Primary prevention of periodontitis: managing gingivitis

A state-of-the-art review of the recent advances in drug delivery systems for different therapeutic agents in periodontitis

Periodontitis (PD) is a chronic gum illness that may be hard to cure for a number of reasons, including the fact that no one knows what causes it, the side effects of anti-microbial treatment, and how various kinds of bacteria interact with one another. As a result, novel therapeutic approaches for PD treatment must be developed. Additionally, supplementary antibacterial regimens, including local and systemic medication administration of chemical agents, are necessary for deep pockets to assist with mechanical debridement of tooth surfaces. As our knowledge of periodontal disease and drug delivery systems (DDSs) grows, new targeted delivery systems like extracellular vesicles, lipid-based nanoparticles (NPs), metallic NPs, and polymer NPs have been developed. These systems aim to improve the targeting and precision of PD treatments while reducing the systemic side effects of antibiotics. Nanozymes, photodermal therapy, antibacterial metallic NPs, and traditional PD therapies have all been reviewed in this research. Medicinal herbs, antibiotics, photothermal therapy, nanozymes, antibacterial metallic NPs, and conventional therapies for PD have all been examined in this research. After that, we reviewed the key features of many innovative DDSs and how they worked for PD therapy. Finally, we have discussed the advantages and disadvantages of these DDSs.

Gingivitis Control in Children, Adolescents and Young Adults With Chronic Kidney Disease by a Need-Related Programme: A Randomised Clinical Trial

OBJECTIVES

Children and young patients with chronic kidney disease (CKD) are at persistent risk of gingivitis despite usual preventive measures. This clinical study aimed to determine the efficacy of an intensive oral preventive programme (OPP) for young patients with CKD in treating plaque-induced gingivitis modified by systemic factors.

METHODS

Young patients with CKD (N = 30) were recruited/randomised to a need-related OPP (n = 15) or treatment as usual (TAU) including mainly motivation and instructions (controls, n = 15) followed by a single intensive prophylactic appointment after 3 months. For the OPP group, depending on the baseline degree of inflammation (PBI) professional mechanical plaque removal, local chlorhexidine gel application and mouth rinse were applied at need-related appointments focussing on local plaque control and reduction in inflammation.

RESULTS

After 3 months OPP, lower plaque indices were found (2.62-0.66, p < 0.05) in contrast to TAU (2.32-2.05, p > 0.05) with differences between study groups (p < 0.05). Regarding gingivitis, lower PBI values than baseline were observed in OPP (1.03-0.05, p < 0.05) than TAU (1.15-1.00; p > 0.05); OPP reductions (effect size) were higher than after a single intensive appointment (1.00-0.36; p < 0.05). Degree of immunosuppressive therapy did not differ between groups throughout the study.

CONCLUSIONS

Young patients with CKD suffer from generalised gingivitis with increased bleeding sites. This moderate degree of inflammation shows a normal distribution of high and low plaque responders, with no pattern of impact for the degree of immunosuppression. Effectiveness and duration of preventive measures follow a dose-response principle. Therefore, need-related preventive measures should be implemented and maintained in future regular care for CKD patients.

TRIAL REGISTRATION

German Clinical Trials Register, registration number: DRKS00010580.

Oral health behaviours and metabolic syndrome: mediation effect of lifestyle habits

BACKGROUND

Recent studies have reported an association between toothbrushing frequency and systemic health. Plaque control, achieved through frequent brushing, is known to prevent dental caries and periodontal disease, potentially reducing the risk of systemic diseases. However, individuals with good oral health behaviours may also exhibit healthier lifestyle habits which could impact systemic health. In examining the relationship between oral health behaviours and systemic health, it is important to consider the influence of factors that mediate the relationship between them. This study conducted mediation analyses to evaluate the extent to which lifestyle habits and periodontal status mediate the relationship between oral health behaviours and systemic health.

METHODS

Health examinations, including dental assessments, were performed on 15,579 individuals at the Aichi Health Promotion Foundation. Of these, 12,540 participants aged 40-74 years were included in the analysis. Mediation analyses were conducted using the number of metabolic syndrome (MS) components as the outcome variable, oral health behaviours (regular dental visits, use of interdental brushes or dental floss, and toothbrushing frequency) as exposure variables, lifestyle habits (smoking, drinking, exercise, and eating habits) and periodontal status as mediators, and age and sex as covariates.

RESULTS

Regular dental visits showed significant total and indirect effects on MS, although no significant direct effect was observed. The use of interdental brushes or dental floss and toothbrushing frequency demonstrated significant total, direct and indirect effects on MS. Exercise habits, eating habits and periodontal status were significant mediators in the relationship between regular dental visits and MS. These mediators also significantly influenced the associations between both the use of interdental brushes or dental floss and toothbrushing frequency with MS.

CONCLUSION

The relationship between oral health behaviours and MS is mediated by lifestyle habits and periodontal status. Among the mediating variables tested in this study, the indirect effects of diet and exercise habits tended to be stronger than the indirect effect of periodontal disease. Oral health behaviours may influence systemic health through their impact on lifestyle habits.

Plaque scores after 1 or 2 minutes of toothbrushing A systematic review and meta-analysis

AIM

To evaluate the difference in plaque score reduction achieved by 1 and 2 min of toothbrushing, based on data from single brushing exercises.

METHODS

MEDLINE-PubMed, Cochrane-CENTRAL databases and the first five pages of Google Scholar were searched for randomised controlled trials. Extracted data were summarised in a descriptive and, if possible, a meta-analysis using standardised mean difference (SMD). Separate analyses were performed for manual (MTB) and powered (PTB) toothbrushes.

RESULTS

Based on the selection criteria, the search identified five unique eligible publications providing 16 comparisons. For both toothbrush types, 2 min of brushing resulted in a significantly higher plaque score reduction. The SMD of 1 versus 2 min of brushing using MTB was 0.69 [95% CI: 0.06, 1.33] (p = 0.03) can be interpreted as a medium size effect and the SMD of using a PTB was 0.47 [95% CI: 0.28, 0.66], (p < 0.00001) interpreted as a small size effect.

CONCLUSION

With respect to plaque scores, based on single brushing exercises, there is moderate certainty for the recommendation to brush for 2 min over 1 min.

Human and bacterial genetic variation shape oral microbiomes and health

It is largely unknown which human genetic variants shape a person's oral microbiome and potentially promote its dysbiosis. We characterized the oral microbiomes of 12,519 people by analyzing whole-genome sequencing reads from previously sequenced saliva-derived DNA. Human genetic variation at 11 loci (10 novel) associated with differences in oral microbiome composition. Nearly all of these associations implicated candidate genes with readily interpretable functions, several related to carbohydrate availability. The strongest association ( p =3.0x10 -188 ) involved the common FUT2 W154X loss-of-function variant, which associated with the abundances of 32 bacterial species. Human host genetics also appeared to powerfully shape within-species genetic variation in oral bacteria. Variation at the 11 human loci associated with variation in gene dosages in 68 regions of bacterial genomes. Several such associations implicated interactions of bacterial proteins with histo-blood group antigens presented on host mucosal cell surfaces and salivary proteins. Common, multi-allelic copy-number variation of AMY1 , which encodes salivary amylase, associated with oral microbiome composition ( p =1.5x10 -53 ) and with dentures use in UK Biobank ( p =5.9x10 -35 , n=418k), suggesting that amylase abundance impacts oral health by influencing the oral microbiome. Two other microbiome composition-associated loci, FUT2 and PITX1 , also significantly associated with dentures risk, collectively nominating numerous microbial taxa that might contribute to tooth decay.

Management of the endodontic-periodontal lesion

Endodontic-periodontal lesions (EPLs) develop due to the various pathways that allow microbial migration between these two compartments. The authors review the historical and current research on the aetiology, diagnostic pathways, prognostic factors and management strategies for EPLs, emphasising a multidisciplinary approach to managing EPLs. This paper aims to guide clinicians in managing these challenging cases with a combination of endodontic and periodontal therapies.

