and explore potential therapeutic biomarkers, we employed two complementary computational approaches: Random Forest, a robust machine learning algorithm for feature selection, and Weighted Gene Co-expression Network Analysis (WGCNA), a systems biology method for identifying co-expressed gene modules. Through comprehensive analysis of these combined datasets, our objective is to elucidate the underlying molecular pathways governing periodontal disease progression, thereby identifying novel therapeutic targets that may facilitate the design of improved clinical interventions for this condition. This study establishes a substantial scientific foundation that contributes to both clinical applications and fundamental research in periodontitis. The findings not only offer valuable insights for developing early diagnostic strategies and therapeutic interventions but also provide a robust theoretical framework to guide future investigations into the molecular mechanisms underlying this complex disease.

Anti-inflammatory Annexin A1 in Periodontitis via Formyl Peptide Receptor 2

Although annexin A1 (ANXA1) is known to mediate inflammatory responses through N-formyl peptide receptor 2 (FPR2), the role of the ANXA1-FPR2 signaling pathway in periodontal disease remains unclear. This study investigated the contribution of this pathway to the pathophysiology of periodontal disease. Using a ligature-induced mouse model, we performed histologic analyses to examine ANXA1 and FPR2 expression. We observed upregulation of ANXA1 and FPR2 within the gingiva and periodontal ligament. In vitro analysis of human periodontal ligament cells revealed that interleukin 1β (IL-1β)-induced secretion of IL-8 and granulocyte-macrophage colony-stimulating factor was significantly increased in the presence of WRW4, an FPR2 antagonist. Furthermore, IL-1β-mediated upregulation of IL-8 was significantly enhanced in human periodontal ligament cells by silencing ANXA1 and FPR2 expression via small interfering RNAs. The effect of the ANXA1-FPR2 signaling pathway on periodontal tissue destruction was also examined in murine periodontitis under daily administration of WRW4 or an ANXA1 N-terminal mimetic peptide, Ac2-26, with micro-computed tomography and histologic analyses. WRW4 administration significantly intensified alveolar bone resorption, increased the number of osteoclasts on the alveolar bone surface, and dilated blood vessels in the periodontal ligament. Conversely, Ac2-26 administration significantly mitigated alveolar bone resorption. Collectively, these findings suggest a role for the ANXA1-FPR2 signaling pathway in attenuating the pathogenesis of periodontal disease by regulating localized inflammatory responses within periodontal tissues.

Effects of periodontal treatment on periodontal status in Finland: a register-based study

OBJECTIVE

This register-based follow-up study investigated periodontal status after periodontal treatment (PT) based on need following oral health examination (OHE).

MATERIALS AND METHODS

A total of 42,533 adults aged 18-89 years receiving OHE in the public oral health clinics of the City of Helsinki in 2009 were included. Dentists recorded periodontal status by the Community Periodontal Index (CPI), and determined the individual recall interval (IRI). Follow-up OHE between 2010 and 2015 was performed for 16,040 adults based on IRI or later. Outcome of interest was change of CPI during follow-up and was modelled with proportional odds model for each sextant separately. Results were reported as odds ratios (ORs).

RESULTS

Signs of periodontal disease were present in 95% of the study population. Symptoms of periodontitis (CPI score 3 or 4) were observed in 24% of patients. In models, PT indicated better outcome in all six sextants and in sextant 5 after one treatment (OR 5.05, 95% confidence interval [CI] 4.53-5.63). A poorer outcome was observed in patients with diabetes or severe mental disorders and in men.

CONCLUSIONS

The study population had a high prevalence of periodontal diseases. Men and patients with diabetes or severe mental disorders should be specifically targeted by dentists.

A Potential Link Between Oral Microbiota and Female Reproductive Health

Oral cavity dysbiosis is associated with numerous inflammatory diseases, including diabetes, inflammatory bowel diseases, and periodontal disease. Changes in the oral microenvironment lead to bidirectional interactions between pathogens and individual host systems, which may induce systemic inflammation. There is increasing evidence linking the condition of the oral cavity with the most common causes of female infertility, such as polycystic ovary syndrome and endometriosis, as well as gestational complications, e.g., low birth weight, preterm delivery, and miscarriages. This review highlights the composition of the female oral microbiome in relation to infertility-related disorders, such as endometriosis and polycystic ovary syndrome, and provides a comprehensive overview of the current state of knowledge on the relationship between a dysbiotic oral microbiome, pregnancy, and its impact on the female reproductive tract.

Bacterial DNA in patients with ruptured intracranial aneurysms: Investigating the potential role of periodontal and gut microbiota

BACKGROUND AND OBJECTIVES

Chronic periodontal bacterial infections and disruptions in gut microbiota are responsible for systemic inflammation, which may contribute to the rupture of intracranial aneurysm. This study aimed to assess the presence of bacterial DNA from Fusobacterium nucleatum and Escherichia coli within arterial tissues of intracranial aneurysms.

METHODOLOGY

A comprehensive cross-sectional study was conducted, applying stringent inclusion and exclusion criteria to carefully select the study population from patients admitted to the Division of Neurosurgery at Hospital das Clínicas, University of São Paulo. Samples were collected post-aneurysm microsurgical clipping, preserving their integrity for subsequent DNA extraction. Polymerase chain reaction (PCR) techniques were employed to identify bacterial DNA within these samples.

RESULTS

In total, 36 patient samples underwent a detailed analysis. The presence of Escherichia coli DNA exhibited a statistically significant correlation with the occurrence of ruptured intracranial aneurysms (Qualitative Odds Ratio [OR] 4.3 [1.01 - 23.4] and Quantitative OR 0.99 [0.99-1.0], Student's t-test [P = 0.9]). However, the presence of Fusobacterium nucleatum DNA did not demonstrate a statistically significant correlation with ruptured intracranial aneurysms (Qualitative OR 1.52 [0.4-6.1] and Quantitative OR 0.04 [0.01-5.22 ×108], Student's t-test [P = 0.78]).

CONCLUSION

The identification of Escherichia coli bacterial DNA in arterial tissues was positively associated with the occurrence of ruptured intracranial aneurysms, suggesting a potential role for these microorganisms in aneurysm pathogenesis and rupture. The development of therapeutic and prophylactic strategies can be established through future research endeavors.

Burden of periodontal diseases in young adults

We aimed to provide a comprehensive overview of the global burden of periodontal disease among young adults over the period from 1990 to 2019. The analysis considered various factors such as age, sex, country, and Socio-demographic Index (SDI). This study utilized GBD 2019 database to examine the trends in both incidence and disability-adjusted life years (DALY) rates of periodontal diseases among young adults from 1990 to 2019. The data was analyzed based on age-standardization rate. To quantify the temporal and geographic patterns we calculated the estimated annual percentage change (EAPC) and its corresponding 95% confidence interval (CI). The region with the highest age-standardized incidence rate (ASIR) and age-standardized DALY rate was Western sub-Saharan Africa (ASIR: 3949.18, DALY: 336.16) in 2019, while the country with the highest ASIR and age-standardized DALY rate was Qatar (ASIR: 7197.30, DALY: 443.44). the Low SDI area had the highest ASIR and age-standardized DALY rate (ASIR:3469.92, DALY:259.83). The ASIR and age-standardized DALY rate per 100,000 young adults with periodontal diseases exhibited an upward trend from 1990 to 2019, with respective estimated annual percentage changes (EAPC) of 0.41 and 0.45. The high-middle SDI region and middle SDI region both demonstrated a consistent growth pattern, with EAPCs of 0.46 and 0.42, respectively. Over the same time period, Tropical Latin America experienced the largest increase in ASIR and age-standardized DALY rate (EAPCs of 0.55 and 0.63, respectively), while Qatar saw the highest EAPCs in both ASIR (1.55) and age-standardized DALY rate (1.44). The ASIR and age-standardized DALY rate of periodontal disease exhibited a consistent upward trajectory from 1990 to 2019.

