Effect of obesity on periodontal attachment loss progression: a 5-year population-based prospective study

Persistent deciduous teeth: Association of prevalence with breed, breed size and body weight in pure-bred client-owned dogs in the United States

Dogs use their teeth for a multitude of tasks and, as such, it is vital for their health and wellbeing that their oral health is maintained. Persistent deciduous teeth (PDT), those that fail to fall out at the appropriate time, are associated with malocclusion (misaligned bite), soft tissue trauma and increased risk of periodontal disease. The objective of the current study was to perform a retrospective analysis of veterinary medical data to understand the effect of dog breed size, dog breed and body weight on prevalence of PDT. Medical records collected from almost 3 million dogs visiting a chain of veterinary hospitals across the United States over a 5-year period showed an overall prevalence of 7% for PDT, the data represented 60 breeds with extra-small breeds (<6.5 kg) showing significantly higher prevalence (15%) than all other breed sizes (P < 0.001). Statistical modelling of extra-small, small and medium-small breed sizes showed that those on Wellness Plans or that had not received a dental prophylaxis for at least two years had significantly increased odds of PDT being detected (Odds ratio 2.72-3.2 and 2.17-3.36 respectively, P < 0.0001). Dogs with a below ideal body condition score had a decreased odds of PDT (Odds ratio 0.57-0.89, P < 0.0001) whereas those above ideal had an increased odds (Odds ratio 1.11-1.60, P < 0.0001). The findings from this extensive dataset highlight the importance of regular veterinarian examinations to identify and remove PDT, helping to avoid increasing the risk of associated issues such as periodontal disease and malocclusion.

Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis

BACKGROUND

A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis.

METHODS

Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011‒2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis.

RESULTS

Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [ORQ5vs1] = 1.787, 95% confidence interval: 1.209-2.640) or %BF (ORQ5vs1 = 2.221, 1.509-3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR = 1.528, 1.037-2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men.

CONCLUSIONS

The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.

Prevalence and Risk Factors of Periodontal Disease among Rural and Urban Residents of a South Indian City: A Cross-Sectional Study

Background

The prevalence of oral diseases has been increasing alarmingly in the state of Kerala. Screening for periodontal disease (PD) is crucial due to its negative impact on oral and overall health. Since the occurrence and severity of PD depend on its risk factors, a structured survey in randomly selected districts in the state can be a valuable tool for policymakers to envisage strategies to enhance oral health care and control shared systemic illnesses. Data on the prevalence and risk factors of PD among the residents of the Thiruvananthapuram district of Kerala is not currently available in the public domain. This data could also be representative of the other 13 districts with more or less similar topographical, cultural, and lifestyle characteristics.

Aim

To study the prevalence of PD and its risk factors among the residents of the Thiruvananthapuram district of Kerala and to compare the urban-rural differences.

Materials and Methods

In this community-based cross-sectional study, a multistage cluster random sampling method was used to select the participants. Among the 1285 participants, 560 were from urban areas, and 725 were from rural areas. A modification of the Ramfjord PD index was used to assess periodontal health. The epidemiological risk factors were evaluated using sociodemographic data, personal histories, and physical and biochemical parameters. Multivariate logistic regression was used to determine the relationship of PD with independent variables. Mediation analysis was performed to examine the mediating effects of independent factors.

Results

The rural population (61.4%) had a higher frequency of PD than the urban (35.5%) and an overall prevalence of 50%. Aging, poor oral hygiene, and low educational level (EL) were significant risk factors for PD in urban and rural settings, with hypertension only being significant in the latter. A higher odds ratio (9.07-29.68) with a confidence interval of (5.45-48.94) for poor oral hygiene was noted. Poor oral hygiene and tobacco use had mediating effects between low EL and PD.

Conclusions

In this study, the overall prevalence of PD was 50%, with the rural population being more afflicted. Poor oral hygiene has been identified as a modifiable risk factor for PD in urban and rural populations. Poor oral hygiene and tobacco use have been demonstrated to be mediators of the strong link between low EL and PD. Therefore, this study reiterates the need for better oral health awareness and treatment facilities to minimize the impact of the above risk factors on the periodontium. A shared risk relationship between PD and hypertension in the rural population emphasizes the need for an integrated approach to public health by including oral health as part of noncommunicable disease prevention and intervention programs.