Interplay between periodontitis and chronic kidney disease

Periodontitis is a ubiquitous chronic inflammatory disease affecting the supporting tissues of the teeth and is a major cause of multiple tooth loss. Despite being preventable, periodontitis and dental caries are responsible for more years lost to disability than any other human condition. The most severe form of periodontitis affects 1 billion individuals, and its prevalence is increasing globally. Periodontitis arises from a dysregulated and hyperactive inflammatory response to dysbiosis in the periodontal microbiome. This response has systemic effects associated with premature mortality and elevated risk of several systemic non-communicable diseases (NCDs), including atheromatous cardiovascular disease, type 2 diabetes and chronic kidney disease (CKD). This risk association between periodontitis and NCDs is independent of their shared common risk factors, suggesting that periodontitis is a non-traditional risk factor for NCDs such as CKD. As periodontitis progresses, the immune cells and mediators underpinning its pathophysiology leak into the systemic circulation through the ulcerated oral mucosal lining, inducing in a systemic inflammatory profile that closely mirrors that observed in patients with CKD. The relationship between periodontitis and CKD seems to be bi-directional, but large-scale intervention studies are required to clarify causality and could lead to new care pathways for managing each condition as an exposure for the other.

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.

Varying responses to periodontal treatment in different extent of plaque-induced gingivitis: a prospective cohort study

OBJECTIVES

To compare the clinical response to periodontal treatment in localized and generalized gingivitis using periodontal variables and patient-reported outcomes (PROs).

MATERIALS AND METHODS

Sixty participants (30 with localized gingivitis, 30 with generalized gingivitis) underwent scaling, polishing, and oral hygiene instruction at baseline and monthly follow-ups until periodontal health was restored. Periodontal variables (bleeding on probing [BOP], gingival index [GI], and plaque index [PLI]) along with PROs on oral hygiene practices and the Self-Efficacy Scale for Self-Care (SESS) were assessed.

RESULTS

At 1-month follow-up, generalized gingivitis showed significantly greater improvements in BOP (p < 0.001) and GI (p < 0.001) versus localized gingivitis, with no intergroup difference in PLI reduction (p = 0.747). Periodontal health was achieved in 80% of localized cases versus 30% of generalized cases after single-session therapy (p < 0.001), with 70% of generalized cases requiring multiple re-treatments. Unresolved generalized cases had higher baseline BOP (p = 0.014) but similar baseline PLI (p = 0.322) and no significant differences in treatment-induced BOP (p = 0.137) or PLI changes (p = 0.563). SESS scores improved significantly in both groups, with greater SE-D score improvement in localized cases. Localized gingivitis had higher baseline prolonged brushing rates (> 2 min: 66.7% vs. 33.3%), but post-intervention oral hygiene did not differ between groups.

CONCLUSIONS

Localized gingivitis responded well to single-session therapy, whereas generalized gingivitis required multiple treatments due to higher baseline inflammation, emphasizing the need for distinct clinical strategies.

CLINICAL RELEVANCE

This study supports subtype-specific management in gingivitis, advocating single-session therapy for localized cases and staged interventions for generalized cases to optimize outcomes and reduce overtreatment.

Emerging Applications of Digital Technologies for Periodontal Screening, Diagnosis and Prognosis in the Dental Setting

AIM

To comprehensively review digital technologies (including artificial intelligence, AI) for periodontal screening, diagnosis and prognosis in the dental setting, focusing on accuracy metrics.

MATERIALS AND METHODS

Two separate literature searches were conducted for periodontal screening and diagnosis (part I, scoping review) and prognosis (part II, systematic approach). PubMed, Scopus and Embase databases were searched.

RESULTS

In part I, 40 studies evaluated AI and advanced imaging on different substrata. The combination of AI with 2D radiographs was the most frequently investigated and demonstrated a high level of periodontitis detection and stage definition. In part II, eight studies, identified as having a high risk of bias, tested supervised machine learning models using 6-74 predictors. The models demonstrated variable predictive accuracy, often outperforming traditional risk assessment tools and classical statistical models in the few studies evaluating such comparisons.

CONCLUSIONS

AI and advanced imaging techniques are promising for periodontal screening, diagnosis and prognosis in the dental setting, although the evidence remains inconsistent and inconclusive. In addition, AI-driven analysis of 2D radiographs (for diagnosis and staging of periodontitis), neural networks and the aggregation of multiple algorithms (for predicting tooth-related outcomes) appear to be the most promising approaches entering clinical application.

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.

Current Status of Dental Examinations During Pregnancy Term in Matsudo City, Japan

AIM

Poor oral hygiene during pregnancy is associated with pre-term birth, low birth weight, and pregnancy-induced hypertension, suggesting its significant effects on both maternal and fetal health. However, global guidelines indicate that oral care during pregnancy remains an underdeveloped field, and no large-scale reports on dental studies conducted during pregnancy exist in Japan. Therefore, we assessed the key factors that contribute to maintaining oral health during pregnancy in a cohort of Japanese women.

METHODS

We conducted dental examinations on 907 pregnant women in Matsudo City, Japan, and investigated the key factors for maintaining 379 women (41.7%) had untreated cavities. An increase in the frequency of toothbrushing was associated with a higher number of treated teeth (r=0.315, p < 0.001). However, periodontal disease-related factors such as gingival bleeding (71.2%) and the condition of periodontal pockets showed little correlation with brushing frequency(r=-0.139, p > 0.05 for untreated teeth and brushing frequency).

CONCLUSIONS

While brushing teeth three times a day, including during pregnancy, is ideal, attention should also be directed to other aspects, such as brushing technique and thoroughness, which may require further consideration. This report serves as a foundation for obstetricians and dentists to recognize the importance of oral hygiene management during pregnancy and advocate for dental checkups during pregnancy, providing valuable opportunities to increase awareness regarding this issue.

The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review

Periodontitis is a complex, multifactorial chronic inflammatory condition that impacts the adjacent hard and soft tissues. Microorganisms, especially gram-negative anaerobic pathogens, are a causative factor for periodontal disease. Periodontitis is identified by observing deeper periodontal pockets, clinical attachment loss, and the reduction of alveolar bone, often in conjunction with these indicators. The condition can vary in severity and be classified as mild, moderate, or severe. Scaling and root planing, combined with mechanical debridement, may not adequately reduce the bacterial load; therefore, adding local or systemic antimicrobials is advised as an adjunctive treatment. Commonly utilized local drug delivery agents for patients suffering from periodontitis include tetracycline, metronidazole, minocycline, doxycycline, and chlorhexidine. This system targets the pockets and eliminates the pathogens. Metronidazole is a nitroimidazole compound used commonly against gram-negative anaerobes. Its mechanism lies in four basic steps through which bacterial cell death occurs. A 25% metronidazole gel is used widely in periodontitis patients. The effectiveness of metronidazole as a local drug delivery agent has been evaluated in numerous studies, which have shown improvements in clinical parameters. To achieve favorable clinical outcomes, the non-surgical treatment of peri-implantitis should involve the systemic or local administration of metronidazole. Thus, the role of metronidazole in the emergence of periodontal diseases and its therapeutic uses are investigated in this narrative review.

All Properties of Infertility Microbiome in a Review Article

BACKGROUND

The microbiome is crucial for many physiological processes, including immunity, metabolism, and reproduction.

AIMS

This review aims to contribute to a detailed understanding of the microbiome of the genital tract, which can lead to better management of dysbiosis and reproductive disorders.

METHODS

Data from the four international information databases Medline, Scopus, Embase, and Google Scholar. The search strategy was based on the combination of the following terms: "microbiota," "microbiome," "microfilm," "microflora," "fertility," or "infertility."

RESULT

The advent of next-generation sequencing-based technologies during the last decade has revealed the presence of microbial communities in nearly every part of the human body, including the reproductive system. Several studies have shown significant differences between the microbiota of the vagina and endometrium, as well as other parts of the upper genital tract.

DISCUSSION

The human microbiome plays a critical role in determining a person's health state, and the microbiome of the genital tract may impact fertility potential before and after assisted reproductive treatments (ARTs).

CONCLUSION

To completely understand the role of the microbiome, future research should focus not only on the description of microbiota but also on the interaction between bacteria, the production of biofilms, and the interaction of microorganisms with human cells.

WDR36 inhibits the osteogenic differentiation and migration of periodontal ligament stem cells

BACKGROUND

Periodontitis is an inflammatory disease caused by the host’s immune response and various interactions between pathogens, which lead to the loss of connective tissue and bone. In recent years, mesenchymal stem cell (SC) transplantation technology has become a research hotspot, which can form periodontal ligament, cementum, and alveolar bone through proliferation and differentiation.