Correlation Between Periodontal Disease and Oral, Oropharyngeal, and Parapharyngeal Cancers

Background

Periodontitis is an inflammatory disease, and contributes to several inflammatory conditions, such as cancer. The relationship between periodontal disorders and different human malignancies is not well understood. The purpose of this study is to assess the association of periodontitis severity with cancers in the oral cavity, oropharyngeal and parapharyngeal regions.

Methods

The sample comprised 300 participants divided into four case groups: 75 oral, oropharyngeal, or parapharyngeal cancer patients with periodontitis (CA-with-P); 75 oral, oropharyngeal, or parapharyngeal cancer patients without periodontitis (CA-without-P); 75 periodontitis (P) patients without cancers; and a control (C) group of 75 healthy individuals. All participants were subjected to a periodontal examination that considered parameters such as bleeding on probing (BOP), plaque index (PI), probing pocket depth (PPD), and clinical attachment loss (CAL). The type of tumours was identified via a histological analysis of a biopsy sample. Saliva samples were also collected, and an enzyme-linked immunosorbent assay (ELISA) kit was used to determine interleukin 8 (IL-8) and nuclear factor kappa B (NF-κB) levels.

Results

The research findings indicated a significant increase in the number of sites with clinical observations of BOP (85.11,73.84), PI (87.23.88.14), PPD (8.03,6.82), and CAL (8.67,7.34) in groups CA-with-P and P. The CA-with-P, CA-without-P, and P groups had higher levels of salivary IL-8 (192.03, 121.89,89.22) and NF-κB (10.242, 8.172, 6.324) than the C group. Moreover, there was a significant correlation between the severity of periodontitis and the malignancies in the oral, oropharynx, and parapharyngeal regions.

Conclusion

This study assessed the mechanisms underlying the correlation between these two disorders, as elucidated by higher levels of salivary IL-8, NF-κB and an increase in clinical periodontal parameters. Periodontal bacteria, which contributes to the development of periodontal disorders, could have a major impact on the onset of oral cancers.

Revolutionizing Dentistry: Preclinical Insights and Future Applications of mRNA Vaccines in Dentistry-A Narrative Review

Background: Recent advances in mRNA vaccine technology, accelerated by the global COVID-19 pandemic, have generated significant interest in their applications beyond infectious diseases. Dentistry has emerged as a promising field for exploring the potential of mRNA-based therapies in preventing and treating oral diseases. Objectives: This narrative review aims to evaluate the current status of mRNA vaccine development and its preclinical applications in oral health, focusing on periodontal disease, dental caries, regenerative medicine, implantology, and oral cancer. Methods: The review synthesizes findings from preclinical studies, including research conducted in animal models and in vitro, to assess the potential of mRNA-based therapies to modulate immune responses and promote tissue regeneration in the oral cavity. Clinical trials were only mentioned in the context of broader areas of mRNA vaccine implementation such as oncology and immunotherapy. Results: The preclinical studies highlight the capacity of mRNA vaccines to enhance the body's immune response and facilitate tissue repair processes. Despite these promising results, challenges persist in delivering mRNA vaccines effectively within the complex oral environment. These challenges include vaccine stability, delivery mechanisms, and the modulation of immune responses. Conclusions: While mRNA vaccines offer significant promise for revolutionizing oral health care, they face notable limitations concerning safety, efficacy, and clinical feasibility. Overcoming these obstacles through further research is essential to unlock their full translational potential and ensure their safe and effective integration into dental practice.

Flavonoid gossypetin protects alveolar bone and limits inflammation in ligature-induced periodontitis in mice

BACKGROUND

Bacterial-induced inflammation instigates the destruction of hard and soft tissues surrounding teeth in periodontitis. In severe cases, the increased number and activity of osteoclasts induces the resorption of alveolar bones, ultimately leading to tooth loss. Because of their diverse chemical structures and bioactivities, natural compounds are often suggested to treat a wide variety of diseases, including inflammatory disorders.

METHODS

In the present study, we demonstrated an inhibitory effect of gossypetin, a hexahydroxy flavone, on osteoclast differentiation and bone resorption using in vitro culture of osteoclasts from mouse bone marrow macrophage (BMM) precursors and in vivo model of ligature-induced periodontitis in mice.

RESULTS

Gossypetin significantly reduced the differentiation of osteoclasts from mouse BMM precursors in the presence of the receptor activator of nuclear factor κB ligand (RANKL). In vitro, gossypetin inhibited critical signaling events downstream of RANKL including the auto-amplification of nuclear factor of activated T-cells, cytoplasmic 1, Ca2+ oscillations, and the generation of reactive oxygen species. In a mouse ligature-induced periodontitis model, the administration of gossypetin significantly reduced osteoclastogenesis and alveolar bone resorption. Furthermore, gossypetin prevented the ligature-induced increase in macrophages and T cells and reduced the production of tumor necrosis factor-α and interleukin-6.

CONCLUSION

Taken together, these results show anti-osteoclastogenic and anti-inflammatory effects of gossypetin, suggesting the potential use of this natural compound in periodontitis.

Association between periodontal disease and gestational diabetes: Systematic review and meta-analysis

AIM

Periodontal disease (PD) can aggravate insulin resistance during pregnancy and trigger the development of gestational diabetes mellitus (GDM).

METHODS

A systematic review and meta-analysis was carried out. Two researchers carried out a literature search using internet databases. Studies that met the inclusion criteria were selected. OR was used as the measure of association. The fixed effects model was applied, and due to the presence of heterogeneity, the DerSimonian and Laird random effects model was applied. The level of significance was p < 0.05. The presence of biases was assessed using the Egger test and the funnel plot.

RESULTS

Of the 176 articles found, 11 were included. 2032 pregnant women were analyzed, of which 572 developed GDM. It was found that PD was a risk factor for developing GDM when all studies were assessed (OR=1.83 95 % CI 1.25-2.69, p < 0.0017) and when analyzing only those that included an adjusted OR (OR= 1.83 95 % CI 1.31-2.56, p < 0.004).

CONCLUSIONS

PD poses a high risk of suffering from GDM. The development of oral health programs in women who wish to conceive is essential to improve metabolic control and reduce obstetric and perinatal complications.

A Novel Therapeutic Calcium Peroxide Loaded Injectable Bio-adhesive Hydrogel Against Periodontitis

OBJECTIVES

Periodontitis is a prevalent oral disease that can significantly impact patients' life quality and systemic health. However, non-surgical subgingival scaling is largely compromised due to poor patient compliance, leading to a high recurrence rate of periodontitis. Therefore, this research aims to explore new approaches to enhance the effectiveness of existing local drug administration therapies.

MATERIALS AND METHODS

Gelatin-oxidized dextran hydrogel loaded with calcium peroxide and penicillin (CP-P hydrogel) was synthesized and characterized using Universal mechanical testing machine, Fourier transform infrared spectroscopy, swelling test, and dissolved oxygen meter. Furthermore, the cytotoxicity, osteogenic ability, antibacterial behavior, and alveolar bone regenerating capability of CP-P hydrogel were conducted both in vitro and in vivo.