Periodontal Disease and Its Association with Metabolic Syndrome-A Comprehensive Review

Periodontal disease is a complex and progressive chronic inflammatory condition that leads to the loss of alveolar bone and teeth. It has been associated with various systemic diseases, including diabetes mellitus and obesity, among others. Some of these conditions are part of the metabolic syndrome cluster, a group of interconnected systemic diseases that significantly raise the risk of cardiovascular diseases, diabetes mellitus, and stroke. The metabolic syndrome cluster encompasses central obesity, dyslipidemia, insulin resistance, and hypertension. In this review, our objective is to investigate the correlation between periodontal disease and the components and outcomes of the metabolic syndrome cluster. By doing so, we aim to gain insights into the fundamental mechanisms that link each systemic condition with the metabolic syndrome. This deeper understanding of the interplay between these conditions and periodontal disease can pave the way for more effective treatments that take into account the broader impact of managing periodontal disease on the comprehensive treatment of systemic diseases, and vice versa.

Association of obesity and weight gain with alveolar bone loss: Results of the Northern Finland Birth Cohort 1966 study

AIM

To investigate whether long-term obesity, long-term central obesity and weight gain are associated with alveolar bone loss.

MATERIALS AND METHODS

A sub-population (n = 1318) of the Northern Finland Birth Cohort 1966 was categorized based on body mass index (BMI: normal weight, overweight and obesity) and waist circumference (WC: no central obesity, central obesity) at ages 31 and 46. These categories were combined to define whether the participants stayed in the same categories or passed on to a higher category (weight gain). Alveolar bone level (BL) data were collected at age 46.

RESULTS

The associations of long-term obesity and weight gain with BL ≥ 5 mm were stronger in smokers than in the total population and in never smokers. Males who passed on to higher BMI and WC categories showed a higher likelihood for BL ≥ 5 mm (range in relative risks [RRs] 1.3-2.2) than males who stayed in the same categories (range in RRs 0.7-1.1). The associations with BL ≥ 5 mm were weak or non-existent in females.

CONCLUSIONS

The relation between obesity and periodontal diseases seems more complex than previously presumed. The role of gender and smoking should be taken into account in future studies.

Effect of Overweight and Obesity on Periodontal Treatment Intensity

INTRODUCTION

Obesity is associated with greater utilization of medical resources, but it is unclear if a similar relationship exists for dental care.

OBJECTIVES

This retrospective cohort study compared periodontal disease treatment among obese, overweight, and normal-weight patients attending an urban US dental school clinic.

METHODS

Periodontal, demographic, and medical history data for 3,443 adult patients examined between July 1, 2010, and July 31, 2019, were extracted from electronic health records. Body mass index (BMI) was computed from self-reported height and weight and categorized as obese (≥30 kg/m²), overweight (25-29.9 kg/m²), or normal (18-24.9 kg/m²). Periodontal disease was categorized using clinical probing measures. Procedure codes defined treatment type (surgical, nonsurgical, local chemotherapeutics, or none). Logistic regression models controlling for initial periodontal disease severity, age, gender, tobacco use, history of diabetes, dental insurance type, and follow-up (log of days) estimated odds ratios (ORs) and 95% confidence intervals (CIs) of any treatment among obese and overweight relative to normal-weight patients. The association between BMI and a periodontal treatment intensity score, based on treatment type, number of teeth treated, and number of visits, was evaluated with multivariable negative binomial regression.

RESULTS

Mean age at baseline was 44 ± 15 y, and severe periodontal disease was present in 32% of obese, 31% of overweight, and 21% of normal-weight patients. Average follow-up was 3.9 ± 1.6 y. Obese and overweight patients were more likely to have nonsurgical scaling and root planing or surgical procedures than normal-weight patients. Adjusted odds of any treatment were higher among obese (OR = 1.34; 95% CI, 1.14-1.72) and overweight (OR = 1.18; 95% CI, 0.97-1.42) relative to normal weight. Obese and overweight patients had 40% and 24% higher treatment intensity scores, respectively, than normal-weight patients.