AIM

To elucidate the regulatory effects of WD repeat-containing protein 36 (WDR36) on the senescence, migration, and osteogenic differentiation of periodontal ligament SCs (PDLSCs).

METHODS

The migration and chemotaxis of PDLSCs were detected by the scratch-wound migration test and transwell chemotaxis test. Alkaline phosphatase (ALP) activity, Alizarin red staining, calcium content, and real-time reverse transcription polymerase chain reaction (RT-qPCR) of key transcription factors were used to detect the osteogenic differentiation function of PDLSCs. Cell senescence was determined by senescence-associated β-galactosidase staining.

RESULTS

The 24-hour and 48-hour scratch-wound migration test and 48-hour transwell chemotaxis test showed that overexpression of WDR36 inhibited the migration/chemotaxis of PDLSCs. Simultaneously, WDR36 depletion promoted the migration/chemotaxis of PDLSCs. The results of ALP activity, Alizarin red staining, calcium content, and RT-qPCR showed that overexpression of WDR36 inhibited the osteogenic differentiation of PDLSCs, and WDR36 depletion promoted the osteogenic differentiation of PDLSCs. Senescence-associated β-galactosidase staining showed that 0.1 μg/mL icariin (ICA) and overexpression of WDR36 inhibited the senescence of PDLSCs, and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.

CONCLUSION

WDR36 inhibits the migration and chemotaxis, osteogenic differentiation, and senescence of PDLSCs; 0.1 μg/mL ICA inhibits the senescence of PDLSCs. Therefore, WDR36 might serve as a target for periodontal tissue regeneration and the treatment of periodontitis.

Translation, cross-cultural adaptation, reliability, and validity assessment of a Turkish version of the oral and systemic health impact profile for periodontal disease (OSHIP-Perio)

The development of the Oral Health Impact Profile-49 (OHIP-49) and its shorter version, OHIP-14, has been criticized for not adequately considering the influence of systemic health on Periodontal health. The lack of a Periodontal status domain in OHIP scales has led to the proposal of the development of a new profile, Oral and Systemic Health Impact Profile (OSHIP-Perio). The newly developed profile has not undergone translation into other languages, cross-cultural adaptation, or validation and reliability testing. The primary objective of this study was to conduct a cross-cultural adaptation, validation, and reliability assessment of the Turkish translation of OSHIP-Perio for the first time. The data set comprises of responses from 354 individuals who participated in a face-to-face survey involving a series of fourteen inquiries related to the influence of Periodontal diseases on their general quality of life. The survey employed the OHIP-14-TR gold standard questionnaire, which has undergone prior validation and reliability testing in cross-cultural adaptation studies. Confirmatory factor analysis was employed to evaluate the construct validity. Test-retest reliability was evaluated using the Spearman-Brown and Gutmann test. Cronbach's alpha was used to assess the internal consistency. The concurrent validity was assessed using Spearman's correlation coefficient. The confirmatory factor analysis revealed that the scale is characterized by a single factor. The Spearman's correlation coefficient results were found to be 0.922 for concurrent validity. The internal consistency analysis yielded a Cronbach's alpha value of 0.944 for the scale. The Spearman-Brown and Guttmann methods yielded coefficients of 0.972 value for test-retest reliability. No floor or ceiling effects were found to be present. The Turkish version of the OSHIP-Perio questionnaire has been found to be valid and reliable. The OSHIP-Perio-TR can be used to assess the relationship between general well-being, its influence on Periodontal health, and the perception of illness in individuals with Periodontal diseases.

Oral health of nursing home residents in Flanders, Belgium, and its associated factors

Oral health in care-dependent older adults is often compromised due to care dependency associated with deteriorating general health. This cross-sectional study assessed the oral health of 458 nursing home residents in Flanders, with a mean age of 82.7 years (70.3% female), using the optimised Oral Health Section of the interRAI Suite of Instruments and validated dental indices. Among residents with natural teeth (53.9%), poor oral hygiene (75.7%), poor tooth condition (56.6%), and poor gum condition (49.9%) were common. High dental plaque levels yielded a mean Oral Hygiene Index of 4.5, and 44.0% of participants had untreated caries with pulp involvement. A mean Modified Gingival Index of 1.8 indicated mild inflammation of the entire gingiva. Denture hygiene was inadequate in 68.5% of cases. Self-reported issues included dry mouth (32.8%) and chewing difficulties (23.4%). The higher correlation coefficients were observed between oral hygiene and gum condition (r = 0.324, p < 0.0001) and between chewing difficulty and pain (r = 0.247, p < 0.0001). Bivariate analyses showed cognitive and functional impairments were strongly linked to poor oral hygiene and gingival health. These findings highlighted the persistent need to improve oral health care in nursing home residents, particularly among those with cognitive decline or reduced self-care abilities.Trial registration: ClinicalTrials.gov NCT06536322- Retrospectively registered July 23rd, 2024.

Alleviation of Plaque and Gingivitis with Dental Water Jet in Regular and Orthodontic Patients: A Systematic Review and Meta-Analysis

Objectives: This review aimed to compare the effectiveness of using a dental water jet (WJ) to manual tooth brushing (MTB) alone or when combined with flossing (MTB + F) in improving plaque index (PI), bleeding index (BI), and gingival index (GI) in regular and orthodontic patients. Materials and Method: This review was registered with the PROSPERO registry (CRD42022296752). Three reviewers conducted a comprehensive search of MEDLINE, the Cochrane Library, and Google Scholar for studies published between 1990 and July 2022. Eligible studies were randomized clinical trials, excluding those involving peri-implantitis, patients with impaired manual dexterity, or powered brushes. The outcomes of interest (PI, BI, and GI) were measured across short-, intermediate-, and long-term periods. Results: Eighteen RCTs were included in this review. PI: in regular patients, use of a WJ showed no additional improvement over flossing, and the results were inconsistent when compared to MTB alone. For orthodontic patients, use of a WJ provided a slight improvement over flossing in the short term and MTB alone in the intermediate term. BI: use of a WJ demonstrated a slight improvement over flossing and MTB alone in both patient groups at different time points. GI: use of a WJ was comparable to flossing but showed slight benefits over MTB alone in the short term for regular patients and in the intermediate term for orthodontic patients. Conclusions: use of a WJ may provide slight benefits in BI and GI compared to flossing or MTB alone, especially for orthodontic patients. Clinical relevance: incorporating a WJ into the daily oral hygiene routine is recommended due to its potential benefits over brushing alone and its user-friendly alternative to flossing.

Association between geriatric nutritional risk index and overactive bladder in the elderly population: a cross-sectional study

Background

The prevalence of overactive bladder (OAB) is increasing in the elderly population and there is growing evidence that malnutrition affects the urinary system. Despite this, research on the relationship between nutritional factors and OAB remains limited.

Methods

We included 17,161 elderly individuals from the National Health and Nutrition Examination Survey conducted between 2005 and 2018. Overactive Bladder Symptom Scores (OABSS) were utilized to assess symptoms of OAB. A multifactorial logistic regression analysis was employed to evaluate the independent association between the Geriatric Nutritional Risk Index (GNRI) and the prevalence of OAB. Restricted cubic spline plots examined the potential non-linear relationship between GNRI and OAB. Influencing factors were assessed through subgroup analyses, while the predictive utility of GNRI was assessed with receiver operating characteristic (ROC) curves. The influence of inflammatory response and cognitive function on the interaction between GNRI and OAB was also examined by mediation analysis.

Results

GNRI in the OAB group was significantly lower than that in the non-OAB group. Multifactorial logistic regression analysis revealed that GNRI significantly predicts OAB (p < 0.05). The Restricted Cubic Spline (RCS) curve indicated a non-linear negative correlation between GNRI and the risk of OAB in the elderly (non-linear p = 0.0029). In receiver operating characteristic analysis, GNRI outperforms serum albumin or body mass index (BMI) alone in predicting OAB risk. The study revealed that inflammatory response mediates the relationship between GNRI and OAB, while cognitive function has a relatively weaker influence on the strength of the association between GNRI and OAB.

Conclusion

GNRI serves as a reliable predictive marker for OAB in the elderly population, demonstrating a nonlinear inverse correlation with OAB prevalence. Furthermore, this study elucidates the underlying inflammatory mechanisms that link GNRI to the development of OAB.

A personalized periodontitis risk based on nonimage electronic dental records by machine learning

OBJECTIVE

This study aimed to develop a machine-learning (ML) model to predict the risk for Periodontal Disease (PD) based on nonimage electronic dental records (EDRs).