RESULTS

The CP-P hydrogel demonstrated excellent mechanical properties, minimal swelling, and ideal biocompatibility. It created more favorable environments in the periodontal pocket by reversing anaerobic environment, eliminating drug-resistant bacteria and enhancing the therapeutic potency of drugs. By continuously releasing drugs in the periodontal pocket, the CP-P hydrogel effectively inhibited bacteria and reduce local inflammation response. In addition to bacteriostatic effects, the CP-P hydrogel also promoted the expression of osteogenic genes and enhanced osteogenic differentiation of PDLSCs in vitro.

CONCLUSIONS

CP-P hydrogel can be developed as a new therapeutic platform to enhance the effectiveness of local drug administration strategy against periodontitis.

Dental Caries, Erosive Tooth Wear, and Periodontal Status of Military Student Pilots in Finland: A Comparative Cross-Sectional Study

INTRODUCTION

Oral health is a crucial factor for service safety among military pilots, but studies specifically on pilots are still very few in Finland. The aim of this study was to assess the oral health status of military student pilots compared to other conscripts of the same age group.

MATERIALS AND METHODS

The data were collected during the oral health examinations of the annual class of the Pilot Reserve Officer Course students at the beginning of their duty at the Air Force Academy (N = 38). A voluntary random sample of conscripts' oral health data (N = 574) collected from the 8 largest garrisons was used as a peer group. The study included males born between 2000 and 2002. The examinations were conducted in accordance with the WHO guidelines. Values of decayed (DT), missing, and filled teeth as well as the combined decayed, missing, and filled teeth value were recorded along with Basic Erosive Wear Examination scoring and Community Periodontal Index. The study was designed in accordance with the STROBE guidelines.

RESULTS

The proportion of student pilots without any decayed teeth (DT = 0) was 42.1% with third molars and 44.7% without third molars. Among other conscripts, the proportions were 29.1% and 30.8%, respectively. Mean DT values among student pilots were 1.16 (third molars included) and 1.11 (third molars not included) (P = .543), and among other conscripts 1.10 and 1.00 (P = .429), respectively.The mean decayed, missing, and filled teeth values were 2.50 among student pilots and 3.34 among others (third molars included), and 2.18 and 3.10 (without third molars), respectively (P = .289 and .211).The proportion of student pilots with at least moderate erosive tooth wear (Basic Erosive Wear Examination sum > 2) was 68.4%, while for other conscripts it was 22.1% (P = .000). None of the student pilots fell into Community Periodontal Index class 3 or 4, whereas 9.9% of other conscripts did (P = .006).

CONCLUSIONS

The student pilots exhibited good overall oral health, which differed from that of other conscripts, mainly in terms of erosive changes. Continuous monitoring is crucial, as maintaining optimal oral health is vital for reducing the risk of barodontalgia and thus improving flight safety. Therefore, it is important to be aware that those who aspire to be military pilots are at an increased risk of erosive changes to their teeth.

The association between periodontal disease and adverse pregnancy outcomes: a bibliometric analysis from 2000 to 2023

Background

Periodontal disease (PD) refers to a chronic inflammatory disorder affecting the supporting tissues of the teeth triggered by bacterial infection and is recognized to promote systemic inflammation, leading to dysfunction in specific organs. Adverse pregnancy outcomes (APOs), including preterm birth, small for gestational age infants, gestational diabetes and preeclampsia, are linked to pregnancy complications. Recently, the correlation between periodontal disease and adverse pregnancy outcomes has garnered global attention. However, bibliometric studies in this area remain limited. This study aimed to visualize knowledge framework and research trends concerning the relationship between periodontal disease and adverse pregnancy outcomes from 2000 to 2023 through bibliometric approaches.

Methods

On September 22, 2024, articles and reviews on the connection between periodontal disease and adverse pregnancy outcomes were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace [6.3.R1 (64-bit) Advanced] was used to perform knowledge mapping and bibliometric studies.

Results

Over the past 23 years, 932 articles from 73 countries were collected, with the U.S. contributing over one-third (355), followed by Brazil (85) and India (59). The literature in this field has experienced multiple growth phases since 2000, with particularly rapid growth observed after 2019. The University of North Carolina (n = 34, 3.65%) is the leading institution in terms of publication output, primarily representing the U.S. Notably, the Journal of Periodontology and the American Journal of Obstetrics and Gynecology are the most frequently cited journals in the fields of periodontology and obstetrics, respectively. These publications are authored by 94 researchers, with Steven Offenbacher being both the most productive and most highly cited author, making significant contributions to the field. A visual analysis of keywords identifies "oral microbiota," "oral health," "adverse pregnancy outcomes," and "global burden" as emerging research hotspots in exploring the correlation between periodontal disease and adverse pregnancy outcomes.

Conclusions

This first bibliometric and visual analysis of periodontal disease and adverse pregnancy outcomes offers a concise overview of the field and suggests future research should focus on risk factors, high-risk populations, oral microbiota, mechanisms, interventions, and international collaboration.

Artificial intelligence-powered innovations in periodontal diagnosis: a new era in dental healthcare

Background

The aging population is increasingly affected by periodontal disease, a condition often overlooked due to its asymptomatic nature. Despite its silent onset, periodontitis is linked to various systemic conditions, contributing to severe complications and a reduced quality of life. With over a billion people globally affected, periodontal diseases present a significant public health challenge. Current diagnostic methods, including clinical exams and radiographs, have limitations, emphasizing the need for more accurate detection methods. This study aims to develop AI-driven models to enhance diagnostic precision and consistency in detecting periodontal disease.

Methods

We analyzed 2,000 panoramic radiographs using image processing techniques. The YOLOv8 model segmented teeth, identified the cemento-enamel junction (CEJ), and quantified alveolar bone loss to assess stages of periodontitis.

Results

The teeth segmentation model achieved an accuracy of 97%, while the CEJ and alveolar bone segmentation models reached 98%. The AI system demonstrated outstanding performance, with 94.4% accuracy and perfect sensitivity (100%), surpassing periodontists who achieved 91.1% accuracy and 90.6% sensitivity. General practitioners (GPs) benefitted from AI assistance, reaching 86.7% accuracy and 85.9% sensitivity, further improving diagnostic outcomes.

Conclusions

This study highlights that AI models can effectively detect periodontal bone loss from panoramic radiographs, outperforming current diagnostic methods. The integration of AI into periodontal care offers faster, more accurate, and comprehensive treatment, ultimately improving patient outcomes and alleviating healthcare burdens.

The effect of self-reported flossing behavior on cardiovascular disease events and mortality: Findings from the 2009-2016 National Health and Nutrition Examination Surveys

BACKGROUND

There is increasing evidence suggesting that daily oral hygiene self-care measures may alleviate cardiovascular disease (CVD) risk. The authors aimed to determine the influence of self-reported dental flossing behavior on the prevalence of CVD events, CVD-linked mortality, and a CVD risk marker of inflammation (ie, C-reactive protein [CRP]).

METHODS

Data from 18,801 adult participants of the 2009-2016 National Health and Nutrition Examination Surveys were analyzed with regard to flossing behavior, prevalence of CVD events, mortality cause data, and CRP levels. Information on mortality was obtained from the US mortality registry, updated to 2019. Participants who answered the flossing question were divided into 4 groups according to their frequency of flossing: not flossing (0 d/wk); occasional flossing (1-3 d/wk); frequent flossing (4-6 d/wk); and daily flossing (7 d/wk). Multiple logistic regression and Cox proportional hazard regression were used for analysis.