CONCLUSION

These results indicate obese and overweight individuals require more intensive periodontal treatment compared to normal-weight individuals, independent of initial disease severity.

KNOWLEDGE OF TRANSFER STATEMENT

The results of this study can be used by dental providers and policymakers to better understand patient characteristics that influence the variability in frequency and length of periodontal treatment. Knowledge of a patient's body mass index may be useful in identifying patients who possibly will have a poorer periodontal prognosis.

Is Obesity a Risk Factor for Periodontal Disease in Adults? A Systematic Review

There is inconclusive evidence about the link between the severity and prevalence of periodontitis in obese adults. Therefore, this systematic review aims to explore the possibility of significant evidence on the association between obesity and periodontitis and to determine the necessity to consider obesity as a risk factor for periodontitis. We followed the PRISMA protocol, and studies that met the eligibility criteria were included in this review. The risk of bias in individual studies was also evaluated. This review included 15 observational studies (9 cross-sectional studies, 2 case-control, and 4 cohort studies). The total study subjects from these studies were 6603 (males = 3432; females = 3171). Most studies showed a significant association between obesity and periodontitis. Among these studies, a few showed obese females to be at a higher risk, and one study found no association between obesity and periodontal disease at all. Based on the evidence obtained from this review, the body mass index (BMI) should be routinely assessed in patients to assess the risk for periodontal disease and to offer personalized management of periodontitis. Based on the findings of this review, we recommend the need to initiate awareness among clinicians and implement dental hygiene care prevention measures for obese patients.

Association between BMI and periodontitis in women living with or at risk for HIV

AIMS

Currently, there is no data available assessing the association between body mass index (BMI) and periodontitis among women living with HIV (WLWH). This study aims to investigate this association among WLWH and women at risk for HIV (WRH) in the United States.

METHODS AND RESULTS

Data from 351 WLWH and 52 WRH participants from the Women's Interagency HIV Study having pocket depths and clinical periodontal attachment loss assessments in 2003-2004 were included. Multinomial logistic regression analyses in the full sample assessed the relationship between BMI (underweight/normal, overweight, or obese) and periodontitis by severity (mild, moderate, severe), adjusting for study sites, age, education, annual household income, smoking, alcohol consumption, and diabetes. Overall, 75.2% women (76.0% WLWH; 69.0% WRH) had periodontitis. Moreover, 75.0% obese and 75.3% overweight women were affected by periodontitis. In the full sample, adjusted odds ratio (aOR) of having mild, moderate, and severe periodontitis in obese women were: 1.14 (95% confidence interval [CI]: 0.51-2.52), 1.02 (95% CI: 0.46-2.29), and 0.24 (95% CI: 0.06-1.07), respectively, and in overweight women: 0.70 (95% CI: 0.31-1.58), 0.85 (95% CI: 0.38-1.90), and 0.31 (95% CI: 0.08-1.15), respectively.

CONCLUSIONS

Even with high prevalence of periodontitis among women with or without HIV infection in this cohort, this study does not provide evidence of an association between BMI and periodontitis.

Effect of Bacterial Infection on Ghrelin Receptor Regulation in Periodontal Cells and Tissues

The effect of bacterial infection on the expression of growth hormone secretagogue receptor (GHS-R) was investigated in periodontal cells and tissues, and the actions of ghrelin were evaluated. GHS-R was assessed in periodontal tissues of rats with and without periodontitis. Human gingival fibroblasts (HGFs) were exposed to Fusobacterium nucleatum in the presence and absence of ghrelin. GHS-R expression was determined by real-time PCR and immunocytochemistry. Furthermore, wound healing, cell viability, proliferation, and migration were evaluated. GHS-R expression was significantly higher at periodontitis sites as compared to healthy sites in rat tissues. F. nucleatum significantly increased the GHS-R expression and protein level in HGFs. Moreover, ghrelin significantly abrogated the stimulatory effects of F. nucleatum on CCL2 and IL-6 expressions in HGFs and did not affect cell viability and proliferation significantly. Ghrelin stimulated while F. nucleatum decreased wound closure, probably due to reduced cell migration. Our results show original evidence that bacterial infection upregulates GHS-R in rat periodontal tissues and HGFs. Moreover, our study shows that ghrelin inhibited the proinflammatory actions of F. nucleatum on HGFs without interfering with cell viability and proliferation, suggesting that ghrelin and its receptor may act as a protective molecule during bacterial infection on periodontal cells.