METHODS

By using EDRs collected in the BigMouth repository, dental patients from the US were included. Patients were labeled as cases or controls, based on PD diagnosis, treatment and pocketing. By learning from their data, a model was trained. The ability of the developed model to predict PD was evaluated by the accuracy, sensitivity, specificity and area under the curve (AUROC) and the most important features were determined. The best-performing model was applied to the validation set.

RESULTS

The final study population included 43,331 participants. Based on the development set, the Random Forest model performed with high sensitivity (81 %) and had an excellent AUROC (94 %), compared to four other ML and deep learning techniques. The most important predictors were bleeding proportion, age, the number of visits, prior preventive treatment, smoking and drugs usage. When the model was applied to the validation set, the model could detect almost all cases (91 %), but overestimated controls (specificity=0.54). When EDRs were retrieved 3 years before the PD diagnosis, the predictions for PD were still sensitive (89 %).

CONCLUSION

Based on consistent and complete EDR, ML has an excellent ability to assist with the early detection and prevention of PD cases. Further research is required to follow-up high-risk controls and improve the model's internal and external validation. Improved EDR documentation is an important first step.

CLINICAL SIGNIFICANCE

If such ML models become clinically applied, clinicians can be assisted with personalized risk predictions based on the individual. If the key riskcontributing factors for the individual are revealed/provided, ML can suggest targeted prevention interventions. These advancements can contribute to a reduced workload, sustainable EDRs, data-based dental care, and, ultimately, improved patient outcomes.

Common practices of dental implant maintenance among dental hygienists working in the Netherlands - A survey

BACKGROUND

Dental implant maintenance is crucial to obtain and maintain a healthy peri-implant situation. Although it is part of a dental hygienists (DH) scope of practice, the knowledge and common practices among DHs in the Netherlands are unclear.

MATERIALS AND METHODS

A web-based survey was distributed by the Dutch Association of DHs, by spreading survey QR codes and snowballing. The role of the different DH curricula 2- or 3-year diploma and a 4-year bachelor's degree is evaluated.

RESULTS

In total, 165 (diploma: 73, bachelor: 92) DHs responded. Peri-implant diseases were well known (98%), indices and clinical symptoms were used to assess peri-implant tissues. A periodontal probe (97%) was used and bone loss was evaluated on radiographs (89%). Treatment was performed supra- and subgingivally (69%), mostly by titanium (45%) or plastic hand instruments (42%). Ultrasonic (52%) and air-abrasive (52%) devices were often used. The recall interval for maintenance was based on a risk-adjusted protocol (70%). DHs with a bachelor's received significantly more training compared to DHs with a diploma during primary education (p < 0.001). Diploma DHs mainly obtained their knowledge from continuing education (p = 0.04). In general, there was no significant difference in knowledge or common practices.

CONCLUSIONS

The primary education of DHs with a 2- or 3-year diploma and a 4-year bachelor's varies. Due to the continuing education of diploma DHs, knowledge and common practices generally do not differ. Most DHs in the Netherlands perform implant maintenance. A periodontal probe and radiographs are used for examination. Instrumentation is performed supra- and subgingivally, usually with titanium or plastic hand instruments. The recall interval is based on a patient's risk assessment.

Essential oils mouthwash with or without alcohol in relation to effect on parameters of plaque and gingivitis: A systematic review and meta-analysis

AIM

The primary aim was to systematically assess the available literature on the effect of an essential oils mouthwash without alcohol (EOalc-) compared to an essential oils mouthwash with alcohol (EOalc+) on plaque scores and parameters of gingival health. The secondary aim was to evaluate user appreciation.

MATERIALS AND METHODS

The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched to identify eligible studies published up to and including March 2024. Papers comparing the effectiveness of EOalc- and EOalc+ were included. The quality was assessed. A descriptive analysis and a meta-analysis were performed.

RESULTS

After screening, seven papers were found to be eligible. The descriptive analysis demonstrates a significant difference in plaque scores in favour of EOalc+. This is confirmed by the meta-analyses of plaque scores in non-brushing and brushing studies (DiffM = 0.40; 95% CI [0.27; 0.53], p < 0.00001 and DiffM = 0.05; 95% CI [0.01; 0.10], p = 0.01, respectively). This finding is also supported by the sub-analysis of brands. The meta-analyses of bleeding and gingival scores in brushing studies did not show significant differences between products. For user appreciation, the difference found was for taste perception in favour of EOalc- (DiffM = 1.63; 95% CI [0.72; 2.55], p = 0.0004).

CONCLUSION

When an EO-mouthwash is used in non-brushing or brushing situations, with small to moderate certainty, EOalc- provided less effect regarding plaque control than EOalc+. For bleeding and gingival index there is weak certainty for no difference. In terms of the taste perception EOalc- seems more appreciated.

Effect of a powered and a manual toothbrush in subjects susceptible to gingival recession: A 36-month randomized controlled clinical study

OBJECTIVE

The objective of this long-term clinical study was to evaluate the influence of a newly developed powered toothbrush (PT) on the size and number of pre-existing gingival recessions (GR) in comparison to a manual toothbrush (MT).

METHODS

This was a prospective, single-blind, parallel-group, randomized controlled clinical study. Participants without periodontitis, but with at least two teeth (index teeth) showing GR ≥2 mm were randomized to brush either twice daily with a MT or with a PT with a linear magnetic drive causing the round brush head to produce gentle micro vibrations along with oscillating-rotating movements. Primary outcome parameter was the mean change of GR at the index teeth over 36 months.

RESULTS

Totally 87 out of 92 participants completed the study (MT/PT: n = 42/n = 45). At the 36-month evaluation the mean (standard deviation) change of GR at index teeth differed significantly between MT 0.17 (0.77) and PT -0.10 (0.63) (p = 0.013). Furthermore, the amount of GR sites which improved ≥1 mm or remained stable during the study period did not differ between MT and PT, but the number of sites worsened ≥1 mm was significantly in favour for PT (MT 23 (25.5%) versus PT 10 (10.6%); p = 0.009). A binary logistic regression identified tooth type (OR = 2.991 for pre-/molar (1.096 [95% CI 1.002-8.933]; p = 0.050)) and manual brushing (OR = 3.341 (1.206 [95% CI 1291-8648]; p = 0.013)) as risk factors for recession impairment at the index teeth. There were no differences between groups for adverse events.

CONCLUSION

In a population with pre-existing gingival recessions and consequently a high risk of developing further recession the PT seems to be favourable with regard to further development of GR.

Global burden and trends of severe periodontitis among women of childbearing age, 1990-2021

BACKGROUND

The global burden and trend of severe periodontitis, as well as its association with sociodemographic development, among women of childbearing age (WCBA) have been unclear so far. This study aims to assess the epidemiological pattern of severe periodontitis in WCBA from 1990 to 2021 and provide projections through 2040.

METHODS

Data on the incidence, prevalence, and disability-adjusted life years (DALYs) of severe periodontitis among WCBA from 1990 to 2021 were retrieved from the Global Burden of Disease (GBD) study 2021. The Bayesian age-period-cohort model was run to project the age-standardized incidence rate (ASIR) through 2040.

RESULTS

In 2021, an estimated 26,315,786 incident cases, 257,234,399 prevalent cases, and 1,680,425 DALYs were reported globally. From 1990 to 2021, a consistent annual increase in the age-standardized rate of severe periodontitis was observed, and the ASIR is projected to continue to rise until 2040. Additionally, the burden of severe periodontitis demonstrated a downward trend with increasing sociodemographic development. In 2021, age-specific rates of severe periodontitis increased with age, with the most significant changes occurring in younger age groups.

CONCLUSION

The rising global burden of severe periodontitis, along with regional and age variations, highlights the urgent need for innovative prevention and healthcare strategies to reduce this burden among WCBA globally.

PLAIN LANGUAGE SUMMARY

Women of childbearing age (WCBA) represent nearly a quarter of the global population, yet there is a significant gap in consistent global and regional surveillance data on severe periodontitis in this group. Our study revealed that severe periodontitis among WCBA poses a substantial public health challenge worldwide. From 1990 to 2021, the age-standardized rate of severe periodontitis increased globally, with the most significant rise observed in regions with middle socioeconomic development. This condition disproportionately affects women in their prime years, with the fastest growth seen among younger WCBA. It is essential that healthcare providers recognize the gender disparities and societal factors related to socioeconomic development that contribute to the risk of severe periodontitis in this population. To address this issue effectively, it is crucial to develop region- and age-specific prevention strategies, as well as targeted healthcare interventions.