RESULTS

Daily flossing was associated with lower prevalence of CVD events after adjusting for age, sex, sociodemographic factors, and lifestyle habits (model 2); the odds ratio was 0.71 (95% CI, 0.59 to 0.85) for CVD prevalence in the daily flossing group compared with the not flossing group. The odds ratio for CVD prevalence for each additional day of flossing was 0.95 (95% CI, 0.93 to 0.98; P for linear trend < .001) in model 2, and remained statistically significant after model 2 was further adjusted for metabolic syndrome. Daily flossing compared with not flossing was associated with lower risk of experiencing CVD mortality (hazard ratio, 0.64; 95% CI, 0.49 to 0.84) in model 2. The hazard ratio of CVD mortality for each additional day of flossing was 0.94 (95% CI, 0.90 to 0.98; P for linear trend = .002) in model 2. Participants in the not flossing group had significantly elevated CRP levels, even after multivariable adjustments.

CONCLUSIONS

Poor flossing behavior is associated with higher prevalence of cardiovascular events, increased risk of experiencing CVD mortality, and elevated CRP levels.

PRACTICAL IMPLICATIONS

Improvement in flossing behavior can have an additional benefit in the prevention of CVD events. Cardiologists need to advise patients to improve their personal oral hygiene practices, in addition to the standard diet and exercise advice.

Periodontitis diagnosis: A review of current and future trends in artificial intelligence

BACKGROUND

Artificial intelligence (AI) acts as the state-of-the-art in periodontitis diagnosis in dentistry. Current diagnostic challenges include errors due to a lack of experienced dentists, limited time for radiograph analysis, and mandatory reporting, impacting care quality, cost, and efficiency.

OBJECTIVE

This review aims to evaluate the current and future trends in AI for diagnosing periodontitis.

METHODS

A thorough literature review was conducted following PRISMA guidelines. We searched databases including PubMed, Scopus, Wiley Online Library, and ScienceDirect for studies published between January 2018 and December 2023. Keywords used in the search included "artificial intelligence," "panoramic radiograph," "periodontitis," "periodontal disease," and "diagnosis."

RESULTS

The review included 12 studies from an initial 211 records. These studies used advanced models, particularly convolutional neural networks (CNNs), demonstrating accuracy rates for periodontal bone loss detection ranging from 0.76 to 0.98. Methodologies included deep learning hybrid methods, automated identification systems, and machine learning classifiers, enhancing diagnostic precision and efficiency.

CONCLUSIONS

Integrating AI innovations in periodontitis diagnosis enhances diagnostic accuracy and efficiency, providing a robust alternative to conventional methods. These technologies offer quicker, less labor-intensive, and more precise alternatives to classical approaches. Future research should focus on improving AI model reliability and generalizability to ensure widespread clinical adoption.

Progesterone affects periodontitis in perimenopausal women and in an experimental rat model

Background/purpose

Progesterone (PG) is sex steroid hormone that commonly used to control menopausal symptoms, but its exact role in periodontitis remains unclear. This study aimed to investigate the effects of PG on periodontitis in perimenopausal women and in an experimental rat model.

Materials and methods

Total 412 perimenopausal women with periodontitis and a history of PG deficiency-induced uterine dysfunctional bleeding were enrolled, among which 209 women had been treated with PG. The alveolar bone height (ABH) and bone mineral density (BMD) were measured by cone beam computed tomography in the full-mouth. Additionally, a ligation-induced rat model of periodontitis was established. After treated with PG, the alveolar bone was evaluated by micro-computed tomography, and the expression of osteogenic and inflammatory markers was evaluated by immunohistochemistry. The levels of inflammatory markers were further measured by enzyme linked immunosorbent assay.

Results

In perimenopausal women with periodontitis, significantly lower maximum mesial ABH and higher minimum lingual/palatal BMD were revealed in the PG group than in the control group. Compared with the control group, the mean values of BMD around all teeth were significantly higher in the PG group. In a rat model of periodontitis, the intervention of PG significantly improved the quality of alveolar bone, up-regulated osteogenic markers, and down-regulated inflammatory markers.

Conclusion

PG is associated with the remission of alveolar bone loss in perimenopausal women with periodontitis. PG may contribute to the remission of periodontitis through inhibiting alveolar bone loss and inflammation.

Explainable Deep Learning Approaches for Risk Screening of Periodontitis

Several pieces of evidence have been reported regarding the association between periodontitis and systemic diseases. Despite the emphasized significance of prevention and early diagnosis of periodontitis, there is still a lack of a clinical tool for early screening of this condition. Therefore, this study aims to use explainable artificial intelligence (XAI) technology to facilitate early screening of periodontitis. This is achieved by analyzing various clinical features and providing individualized risk assessment using XAI. We used 1,012 variables for a total of 30,465 participants data from National Health and Nutrition Examination Survey (NHANES). After preprocessing, 9,632 and 5,601 participants were left for all age groups and the over 50 y age group, respectively. They were used to train deep learning and machine learning models optimized for opportunistic screening and diagnosis analysis of periodontitis based on Centers for Disease Control and Prevention/ American Academy of Pediatrics case definition. Local interpretable model-agnostic explanations (LIME) were applied to evaluate potential associated factors, including demographic, lifestyle, medical, and biochemical factors. The deep learning models showed area under the curve values of 0.858 ± 0.011 for the opportunistic screening and 0.865 ± 0.008 for the diagnostic dataset, outperforming baselines. By using LIME, we elicited important features and assessed the combined impact and interpretation of each feature on individual risk. Associated factors such as age, sex, diabetes status, tissue transglutaminase, and smoking status have emerged as crucial features that are about twice as important than other features, while arthritis, sleep disorders, high blood pressure, cholesterol levels, and overweight have also been identified as contributing factors to periodontitis. The feature contribution rankings generated with XAI offered insights that align well with clinically recognized associated factors for periodontitis. These results highlight the utility of XAI in deep learning-based associated factor analysis for detecting clinically associated factors and the assistance of XAI in developing early detection and prevention strategies for periodontitis in medical checkups.

Salivary features of periodontitis and gingivitis in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is associated with cellular abnormalities, tissue and organ dysfunctions, and periodontitis. This investigation examined the relationship between the oral microbiome and salivary biomarkers in T2DM patients with or without periodontitis. This cohort (35-80 years) included systemically healthy non-periodontitis (NP; n = 31), T2DM without periodontitis (DWoP; n = 32) and T2DM with periodontitis (DWP; n = 29). The oral microbiome [Operational Taxonomic Units (OTUs)] (16 s rRNA sequencing) and targeted host salivary biomarkers (immunoassays) were assessed. We identified 47 OTUs that were significantly different in abundance between NP samples and any disease subset or between disease subgroups. The most unique microbiome patterns were observed in the DWP group. Differences in genera/species abundance were also observed when T2DM patients were stratified by extent of periodontal inflammation and disease (i.e., generalized versus localized gingivitis/periodontitis). Salivary biomarkers showed significant elevations in MMP-8, MMP-9, resistin, IL-1β, IL-6, IFNα, and BAFF (THFSR13b) comparing generalized to localized periodontitis. Salivary analytes showed significant positive correlations with specific microbiome members, predominantly in DWP patients. Odds ratio analyses reinforced that a panel of biologic markers (IL-6, MMP-8) and bacteria (e.g., Bacteroidetes, Fusobacteria, Spirochaetes) discriminated the severity and extent of periodontal disease in this diabetic population.