Propolis mouthwashes efficacy in managing gingivitis and periodontitis: a systematic review of the latest findings

BACKGROUND AND OBJECTIVES

Gingivitis and periodontitis are common periodontal diseases that can significantly harm overall oral health, affecting the teeth and their supporting tissues, along with the surrounding anatomical structures, and if left untreated, leading to the total destruction of the alveolar bone and the connective tissues, tooth loss, and other more serious systemic health issues. Numerous studies have shown that propolis can help reduce gum inflammation, inhibit the growth of pathogenic bacteria, and promote tissue regeneration, but with varying degrees of success reported. For this reason, this comprehensive systematic review aims at finding out the truth concerning the efficacy of propolis mouthwashes in treating gingivitis and periodontitis, as its main objective.

DATA SOURCES

Research findings from 6 different databases: China National Knowledge Infrastructure (CNKI), PubMed®, Europe PMC, Cochrane Central Register of Controlled Trials (CENTRAL), BioMed Central, and Google Scholar, were retrieved and examined in addition to a manual search in the references lists.

STUDY SELECTION AND SYNTHESIS

The PICOS framework was used to select and exclude studies. The focus was on clinical randomized controlled trials (RCTs) that examined the effectiveness of propolis-containing mouthwashes in comparison with propolis-free ones for the treatment of gingivitis and periodontitis, employing related periodontal indices. Animal studies, microbiological studies, in-vitro studies, retrospective studies, case-control studies, cohorts, case reports, case series, reviews, letters, editorials, meta-analyses, and non-clinical randomized controlled trials (non-RCTs), all were excluded. A meta-analysis was not performed and data were only studied qualitatively due to the obvious heterogeneity amongst the studies. Data from the selected studies were extracted, and then the revised Cochrane's risk of bias tool (RoB 2.0) was utilised by two of the authors, independently, to evaluate the risk of bias in each study.

RESULTS

At first, 151 results were reached, but then after removing duplicates, 99 records remained, and were later screened, assessed, and studied in full details based on the set PICOS criteria. Out of these 99 articles, ten studies were included in this systematic review, encompassing a total of 453 patients with an age range of (13-70) years old. Propolis mouthwashes with different protocols of application were the intervention whereas placebo or the rest of the tested mouthwashes such as, chlorhexidine, sodium fluoride with cetylpyridinium chloride, sterile distilled water, hydrogen peroxide, were the ones to which propolis mouthwashes were compared. Treatment duration extended from 14 days to 3 months and the follow-up period differed from 14 days to 3 months. In general, propolis mouthwashes decreased plaque accumulations and gingival inflammation in gingivitis patients based on the employed indices. On the other hand, the aforementioned tested mouthwashes other than propolis were deemed equally effective or even superior to propolis in some studies. As an overall assessment for the risk of bias, four studies were assigned as having a low risk of bias. Two studies were deemed to have some concerns, while four studies were identified as having a high risk of bias.

CONCLUSIONS

Despite the fact that propolis has shown positive effects in terms of controlling gingival and periodontal inflammation especially when used with mechanical methods, studies lack certainty and their power of evidence is low with no agreed gold standards. These conclusions come, for sure, within the limitations of this review, like having substantial variability amongst the included studies and the presence of studies with a high risk of bias. The findings demonstrate that propolis-based mouthwashes showed promising clinical outcomes in reducing plaque and gingival inflammation. However, it is highly recommended to conduct more rigorous trials with patient-reported outcome measures, extended follow-up periods, larger samples sizes, better-designed methodologies, typified propolis use, and with the implementation of similar indices in order to obtain more reliable, conclusive, and generalisable results.

PROSPERO REGISTRATION NUMBER

CRD42024524523.

Does adopting a healthy diet improve periodontal parameters in patients susceptible to periodontal disease? A systematic review

OBJECTIVES

The aim of this systematic review is to evaluate evidence relating to whether adopting a diet, associated with improved outcomes for chronic systemic diseases with an inflammatory component, can improve periodontal parameters in patients with periodontal diseases.

DATA SOURCES

Electronic databases and one platform were systematically searched; Medline, Embase, Web of Science and the Cochrane Library including references of relevant studies.

DATA SELECTION AND EXTRACTION

1220 studies were identified of which 9 studies were eligible; 4 RCT's, 1 controlled trial and 4 observational cohort studies DATA SYNTHESIS: 8 out of 9 studies found improved periodontal parameters associated with a diet that was low in refined carbohydrates, low in saturated fats, high in fibre and high in nutrition but the studies were low to medium quality of evidence and the diets, method of recording the diets and periodontal parameters varied between the studies as did the study duration and age of participants.

CONCLUSION

Current evidence supports the hypothesis that adopting a healthy diet has the potential to positively impact periodontal parameters in patients with periodontal diseases, particularly in the older population but the effects may be negated by confounding factors such as smoking. 9 studies were included in the review which were rated moderate or low quality of evidence.

Identification of core genes related to exosomes and screening of potential targets in periodontitis using transcriptome profiling at the single-cell level

BACKGROUND

The progression and severity of periodontitis (PD) are associated with the release of extracellular vesicles by periodontal tissue cells. However, the precise mechanisms through which exosome-related genes (ERGs) influence PD remain unclear. This study aimed to investigate the role and potential mechanisms of key exosome-related genes in PD using transcriptome profiling at the single-cell level.

METHODS

The current study cited GSE16134, GSE10334, GSE171213 datasets and 19,643 ERGs. Initially, differential expression analysis, three machine learning (ML) models, gene expression analysis and receiver operating characteristic (ROC) analysis were proceeded to identify core genes. Subsequently, a core gene-based artificial neural network (ANN) model was built to evaluate the predictive power of core genes for PD. Gene set enrichment analysis (GSEA) and immunoinfiltration analysis were conducted based on core genes. To pinpoint key cell types influencing the progression of periodontal at the single-cell level, a series of single-cell analyses covering pseudo-time series analysis were accomplished. The expression verification of core genes was performed through quantitative reverse transcription polymerase chain reaction (qRT-PCR).

RESULTS

CKAP2, IGLL5, MZB1, CXCL6, and AADACL2 served as core genes diagnosing PD. Four core gene were elevated in the PD group in addition to down-regulated AADACL2. The core gene-based-ANN model had AUC values of 0.909 in GSE16134 dataset, which exceeded AUC of each core gene, highlighting the accurately and credibly predictive performance of ANN model. GSEA revealed that ribosome was co-enriched by 5 core genes, manifesting the expression of these genes might be critical for protein structure or function. Immunoinfiltration analysis found that CKAP2, IGLL5, MZB1, and CXCL6 exhibited positive correlations with most discrepant immune cells/discrepant stromal cells, which were highly infiltrated in PD. B cells and T cells holding crucial parts in PD were identified as key cell types. Pseudo-time series analysis revealed that the expression of IGLL5 and MZB1 increased during T cell differentiation, increased and then decreased during B cell differentiation. The qRT-PCR proved the mRNA expression levels of CKAP2 and MZB1 were increased in the blood of PD patients compared to controls. But the mRNA expression levels of AADACL2 was decreased in the PD patients compared to controls. This is consistent with the trend in the amount of expression in the dataset.

CONCLUSION

CKAP2, IGLL5, MZB1, CXCL6 and AADACL2 were identified as core genes associated with exosomes, helping us to understand the role of these genes in PD.

Relationship between oral health literacy and changes in self-assessment of oral health during COVID-19

Background/purpose

Health literacy is thought to play a major role in implementing health behaviors, such as preventing coronavirus disease 2019 (COVID-19). In this study, we aimed to examine the relationship between oral health literacy (OHL), dietary literacy (DL), and changes in oral health and eating habits during the COVID-19 pandemic.

Materials and methods

The self-assessment questionnaire, including questions on oral and dietary conditions for each period of the COVID-19 pandemic, sources of information, OHL, DL, and frequency of COVID-19 prevention measures, was administered using a web research company. All participants were divided into low- and high-literacy groups based on the median scores: those who scored above the median in the high group and those who scored at or below the median in the low group. Comparisons were conducted between the two groups.

Results

The median OHL and DL scores were 16 and 17 for the 344 participants included in the study (168 males and 176 females); 160 (46.5%) participants had high OHL scores, and 157 (45.6%) had high DL scores. The group with high OHL or DL tended to collect information sent by medical professionals compared to the group with low OHL or DL, had significantly higher scores on self-assessment of oral and dietary conditions, and tended to implement infection control actions more frequently in eating situations.

Conclusion

The high OHL and DL groups gathered information from professionals to have attain oral and dietary conditions regardless of COVID-19 and tended to implement infection prevention measures in oral health and diet.

Wearable Multifunctional Hydrogel for Oral Microenvironment Visualized Sensing Coupled with Sonodynamic Bacterial Elimination and Tooth Whitening

Bacterial-driven dental caries and tooth discoloration are growing concerns as the most common oral health problems. Current diagnostic methods and treatment strategies hardly allow simultaneous early detection and non-invasive treatment of these oral diseases. Herein, a wearable multifunctional double network hydrogel combined with polyaniline and barium titanate (PANI@BTO) nanoparticles is developed for oral microenvironment visualized sensing and sonodynamic therapy. Due to the colorimetric properties of polyaniline, the hydrogel displays a highly sensitive and selective response for visualized sensing of oral acidic microenvironment. Meanwhile, the barium titanate in the hydrogel efficiently generates reactive oxygen species (ROS) under ultrasound irradiation, realizing non-invasive treatment in the oral cavity. Through bacterial elimination experiments and tooth whitening studies, the hydrogel can achieve the dual effect of effectively inhibiting the growth of cariogenic bacteria and degrading tooth surface pigments. Owing to the visualized sensing of the oral acidic microenvironment and efficient sonodynamic therapy function, the proposed hydrogel system offers a solution for the prevention of caries and tooth whitening, which is promising in developing the biomedical system targeting the simultaneous sensing and therapy for oral diseases.

Self-Reported Oral Hygiene Performance of Patients in Albania: A Questionnaire-Based Survey

Background/Objectives: Oral hygiene is a key factor for dental and periodontal diseases and the prognosis of any treatment to restore their consequences. The present survey aimed to evaluate how well informed patients in Albania are on oral hygiene, given the scarce evidence on this topic. Methods: This survey was performed using a Google Forms questionnaire on oral hygiene habits, type and technique of instruments used, and frequency of dental recall visits. Results: A total of 1006 questionnaires were filled in a one-month time period (January 2020) from a population of 75.2% females and 24.8% males, 32.7 ± 11.3 years of age, from whom 94.6% reported a lack of systemic diseases and 80% were non-smokers. All of the population brushed their teeth at least once daily. The most used type of toothbrush was a manual one (91.1%) with medium-bristle hardness in 71% of cases. The most prevalent way of using the toothbrush was through circular movements (36.7%) with a duration of 2-3 min in 72% of the population. Only 77.1% of the population used interdental instruments, mainly interdental floss. Conclusions: Within the limits of this study, it could be concluded that the present population seemed to be mostly appropriately informed, but the information needs further revision and promotion by dentists.

Effects of Toothpaste Containing 2% Zinc Citrate on Gingival Health and Three Related Bacteria-A Randomized Double-Blind Study

OBJECTIVES

Gingivitis is the initial stage of periodontitis, one of the most common oral diseases and the primary cause of tooth loss. This study aims to evaluate the effect of toothpaste containing 2% zinc citrate on gingival health and the abundance of three bacteria related to gingivitis and periodontitis.

METHODS AND MATERIALS

Eleven volunteers with the same oral health status were randomly assigned to the treatment (n = 5) and control (n = 6) groups. The control group used fluoride toothpaste, while the treatment group used fluoride toothpaste supplemented with 2% zinc citrate for 3 months. The plaque index, gingival index, and bleeding index were measured at baseline (0 day), 3 weeks, and 3 months. Dental plaque from four areas of the mouth (FDI criteria) was collected at the same timepoints. A total of 132 dental plaque samples were analyzed using quantitative PCR (qPCR) to monitor the abundance of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia.

RESULTS

Toothpaste containing 2% zinc citrate significantly lowered the gingival index and reduced gum bleeding but did not affect the plaque index. It also reduced the total abundance of the three bacteria related to gingivitis and periodontitis in dental plaque over a long-term period.

CONCLUSIONS

Toothpaste with 2% zinc citrate persistently improves gingival health and reduces the presence of gingivitis-associated bacteria in dental plaque.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (Clinical trial registration no.: ChiCTR1900020592) (09/01/2019).

Plaque cleaning efficacy of waist-shaped interdental brushes among individuals with open interproximal spaces: a systematic review

BACKGROUND

The shape and design of interdental brushes are crucial for appropriate adaptation to the interproximal areas, despite their excellent cleaning efficacy. The aim of this review is to assess and compare the available data on the plaque cleaning efficacy of waist-shaped interdental brushes with any other shaped-interdental brushes among patients with wide interdental spaces.

METHODS

Scopus, PubMed, Cochrane, Science Direct, EBSCO Host, Lilacs, Science Direct, Web of Science, and Google Scholar were searched from the earliest available year (2011) till May 15, 2024. PICO Strategy: P: Individuals with open interproximal spaces; I: Waist-shaped interdental brushes; C: Any other shaped interdental brushes; O: Interproximal plaque cleaning efficacy. The review only comprised randomized controlled trials. The risk of bias assessment and quality of evidence was assessed using the RoB-2 Tool and GRADE Tool respectively.

RESULTS

Three full-text publications that met the requirements for eligibility underwent additional processing for data extraction. The overall results of the review suggest that the plaque cleaning efficacy of waist-shaped interdental brushes is better than straight/cylindrical-shaped interdental brushes in patients with open interdental spaces; especially on the buccal and lingual line angles. However, the pooling of data was not possible due to the high heterogeneity between the studies.

CONCLUSION

The current review suggests that the plaque cleaning efficacy of waist-shaped interdental brushes could be better than straight or cylindrical shaped-interdental brushes in patients with open interproximal spaces, especially in buccal and lingual line angles. However, further research should focus on appropriate methodological techniques to increase overall reporting quality and limit the possibility of bias.

Diagnostic delays of periodontitis and associated factors: a cross-sectional study

OBJECTIVES

This study aimed to investigate total diagnostic delay (TDD) in periodontitis and identify the factors associated with it.

METHODS

In this cross-sectional study, 145 newly examined and diagnosed periodontitis patients were recruited. A structured questionnaire was used to gather data on demographics, symptom onset, duration of diagnostic delay(s), and potential associated factors. Multiple regression analysis and the Mann‒Whitney U test were used to analyse the impact of various factors on the timing of diagnosis delay.

RESULTS

TDD averaged 59.3 ± 70.2 months, with a median of 36 months. Patient delay accounted for 74.4% of the cases, which was attributed to misconceptions about symptoms and reliance on self-medication. Professional delay accounted for 25% of the cases, with a significantly longer median delay (36 months) than patient delay (24 months) (p < 0.05). Factors predicting longer TDD included older age, multiple dentist visits, and the presence of calculus. The use of home remedies was associated with a longer TDD, whereas smoking and gingival swelling were associated with a significantly shorter TDD (P < 0.05).

CONCLUSION

This first-of-its-kind study identified significant diagnostic delays in periodontitis, one of the most common oral diseases, underscoring critical gaps in patient education and care. Age, frequency of dental visits, and misconceptions regarding calculus contribute to these delays.

CLINICAL RELEVANCE

Delayed diagnosis of periodontitis has significant implications, leading to extensive oral damage and eventual tooth loss, which compromises oral function, aesthetics, and quality of life. Addressing these delays through comprehensive public health strategies and improving dental training in periodontology can significantly improve oral and systemic health outcomes, reduce economic burdens, and contribute to the overall well-being of the population.

An Evaluation of a New Ultrasonic Water Irrigator in the Management of Gingival Health: A Randomised Study

INTRODUCTION

This randomised, single-blind, controlled study aimed to compare daily adjunctive use of an ultrasonic water irrigation device to dental floss in controlling plaque and gingival inflammation in patients with gingivitis.

METHODS

Participants were randomly allocated to either daily use of an ultrasonic water irrigator or dental floss as an adjunct to manual toothbrushing for 4 weeks, with periodontal assessment repeated at 1 and 4 weeks after baseline (Rustogi Modified Navy Plaque Index [PI], Loe and Silness Gingival Index [GI] and bleeding on marginal probing [BOMP]).