Association between type 2 diabetes and periodontitis: a population-based study in the North Peru

Background

Periodontitis, one of the most common forms of periodontal disease, has been linked to several cardiovascular factors including metabolic syndrome and inflammatory processes. This study aimed to determine the association between type 2 diabetes mellitus (T2DM) and periodontitis in a representative sample of individuals in the north of Peru.

Materials and methods

Secondary data analysis using information of a population-based survey, enrolling subjects aged 35 to 69 years. The outcome was periodontitis, evaluated using a self-reported and validated 8-item questionnaire (≥5 points compatible with severe periodontitis compared to those without severe periodontitis), whereas the exposure was the presence of T2DM, evaluated using results of oral glucose tolerance test and categorized into two different forms: (a) normoglycemic, prediabetes, and T2DM, and (b) without T2DM, with T2DM and <5 years of diagnosis, and with T2DM and ≥5 years of diagnosis. Poisson regression models were utilized to report prevalence ratios (PR) and 95% confidence intervals (95% CI).

Results

Data from 1606 individuals were analyzed, with a mean age of 48.2 (SD: 10.6) years, and 50.3% were women. Of these, 272 (16.9%) had prediabetes and 176 (11.0%) had T2DM (71.6% with <5 years of disease). Overall, 97.0% presented at least one symptom compatible with periodontitis, 882 (55.0%) had mild, 643 (40.0%) had moderate, and 5% had severe periodontitis. In multivariable model, those with T2DM had a higher prevalence of severe periodontitis (PR = 1.99; 95% CI: 1.12 - 3.54). Similarly, those with <5 years of disease had a higher prevalence of severe periodontitis (PR = 2.48; 95% CI: 1.38 - 4.46).

Conclusions

Our research confirms the association between T2DM and severe periodontitis, especially among those with recent diagnosis (<5 years). Symptoms of periodontitis are quite common in our study population. Our results suggest a need to periodically assess oral health in patients with T2DM.

Effects of periodontal disease on the reproductive performance and offspring of Wistar rats

BACKGROUND

Periodontitis can induce systemic inflammation, and it may affect the testicles and male reproductive performance. This study investigated the effects of periodontitis on the testicles, reproductive performance, and offspring development in male rats.

METHODS

Male Wistar rats were induced with periodontitis by ligating their first molars. After 14 days of inducing periodontal lesions, the animals were observed for an additional 54 days, corresponding to a complete cycle of spermatogenesis. Rats from the periodontitis group (GP, n = 12) and the control group (GC, n = 12) were paired with healthy females (n = 48) for 10 days, equivalent to 2 estrous cycles. Post-mating, the males underwent microtomographic, histological, and reproductive parameter assessments.

RESULTS

Microtomographic analysis revealed higher porosity around the first molar in GP (26 ± 6%) and greater distance between the amelocemental junction and the alveolar bone (1.37 [1.12-1.90] mm), indicative of bone resorption. GP also exhibited significant decreases in final body weight, reduced Sertoli and Leydig cell counts, and lowered testosterone levels compared to GC. Significant morphological alterations in sperm tails were observed in GP compared to GC.

CONCLUSIONS

Periodontitis adversely affected reproductive performance, evoking, and offspring development in male rats. These findings highlight the systemic impacts of periodontal disease on male reproductive health in an animal model.

PLAIN LANGUAGE SUMMARY

Our study investigated how periodontitis can affect male reproductive health in rats and offspring development. We induced periodontitis in male rats and, after a full cycle of sperm production, these rats were mated with healthy females. We observed that the rats with periodontitis had worse reproductive performance compared to the control group without periodontitis. Additionally, the offspring of the rats with periodontitis showed signs of compromised intrauterine development and a higher incidence of congenital malformations. These results highlight that the inflammation caused by periodontitis can have adverse effects beyond the mouth, significantly impacting male reproductive health and offspring development. These findings suggest the need for further research into the clinical implications of periodontitis on reproductive health.

Association of Interleukin-1α with periodontitis among Indians: a narrative review

Background

The etiology of periodontitis is multifactorial, involving interactions between bacterial pathogens, host immune response, and environmental factors. Among the host immune factors, interleukin-1 alpha (IL-1α) has been implicated in the pathogenesis of periodontitis. Many studies have aimed to find the association between IL-1α and periodontitis in various populations worldwide. However, the evidence in the Indian population is limited. Therefore, this study aims to analyse data from the literature related to the genetic correlation between IL-1α polymorphisms and periodontitis among Indians.

Method

Only case-control and cross-sectional studies investigating the association between IL-1α polymorphisms (+4,845 and -889) and various forms of periodontitis in the Indian population were included. PubMed, Medline, Web of Science, Cochrane based reviews, Scopus, and Google Scholar were used for the search.

Results

The findings demonstrate a mixed pattern of associations between these polymorphisms and periodontitis across different regions of India.

Conclusion

The correlation of periodontitis with IL-1α polymorphism in Indians lacks evidence.

Identification of key signaling pathways and novel computational drug target for oral cancer, metabolic disorders and periodontal disease

AIM

Due to conventional endocrinological methods, there is presently no shared work available, and no therapeutic options have been demonstrated in oral cancer (OC) and periodontal disease (PD), type 2 diabetes (T2D), and obese patients. The aim of this study is to determine the similar molecular pathways and potential therapeutic targets in PD, OC, T2D, and obesity that may be used to anticipate the progression of the disease.

METHODS

Four Gene Expression Omnibus (GEO) microarray datasets (GSE29221, GSE15773, GSE16134, and GSE13601) are used for finding differentially expressed genes (DEGs) for T2D, obese, and PD patients with OC in order to explore comparable pathways and therapeutic medications. Gene ontology (GO) and pathway analysis were used to investigate the functional annotations of the genes. The hub genes were then identified using protein-protein interaction (PPI) networks, and the most significant PPI components were evaluated using a clustering approach.

RESULTS

These three gene expression-based datasets yielded a total of seven common DEGs. According to the GO annotation, the majority of the DEGs were connected with the microtubule cytoskeleton structure involved in mitosis. The KEGG pathways revealed that the concordant DEGs are connected to the cell cycle and progesterone-mediated oocyte maturation. Based on topological analysis of the PPI network, major hub genes (CCNB1, BUB1, TTK, PLAT, and AHNAK) and notable modules were revealed. This work additionally identified the connection of TF genes and miRNAs with common DEGs, as well as TF activity.

CONCLUSION

Predictive drug analysis yielded concordant drug compounds involved with T2D, OC, PD, and obesity disorder, which might be beneficial for examining the diagnosis, treatment, and prognosis of metabolic disorders and Oral cancer.

Electronic Cigarettes and Peri-Implantitis: An Umbrella Review

Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis is unknown. The present review evaluates the impact of electronic cigarettes on peri-implantitis and compares the results with traditional cigarettes and nonsmokers. Systematic/meta-analysis studies were searched in PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar until December 30, 2022. Five systematic/meta-analysis studies were identified based on the search strategy in the selected databases. The overall quality assessment of the studies showed acceptable evidence with high quality. All systematic review studies showed that compared with traditional tobacco smoke, electronic cigarettes might reduce or not change the clinical inflammatory symptoms of periodontitis and peri-implantitis, such as bleeding on probing, probing depth, peri-implant bone loss, and response to treatments. Electronic cigarettes contain nicotine, which can harm periodontal and implant health. On the other hand, a wide range of oral health consequences may be associated with using e-cigarettes. E-cigarette is a potential risk factor for the healing process and the results of implant treatment.