RESULTS

Sixty-two participants completed the investigation. Statistically significant reductions in total and marginal PI at Weeks 1 and 4 were noted in both groups compared to baseline (p < 0.05) with no significant differences between groups. BOMP and GI scores were likewise significantly reduced in both groups at Weeks 1 and 4 compared to baseline (p < 0.01). However, at Week 4, those using the ultrasonic water irrigator showed a significantly greater reduction in GI scores when compared to the floss group (-0.35 ± 0.26 vs. -0.16 ± 0.25, respectively, p < 0.01) and a significantly greater reduction in BOMP scores when compared to floss (-0.26 ± 0.12 vs. -0.15 ± 0.15, respectively, p < 0.01). Those using the ultrasonic water irrigator also reported easier usage scores (p < 0.05) when compared to the floss group.

CONCLUSION

Daily use of the ultrasonic water irrigator resulted in significantly greater reductions in gingival inflammation (gingival index and BOMP) than dental floss after 4 weeks, whereas plaque removal was similarly effective using the irrigator or floss.

Analysis of periodontal status in Polish patients with rheumatoid arthritis treated with biological therapies

Introduction

Periodontitis, characterized by inflammation affecting the tooth-supporting tissues, may increase the risk of rheumatoid arthritis (RA) or cardiovascular diseases. The aim of the study was to evaluate the periodontal status in RA patients and its impact on the inflammatory markers and red cell parameters obtained from complete blood laboratory tests to study the risk of cardiovascular disease development.

Material and methods

The cross-sectional study included 50 patients with RA treated with biological therapies: tumor necrosis factor inhibitors, interleukin-6 blockers. Rheumatoid arthritis disease activity was assessed with Disease Activity Score with 28-joint count (DAS28). The periodontal indices modified Approximal Periodontal Index, modified Papillary Bleeding Index, and Periodontal Screening Index (PSI) were used to assess patients' periodontal status. Serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used as inflammatory markers and a potential cardiovascular risk factor.

Results

No statistically significant correlation was found between the periodontal status and RA activity. However, a statistically significant correlation was found between the CRP results and the PSI scores (R = -0.264510, p = 0.048837). Evaluation of the red cell parameters showed statistically significant differences in the markers of inflammation ESR (R = 0.369398, p = 0.008289) and CRP (R = 0.367405, p = 0.008672). Red cell distribution width values were also correlated with RA activity (R = 0.286387, p = 0.043769) and duration of the disease (R = 0.339425, p = 0.015889).

Conclusions

A satisfactory periodontal status was found in most of the study group. Increased CRP levels in patients with periodontitis may indicate the negative impact of periodontal status on the general clinical condition of the patient.

The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis

BACKGROUND

The effect of treating periodontal disease (PD) during pregnancy on adverse birth outcomes, such as preterm birth (PTB) and/or low birth weight (LBW), remains unclear. This is partially due to the fact that Randomized Controlled Trials (RCTs) have used different combinations of treatment approaches to test this hypothesis. In this meta-analysis of RCTs, we assessed the impact of treating PD during pregnancy with scaling and root planning (SRP) and mouthwash use on PTB and LBW.

METHODS

A systematic review with meta-analysis was conducted following PRISMA guidelines. A comprehensive search strategy was employed across electronic databases, including PubMed/Medline, Embase, and Google Scholar. Quality assessment was performed using the Cochrane Risk of Bias 2 Tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effect models.

RESULTS

Out of 133 initially identified reports, 9 RCTs involving 3,985 pregnant women met the inclusion criteria. Periodontal treatment with SRP and mouthwash use in pregnancy was associated with a lower risk of PTB and LBW in meta-analysis with random effects models (pooled RR for PTB = 0.44, 95% CI: 0.22-0.88) and (pooled RR for LBW = 0.33, 95% CI: 0.13-0.84). Substantial heterogeneity was observed among studies (I2 = 91% and 90% for PTB and LBW, respectively), with sensitivity analysis suggesting potential sources of heterogeneity. Funnel plot assessment for publication bias showed evidence of asymmetry.

CONCLUSION

SRP with mouthwash use during pregnancy were associated with significantly lower risks of PTB and LBW. Larger, well-conducted RCTs are warranted to address this issue, as existing trials are small and exhibit methodological and statistical heterogeneity.

Periodontal diseases in Africa

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries

OBJECTIVES

To determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries.

METHODS

A cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no).

RESULTS

3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38-47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use.

CONCLUSIONS

Prevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age.

CLINICAL SIGNIFICANCE

Oral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support.

Domains, competences and learning outcomes for undergraduate education in periodontology

AIM

This review is intended to adapt the current conceptual framework in dental education based on four domains to propose a set of competences, learning outcomes and methods of teaching, learning and assessment for undergraduate education in periodontology.

REVIEW

Based on the current framework of competences and learning outcomes recommended by the Association for Dental Education in Europe (ADEE), undergraduate education in periodontology has been updated using the classification and clinical practice guidelines for the diagnosis and treatment of periodontal and peri-implant diseases.

CONCLUSIONS

Specific learning outcomes have been proposed within each competence area, that is in Domain I (n = 10), Domain II (n = 13), Domain III (n = 33) and Domain IV (n = 12). Teaching methods and learning activities based on the different dimensions of the cognitive process have been proposed. Additionally, 10 key learning outcomes have been proposed as exit outcomes, which implies their accomplishment within the final assessment of any graduating student.

Cross-angled versus flat-trim bristle tuft configurations in manual toothbrushes: A systematic review

AIM

This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients.

MATERIALS AND METHODS

PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate.

RESULTS

Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group.

CONCLUSION

Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.

A feasibility study to recruit, retain and treat periodontitis in volunteers with mild dementia, whilst monitoring their cognition

OBJECTIVES

Dementia patients are challenging to manage dentally. This study determined whether individuals with mild dementia and periodontitis, could be recruited, retained and demonstrate sustained oral health improvements over 2 years following personalised professional periodontitis treatment. The feasibility of same visit cognition measurements was assessed.

METHODS

A non-randomised study in individuals with mild dementia, capacity to consent, periodontitis and ≥6 teeth. Following enrolment and dental/cognitive assessments, personalised periodontal treatment, followed by 3-monthly supportive periodontal care was performed. Cognitive and periodontal assessments were undertaken at 6, 12, 24-months. Participants and project-partners fed back on homecare regimens.

RESULTS

18 participants were recruited, 15 completed 12- & 8 completed 24-months, 1 participant failed to attend one appointment, and early study termination due to COVID19. From baseline to 12-months mean percentage bleeding sites, Turesky plaque score ≥2 and periodontal pockets ≥4 mm decreased significantly (34.4 vs 14.75, p < 0.01; 78.49 vs 57.5, p < 0.01; 18.38 vs 5.14, p < 0.001). Significant change from baseline was retained at 24-months for mean percentage periodontal pockets ≥4 mm (14.47 vs 4.29, p < 0.05; n = 8). Cognition declined significantly to 12-months (mean ACEIII 71.47 vs 65.40, p < 0.05), but not between 12- and 24-months (67.5 vs 65.38, n = 8). Most reported home-care regimen as easy/OK to follow.

CONCLUSIONS

Mild dementia participants with periodontitis can be recruited, retained in a 24-month study and periodontally treated with personalised professional and at-home care regimens. Cognitive assessments can be performed at the same treatment visit. This demonstrates sustained engagement and supports oral health compliance can be successful in challenging cohorts.

Changing from disease-centred to person-centred - Swedish dental hygienists' views on a theory-based behavioural intervention for improved oral hygiene among adolescents

OBJECTIVES

To explore dental hygienists' (DHs') views on (i) a person-centred, theory-based, behavioural intervention for improving oral hygiene among adolescents and (ii) professional and organizational factors to consider in the implementation of such an intervention in daily dental practice.

METHODS

Semi-structured interviews were conducted with 13 DHs who had applied the person-centred, theory-based, behavioural intervention directed at adolescents with poor oral hygiene in a field study within the Public Dental Service, Region Västra Götaland, Sweden. The interviews were audio-taped, transcribed verbatim and analysed using qualitative content analysis.