Correlation of serum vitamin D and IL-8 to stages of periodontitis: a case-control analysis

OBJECTIVES

The current literature lacks the correlation between serum levels of vitamin D and interleukin-8 (IL-8) to the stages of periodontitis. The present research objectives are to evaluate the serum levels of vitamin D and IL-8 in periodontitis participants and healthy controls and to measure their correlation with the stages of periodontitis.

METHODS

The current case-control study was conducted on patients with periodontitis and healthy controls. After obtaining a questionnaire from the participants, the following clinical parameters were measured; periodontal probing depth (PPD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and tooth count. The serum levels of vitamin D and IL-8 were measured using ELISA kits. Then, we measured the correlation of the stages of periodontitis with the serum levels of vitamin D and IL-8.

RESULTS

Ninety-eight participants; 52 with periodontitis and 46 healthy controls were included. The patients with periodontitis showed a significantly lower level of vitamin D, higher PPD, CAL, BOP, and lower number of teeth than the controls. In addition, serum vitamin D significantly correlated with the stages of periodontitis. Serum IL-8 showed no significant difference between the study and control groups while it does not significantly correlate with the stages of periodontitis.

CONCLUSION

The current study's findings suggest a potential association between serum level of vitamin D with severity of periodontitis which necessitates screening vitamin D status in patients with periodontitis and investigating the possibility of vitamin D supplementation in decreasing the progression of periodontitis.

Oral Health of Children and Adolescents with Diabetes Mellitus

Aim: To examine the oral health of children and adolescents with and without diabetes mellitus. Background: Diabetes mellitus is the most common metabolic disease in childhood and demonstrates an increasing incidence. Many children live with gingivitis as a precursor to periodontitis. If left untreated, it can cause the development of periodontitis. The links between periodontitis and diabetes mellitus are known but have been little studied in the age group of children and adolescents. Materials and Methods: Clinical examination and collection of sulcus fluid from participants aged 5 to 21 years was performed. The following data were collected: demographic variables, caries prevalence, DMF-T, VPI, PUFA, salivary flow rate, HbA1c, PSI, and the concentration of IL-1β, IL-6, MMP-8, and TNF-α. Results: Patients with diabetes mellitus showed a significantly lower salivary flow rate with higher concentrations of MMP-8 and IL-1β. The data indicate that at this age, regular visits to the dentist are of great importance for the promotion of oral health in children and adolescents regardless of diabetes and that patients with diabetes mellitus in particular benefit from prevention, as they belong to the periodontitis risk group. Conclusions: Patients with low salivary flow rates and increased inflammatory mediators are high-risk patients for whom dental preventive measures play a major role.

E-cadherin Single Nucleotide Variants Are Associated with Increasing Susceptibility to Periodontitis

OBJECTIVES

 To investigate the association of E-cadherin single nucleotide polymorphisms (SNPs) with periodontitis and the potential of these SNPs for identifying susceptibility to periodontitis.

MATERIALS AND METHODS

 Periodontal clinical parameters were recorded followed by collecting venous blood for DNA extraction. Polymerase chain reaction was used to amplify target segments of the E-cadherin gene. Determination of the genotype and allele frequencies was performed using Sanger sequencing. All statistical analyses were performed using GraphPad Prism (version 9) using a statistically significant difference of p < 0.05.

RESULTS

 A total of 207 participants were recruited into two groups of healthy controls (n = 105) and cases diagnosed with periodontitis stage 2 or 3, grade B or C (n = 102). Analyses indicated that the genotypes and alleles of rs3743674 and rs5030625 E-cadherin SNPs were significantly associated with periodontitis. Results from a binary regression model suggested that the presence of these SNPs may indicate susceptibility to periodontitis and increase the rate of progression. Linkage disequilibrium analysis indicated that E-cadherin variants rs3743674 and rs5030625, and rs10272115 and rs16260 were correlated in a nonrandom manner (r 2 = 0.638 and 0.495, respectively).

CONCLUSION

 E-cadherin gene variants, rs3743674 and rs5030625, were associated with the periodontitis phenotype. These biomarkers may identify individuals susceptible to periodontitis and the rate of disease progression.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009-2014)

BACKGROUND

The cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.

METHODS

We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.

RESULTS

TG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538-0.570)] than in the WC [0.544 (0.528-0.560)] and WHtR [0.544 (0.528-0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

The association of reproductive health factors with periodontitis in 45-80 years old US women from NHANES 2009-2014

OBJECTIVES

We investigated the association of female reproductive factors with periodontitis.

MATERIALS AND METHODS

This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2014 on 2321 women aged 45-80 years who had full-mouth periodontal examination and reproductive questionnaire. The 2018 World Workshop Classification of Periodontal and Peri-implant Diseases was used to classify periodontitis stages.

RESULTS

After adjustment, > 3 pregnancies or live births were associated with increased stage III/IV periodontitis but age at first birth (AFB) > 23 years and female hormone use were associated with decreased stage III/IV periodontitis, while there were no associations of oral contraceptive use or menopause status with stage III/IV periodontitis. Stage III/IV periodontitis was more common in women with > 3 pregnancies or live births and AFB ≤ 23 years or never using female hormones but less common in women with ≥ 3 pregnancies or > 3 live births and AFB > 23 years or using female hormones. >3 pregnancies or live births were related with increased stage III/IV periodontitis and increased AFB was related with lowered stage III/IV periodontitis in overweight and smoking subgroups but using female hormone was related with reduced stage III/IV periodontitis in nonsmoking, non-overweight and black subgroups.

CONCLUSIONS

>3 pregnancies/live births were related with severe periodontitis but AFB > 23 years and female hormone use were related with ameliorating periodontitis.

CLINICAL RELEVANCE

Women with > 3 pregnancies/live births should receive intensive periodontal interventions. Female hormone therapy or AFB > 23 years may be beneficial for periodontal health of > 3 pregnancies/live births women.

Association of the Life's Essential 8 cardiovascular health score with periodontitis among US adults

AIM

To investigate whether cardiovascular health (CVH) is associated with periodontitis.

MATERIALS AND METHODS

We used data from the 2009 to 2014 National Health and Nutrition Examination Survey. We quantified CVH using Life's Essential 8, which includes four health behaviours (diet, smoking, physical activity and sleep) and four health factors (body mass index, blood cholesterol, glucose and pressure). We categorized scores as low (0-49), moderate (50-79) and high (80-100). We calculated subscores of health behaviours and factors and categorized them as low, moderate and high. We used logistic regression to assess the association of CVH with periodontitis, adjusting for age, gender, race/ethnicity, education, poverty index, marital status and health insurance. We computed odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

This study included 9296 adults ≥30 years old. Multivariable-adjusted models showed that subjects with moderate (OR, 0.62; 95% CI: 0.52-0.74) or high (OR, 0.43; 95% CI: 0.33-0.57) CVH had significantly lower odds of periodontitis compared to those with low CVH. These results were consistent in the health behaviours model, but the estimates in the health factors model were not significant.

CONCLUSIONS

Improving CVH may help prevent periodontitis. Longitudinal studies are needed to confirm our findings.

The Role of Interleukin-8 in the Estimation of Responsiveness to Steps 1 and 2 of Periodontal Therapy

OBJECTIVE

To investigate the association between interleukin-8 (IL-8) levels in gingival crevicular fluid (GCF) and total oral fluid (TOF) and the responsiveness to steps 1 and 2 of periodontal therapy.

MATERIALS AND METHODS

One-hundred and fifty-nine patients affected by periodontitis received steps 1 and 2 of periodontal therapy. At baseline, TOF and GCF samples were collected and analysed for IL-8 (Il-8TOF/IL-8GCF) using flow cytometry. Therapy outcomes were relative proportions of residual periodontal pockets (PPD%), pocket closure (PC) rates and pocket probing depth (PPD) reductions; these were associated with IL-8TOF/IL-8GCF.

RESULTS

High IL-8TOF was significantly associated with higher residual PPD% (p = 0.044) and lower PPD reduction compared to low IL-8TOF (high 0.79 ± 1.20 mm vs. low 1.20 ± 1.20 mm, p < 0.001) in non-smokers, while in smokers high IL-8GCF was related to lower PPD reduction (high 0.62 ± 1.22 mm vs. low 0.84 ± 1.12 mm, p = 0.009). Furthermore, high baseline IL-8TOF was significantly associated with poorer PC rates compared to medium and low concentrations in both non-smokers (high 41% vs. medium 55% vs. low 58%, p < 0.001) and smokers (high 34% vs. medium 44% vs. low 46%, p < 0.001).

CONCLUSION

High IL-8 concentrations at baseline had a significant impact on residual PPD%, PC rates and PPD reduction. The findings suggest that, especially in non-smokers, baseline IL-8 levels collected from the TOF could serve as a component in the estimation of responsiveness to steps 1 and 2 of periodontal therapy.

The Management of Periodontally Diseased Individuals-A Registry-Based Study on a Swedish Population

OBJECTIVES

This registry-based study aimed to describe cross-sectional dental and demographic data with focus on diagnosis and treatment of periodontal disease. A second aim was to analyse the extent and content of performed periodontal treatment in patients with varying degrees of periodontitis and if treatment was provided on equal terms. An additional aim was to identify if possible differences in treatments were related to type of dental insurance system.

METHODS

A study population, 225,913 individuals ≥ 20 years living in the Region of Västra Götaland, was identified by the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa). Registry data were retrieved for the period 2010-2012. Logistic regression models were used to predict the probability of receiving periodontal interventions and access to fixed annual fees.

RESULTS

Among the study population, 17% had periodontal disease (≥ 4 teeth with periodontal pockets ≥ 4 mm) and constituted the final study sample. The probability of periodontal intervention increased with severity of periodontitis, in moderate (OR = 2.3) and severe cases (OR = 5.2) compared to the group with minor disease (p < 0.001). Severe periodontitis was associated with male gender, increasing age and smoking. About 30% of the individuals remained untreated over the 3-year period. Individuals with fee-for-service were more likely to receive periodontal intervention than individuals with fixed annual fees (OR = 1.7; p < 0.001).

CONCLUSION

Severe periodontitis and being in the fee-for-service system were associated with more periodontal interventions. However, one-third of the study subjects remained untreated. These findings indicate the need for improved care on equal terms for patients with periodontal disease.

Correlation between Periodontitis and Onset of Alzheimer's Disease: A Literature Review

BACKGROUND

Alzheimer's disease is a slowly progressing neurodegenerative illness and the most common form of dementia. This pathology leads to an increase in cognitive decline and is responsible, in patients, for several difficulties in performing various activities of daily living, such as oral hygiene. Several experimental studies have shown that oral health in patients with Alzheimer's disease worsens in direct proportion to the progression of the disease due to the appearance of gingivitis and periodontitis.

METHODS

This clinical literature review aims to evaluate a possible correlation between periodontal disease and Alzheimer's disease, trying to understand if the periopathogens can contribute to the onset or the progression of Alzheimer's disease (AD). The study was conducted on the database PubMed (MEDLINE) of full-text systematic reviews in English on humans and animals that were published in the last five years, from 2018 to 2023. This returned 50 publications, which, once the eligibility criteria were applied, resulted in the 10 publications examined in this review. The selected articles were organized through the construction of tables, analyzed, and compared through Judith Garrard's Matrix method to arrive at the review results.

RESULTS

Infection by periopathogens can increase the risk of developing Alzheimer's disease, but also the onset of the latter can make it more difficult to maintain proper oral hygiene, favoring the onset of periodontal disease: it is possible to affirm the existence of a correlation between periodontitis and AD. It was found that patients exposed to chronic periodontitis have a greater risk of developing a cognitive decline or AD and that oral pathogens can be responsible for neuropathologies and increasing systemic inflammation.

CONCLUSIONS

Periodontitis and periodontal pathogens represent a real risk factor for the onset or worsening of AD; however, the pathogenetic mechanism is still not completely clear.

Heme oxygenase-1: potential therapeutic targets for periodontitis

Periodontitis is one of the most prevalent inflammatory disease worldwide, which affects 11% of the global population and is a major cause of tooth loss. Recently, oxidative stress (OS) has been found to be the pivital pathophysiological mechanism of periodontitis, and overactivated OS will lead to inflammation, apoptosis, pyroptosis and alveolar bone resorption. Interestingly, heme oxygenase-1 (HO-1), a rate-limiting enzyme in heme degradation, can exert antioxidant activites through its products-carbon monoxide (CO), Fe2+, biliverdin and bilirubin in the inflammatory microenvironment, thus exhibiting anti-inflammatory, anti-apoptotic, anti-pyroptosis and bone homeostasis-regulating properties. In this review, particular focus is given to the role of HO-1 in periodontitis, including the spatial-temporal expression in periodental tissues and pathophysiological mechanisms of HO-1 in periodontitis, as well as the current therapeutic applications of HO-1 targeted drugs for periodontitis. This review aims to elucidate the potential applications of various HO-1 targeted drug therapy in the management of periodontitis, investigate the influence of diverse functional groups on HO-1 and periodontitis, and pave the way for the development of a new generation of therapeutics that will benefit patients suffering from periodontitis.

The seasonal occurrence of periodontitis - a retrospective cohort study from a practice-based research network

OBJECTIVE

Many diseases are characterised by their seasonal appearance due to circannual changes in immune defence and a lifestyle that changes over the seasons. However, there is a lack of studies regarding the influence of seasonality on periodontitis. Therefore, the aim of this non-interventional, retrospective, observational study was to investigate the influence of seasonality on periodontitis.

MATERIALS AND METHODS

Periodontal parameters of 5,908 patients of a practice-based research network (PBRN) were analysed. Probing pocket depth (PPD), Bleeding on Probing (BOP) and tooth mobility were assessed for seasonal fluctuations.

RESULTS

Within the PBRN patient data, seasonality was significantly associated with PPD of the individual months in patients with periodontitis. Pairwise comparison between the months showed significantly higher PPD in July compared to several months. PPD appeared significantly lower in December compared to June and November. Regarding season, the proportion of deep PPDs ([Formula: see text]6 mm) was significantly higher in summer compared to autumn (p = 0.024). Concerning BOP, a significant difference between winter and autumn could be observed (p = 0.016). No seasonal influence was found for tooth mobility.

CONCLUSION

This practice-network based study indicated a tendency for seasonal variations in periodontal parameters among periodontal patients. However, the differences did not achieve clinical relevance.