RESULTS

The main theme 'From individual experts to partners - DHs changing direction from a disease-centred towards a person-centred approach' illustrated a changed professional approach among DHs, from exerting their roles as experts to encouraging partnership in treatment by supporting the adolescents in taking health behavioural decisions and responsibility for their oral health. The DHs considered the changed approach as challenging, but also more enjoyable, compared to conventional information/instruction. Adequate knowledge and skills, personal interest and willingness for a change as well as support from colleagues and clinic management were identified as prerequisites for implementing the person-centred, theory-based, behavioural intervention in daily practice, while the expenditure of time needed in relation to economic demands in care were seen as barriers.

CONCLUSIONS

The findings elucidate that DHs considered the application of a person-centred, theory-based, behavioural intervention to be challenging but also enjoyable. For such an intervention to be implemented in daily practice, prerequisites and barriers need to be considered on both personal/professional and organizational levels.

Periodontal disease and cardiovascular disease: umbrella review

BACKGROUND

Periodontal disease (PD) is an infectious and inflammatory condition that affects the tissues surrounding and supporting the teeth. It has been suggested that PD may be associated with cardiovascular disease (CVD), one of the leading causes of mortality worldwide. Our study aimed to investigate the association between PD and CVD through an umbrella review.

METHODS

A comprehensive search was conducted until April 2024 across various electronic databases, including PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews with or without meta-analysis were considered for inclusion, without any limitations on time or language, provided they examined primary studies linking PD with CVD. The AMSTAR-2 tool was employed to assess the quality and overall confidence of the included studies.

RESULTS

After the initial search, a total of 516 articles were identified. Following the application of selection criteria, 41 articles remained for further consideration. All these studies indicated an association between PD and CVD, with odds ratios and risk ratios ranging from 1.22 to 4.42 and 1.14 to 2.88, respectively.

CONCLUSIONS

Systematic reviews with high overall confidence support the association between PD, tooth loss, and cardiovascular diseases. However, it is crucial to interpret these results with caution due to methodological limitations. The potential public health relevance justifies preventive and corrective oral health strategies. Additionally, the need for rigorous future research is highlighted to strengthen the evidence and guide effective public health strategies.

Impact of oral health literacy on oral health behaviors and outcomes among the older adults: a scoping review

BACKGROUND

Oral Health Literacy (OHL), defined as an ability to obtain, understand, and apply information related to oral health, plays a crucial role in promoting effective oral health outcomes and behaviors. Given the pressing need to enhance oral health among older adults, this scoping review aims to summarize the impact of OHL on oral health behaviors and outcomes in this population.

METHODS

The authors performed an electronic search up through July 22, 2024. Among the 2,226 articles identified, the authors included studies in which the investigators evaluated the association between OHL and oral health behaviors or outcomes restricted to individuals aged 60 years and older. Thematic analysis was used to develop the domain for oral health behaviors or outcomes.

RESULTS

Among the 10 studies analyzed, significant correlations were identified between OHL and various oral health indicators, including periodontitis, the number of remaining teeth, dental prosthesis use, oral hygiene, oral health-related quality of life among men, as well as dissatisfaction with oral health (p < 0.05). However, the results were conflicting across the studies, indicating variability in the strength and nature of these associations. Additionally, OHL was shown to significantly influence oral health-related behaviors, especially the tooth brushing frequency (p < 0.05).

CONCLUSIONS

This review highlights a scarcity of studies addressing OHL in older populations, suggesting that OHL has been deprioritized in efforts to improve oral health for this vulnerable group. Key gaps include the need for age-appropriate OHL assessment tools, stronger evidence linking OHL to specific oral health behaviors and outcomes, and the integration of OHL into broader health initiatives and research in older group. These areas are critical to advancing our understanding and improving oral health outcomes among older adults.

Oral-hygiene-related self-efficacy in periodontal therapy: A 4-year longitudinal study

AIM

Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters.

MATERIALS AND METHODS

Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models.

RESULTS

Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category 'interdental cleaning' was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation rs = -.2349, p = .022) and periodontal inflamed surface area (PISA) (rs = -.2099, p = .042).

CONCLUSIONS

Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.

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

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

Nuclear imaging to visualize periodontal inflammation: Findings of a randomized controlled trial

OBJECTIVE

To investigate non-surgical periodontal therapy by 18F-fluorodeoxyglucose (2-[18F]FDG) uptake using positron emission tomography (PET) integrated with computed tomography (CT).

SUBJECTS

Eighty-five patients with peripheral artery disease and severe periodontitis-randomized into three groups receiving therapy with (PT1; n = 29) or without (PT2; n = 28) systemic antibiotics or no treatment (controls: n = 28)-underwent nuclear imaging at baseline and at 3 months.

RESULTS

Clinical inflammation (periodontal inflamed surface area; PISA) did not significantly differ across the groups at baseline (p = 0.395) but was significantly reduced at 3 months (p < 0.001), and significantly more so in the PT1/PT2 groups than in the control group (p < 0.001/=0.025) and in the PT1 than in the P2 group (p = 0.001). Radiotracer uptake was measured in both jaws using maximum and mean 'standardized uptake values' (SUVmax, SUVmean) and 'target-to-background ratios' (TBRmax, TBRmean). At 3 months, reductions were relatively small in absolute numbers and fell short of revealing correlations with PISA or significant differences across the groups. Still, they were very consistent in both treatment groups, whereas reductions were not consistently seen in the control group.

CONCLUSIONS

2-[18F]FDG PET/CT scans did reflect the clinical effects of periodontal treatment very consistently but, for reasons yet to be clarified, less closely than expected.

Oral diseases and systemic conditions: correlation analyses from the Colombian national health records between 2016 and 2023

Introduction

Prevalence of oral, metabolic, circulatory, and nutritional diseases has tended to increase globally. As these diseases have common contributing factors, such as unhealthy diets, evaluating their epidemiological trends and the relation between them is relevant. In Colombia, the Ministry of Health records the frequency of consultation for these diseases through the Integrated Social Protection Information System. It facilitates the evaluation of their epidemiological behavior at the population level.

Aim

To analyze and correlate the burden of oral diseases (caries and periodontitis) with respect to nutritional, circulatory and metabolic pathologies, as well as their relationships with socioeconomic indices in Colombian regions from 2016 to 2023.

Methods

This study analyzes retrospective data collected between 2016 and 2023 by the National Health Registry in Colombia (SISPRO) according to the ICD-10. Sociodemographic data and the number of disease consultations were extracted. The number of consultations for oral diseases was correlated with systemic pathologies, socioeconomic indices through the Spearman test. Associations were explored via multiple linear regressions. A Principal Component Analyses (PCA) was conducted to identify patterns between socioeconomic, oral and systemic disease variables, as well as to reduce the complexity of the analysis by creating clusters that capture the greatest possible variability in the data.

Results

The average number of consultations per biennium was 24.550.435 being the highest number for 2018-2019. The highest percentage of consultations was related to extensive caries, followed by chronic gingivitis. Moreover, consultations for oral diseases were found to correlate with systemic pathologies. All socioeconomic indices were associated with caries and/or periodontal diseases. This study is the first in Colombia that uses national data on diagnoses assigned to medical and dental consultations. PCA revealed a clustering pattern of pathologies suggesting that they are highly associated one to each other.

Conclusion

Correlations between consultations for oral and systemic diseases stratified by life cycle and socioeconomic indices highlight the importance of conducting epidemiological and public health characterizations and their associations. Identifying these factors is imperative in the prevention and management of both diseases.

Multi-way modelling of oral microbial dynamics and host-microbiome interactions during induced gingivitis

Gingivitis-the inflammation of the gums-is a reversible stage of periodontal disease. It is caused by dental plaque formation due to poor oral hygiene. However, gingivitis susceptibility involves a complex set of interactions between the oral microbiome, oral metabolome and the host. In this study, we investigated the dynamics of the oral microbiome and its interactions with the salivary metabolome during experimental gingivitis in a cohort of 41 systemically healthy participants. We use Parallel Factor Analysis (PARAFAC), which is a multi-way generalization of Principal Component Analysis (PCA) that can model the variability in the response due to subjects, variables and time. Using the modelled responses, we identified microbial subcommunities with similar dynamics that connect to the magnitude of the gingivitis response. By performing high level integration of the predicted metabolic functions of the microbiome and salivary metabolome, we identified pathways of interest that describe the changing proportions of Gram-positive and Gram-negative microbiota, variation in anaerobic bacteria, biofilm formation and virulence.