CLINICAL RELEVANCE

Regarding the seasonality of several diseases there might also be an influence of seasons on the periodontium, which would have a potential influence on periodontal studies and daily periodontal examination.

The association between interdental cleaning and periodontitis in an urban Thai adult cohort: a cross-sectional study

BACKGROUND

Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort.

METHODS

Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes.

RESULTS

Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group.

CONCLUSIONS

Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health.

TRIAL REGISTRATION

The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 ( https://www.thaiclinicaltrials.org ).

Risk factors of periodontal disease: Latin America and the Caribbean Consensus 2024

There is scarcity of information on the determinants of periodontitis in Latin America and Caribbean countries. We conducted a comprehensive review of studies examining the association of smoking and diabetes with periodontitis outcomes in this region. We searched for population-based, cross-sectional and prospective cohort studies from Latin America and the Caribbean region that reported on the association between smoking or diabetes and periodontitis. Databases were searched up to October 2023 by two reviewers. Subsequently, two authors independently conducted a rigorous data extraction process, focusing on study characteristics, the definition of exposures, and periodontitis outcomes, including measures of association and main findings. The results revealed a significant association between smoking and periodontitis, with a stronger effect observed in heavy smokers. Conversely, while some studies observed a higher prevalence of periodontitis among diabetic individuals, the association between diabetes and periodontitis was not significant after adjusting for confounding factors. These findings underscore a significant research gap in population-based studies on the effect of smoking and diabetes on periodontitis within Latin American and Caribbean countries, particularly when it comes to cohort studies. Addressing these gaps is crucial for a deeper understanding of these associations, which could lead to more effective prevention and treatment strategies in the region.

Hormone replacement therapy and periodontitis progression in postmenopausal women: A prospective cohort study

OBJECTIVE

This study aimed to investigate the responses of periodontal environment to hormone replacement therapy (HRT) in postmenopausal women with or without periodontitis.

BACKGROUND

HRT is a common and effective strategy for controlling menopausal symptoms, while the changes of periodontal environment under it, particularly in postmenopausal women with periodontitis, remain unclear.

METHODS

As a prospective cohort study, a total of 97 postmenopausal women receiving HRT were screened, including 47 with and 50 without periodontitis. Correspondingly, 97 women did not receiving HRT were screened as controls during the same period. The full-mouth sulcus bleeding index (SBI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were measured using periodontal probes. The levels of interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in the gingival crevicular fluid were measured using enzyme-linked immunosorbent assay. In addition, cone beam computed tomography was performed to measure the alveolar bone height (ABH) and bone mineral density (BMD).

RESULTS

In postmenopausal women without periodontitis, no significantly changes on periodontal parameters were observed after HRT. In women with stage II periodontitis, SBI, BOP, IL-6, and TNF-α were significant decreased after one year and two years of HRT. Compared to the controls, women with stage II periodontitis who underwent HRT had significantly lower CAL and ABH and higher BMD in the second year. The incidence of at least one site with CAL increase ≥1 mm between baseline and 2 years was significantly lower in the HRT group than in the control group in women with stage II periodontitis. In addition, HRT was significantly associated with a decrease in SBI, BOP, IL-6, and TNF-α in the first year and with a decrease in CAL, SBI, BOP, IL-6, and ABH and an increase in BMD in the second year.

CONCLUSIONS

In postmenopausal women with stage II periodontitis, HRT is associated with the alleviation of inflammation within two years and the remission of alveolar bone loss in the second year. HRT appears to decrease the incidence of CAL increase ≥1 mm within 2 years in women with periodontitis by inhibiting inflammation and alveolar bone loss.

The Protective Role Antioxidant of Vitamin C in the Prevention of oral Disease: A Scoping Review of Current Literature

This review meticulously examined the connection between vitamin C and periodontal disease, as well as the potential of vitamin C to prevent this condition. To gather relevant data, comprehensive electronic searches were conducted across various databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, focusing on studies that explored the relationship between vitamin C and periodontal disease in individuals aged between 18 and above. From an initial pool of 421 articles, 14 were ultimately chosen for detailed analysis. This selection encompassed seven cross-sectional studies, two case-control studies, two cohort studies, and three randomized controlled trials. The analysis of these studies revealed a consistent negative association between vitamin C intake, as well as its levels in the blood, and the incidence of periodontal disease across all seven cross-sectional studies. This indicates that higher vitamin C intake and blood levels are linked to a decreased risk of developing periodontal disease. In the two case-control studies, individuals suffering from periodontitis were found to have both a lower intake of vitamin C and reduced levels of vitamin C in their blood compared to those without the disease, further underscoring the potential protective role of vitamin C against periodontal disease. The progression of periodontal disease was observed to be more rapid in patients with lower dietary intake or blood levels of vitamin C compared to controls. Regarding the effects of vitamin C administration as an intervention, there was an improvement noted in gingival bleeding among patients with gingivitis; however, no significant benefits were observed in cases of periodontitis, specifically concerning alveolar bone absorption. Through the meticulous examination of available studies, this systematic review underscores the notion that adequate vitamin C intake and maintaining sufficient levels of vitamin C in the blood can contribute significantly to reducing the risk of periodontal disease.

Systemic Factors Affecting Prognosis in Periodontics: Part II

This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.

Systemic Factors Affecting Prognosis in Restorative and Prosthetic Dentistry: A Review

The field of restorative and prosthetic dentistry focuses on restoring lost tooth structures and replacing missing teeth and lost tissue to restore or improve esthetics and oral health. Many systemic factors such as metabolic, bone, autoimmune, cardiovascular, and endocrine disorders can affect healing procedures, and bone density and impact oral health. Hence patients suffering from systemic disease when treated for prosthodontic rehabilitation can have negative prognostic outcomes. The commonest prosthodontic treatments that can be affected include dental implants, fixed prostheses, and removable prostheses. Understanding and managing these systemic factors play a key role in the success of prosthodontic treatment.

Acceleration of HDL-Mediated Cholesterol Efflux Alleviates Periodontitis

Periodontitis (PD) is a common inflammatory disease known to be closely associated with metabolic disorders, particularly hyperlipidemia. In the current study, we demonstrated that hypercholesterolemia is a predisposing factor in the development of PD. Logistic regression analysis revealed a strong positive correlation between PD and dyslipidemia. Data from in vivo (PD mouse model subjected to a high cholesterol diet) and in vitro (cholesterol treatment of gingival fibroblasts [GFs]) experiments showed that excess cholesterol influx into GFs potentially contributes to periodontal inflammation and, subsequently, alveolar bone erosion. Additionally, we compared the protective efficacies of cholesterol-lowering drugs with their different modes of action against PD pathogenesis in mice. Among the cholesterol-lowering drugs we tested, fenofibrate exerted the most protective effect against PD pathogenesis due to an increased level of high-density lipoprotein cholesterol, a lipoprotein involved in cholesterol efflux from cells and reverse cholesterol transport. Indeed, cholesterol efflux was suppressed during PD progression by downregulation of the apoA-I binding protein (APOA1BP) expression in inflamed GFs. We also demonstrated that the overexpression of APOA1BP efficiently regulated periodontal inflammation and the subsequent alveolar bone loss by inducing cholesterol efflux. Our collective findings highlight the potential utility of currently available cholesterol-lowering medications for the mitigation of PD pathogenesis. By targeting the acceleration of high-density lipoprotein-mediated cellular cholesterol efflux, a new therapeutic approach for PD may become possible.