The ever-changing landscape in modern dentistry therapeutics - Enhancing the emptying quiver of the periodontist

Introduction/Objectives

Periodontitis comprises of a wide range of inflammatory conditions of the gums leading to soft tissue damage and attachment loss. The initiation of periodontitis constitutes a rather complex disease pathogenesis which is based on pathogenic shifts of the oral microbiota combined with the host-microbiome interactions. The severity of the periodontitis is multifactorial depending on genetic, environmental, as well as host immunity factors.

Data and sources

To make an inclusive analysis on the periodontitis therapeutics, reading of the recent relevant literature was carried out using the MEDLINE/PubMed database, Google Scholar and the NIH public online database for clinical trials (http://www.clinicaltrials.gov).

Conclusions

Tackling the inflammation associated periodontal defects can be succeeded with conventional therapy or resective and regenerative treatment. To date, the mechanical removal of the supragingival and subgingival biofilm is considered the “gold standard” of periodontal therapy in combination with the use of antibacterial compounds. The antimicrobial resistance phenomenon tends to turn all the currently applied antibacterials into “endangered species”. Ongoing efforts through the conduct of clinical trials should be focused on understanding the advantages of modern approaches in comparison to traditional therapies.

Association of periodontal disease with breed size, breed, weight, and age in pure-bred client-owned dogs in the United States

Despite periodontal disease (PD) being amongst the most common diagnoses in primary-care practice, the disease is generally underdiagnosed. However, the millions of clinical records generated by pet hospitals each year provide unique opportunities to generate insights about disease risk across large numbers of dogs. The objective of this study was to undertake a retrospective analysis of medical records to ascertain which sizes and breeds of dog are most frequently diagnosed with PD. Although data collection regarding PD was not consistent, it was assumed that the same inconsistencies in recording periodontal abnormalities were present across the range of bodyweight, breed categories and breeds. Over 3 million medical records across 60 breeds of dogs visiting a chain of veterinary hospitals in the United States collected over a 5-year period were analysed. Statistical analysis of a subset of these records found that extra-small (<6.5 kg) breeds of dog were up to five times more likely to be diagnosed with PD than giant breeds (>25 kg) (P <0.0001). The majority of breeds most frequently diagnosed with PD were in the extra-small, small (6.5-9 kg) and medium-small (9-15 kg) breed size categories. Additional risk factors for PD diagnosis included age, being overweight and time since last scale and polish. Veterinarians should consider targeting client education about dental health, and diagnostic efforts, towards canine patients of the small-breed size categories and those with a higher risk of developing PD (e.g. overweight).

Association of periodontal pocket area with type 2 diabetes and obesity: a cross-sectional study

INTRODUCTION

The aim was to investigate the relationship of full-mouth inflammatory parameters of periodontal disease with diabetes and obesity.

RESEARCH DESIGN AND METHODS

This cross-sectional study conducted diabetes-related examinations and calculated periodontal inflamed and epithelial surface area (PISA and PESA) of 71 Japanese patients with type 2 diabetes. Multiple linear regression analyses were performed to evaluate associations between PISA or PESA and diabetes and obesity parameters.

RESULTS

Median value of body mass index (BMI), hemoglobin A1c (HbA1c) level, fasting plasma glucose (FPG) level, and visceral fat area (VFA) were 25.7 kg/m2, 9.1%, 151 mg/L, and 93.3 cm2, respectively. PISA and PESA were significantly associated with HbA1c after adjusting for age, sex, BMI, smoking status, and full-mouth plaque control level (PISA: coefficient=38.1, 95% CI 8.85 to 67.29, p=0.001; PESA: coefficient=66.89, 95% CI 21.44 to 112.34, p=0.005). PISA was also significantly associated with the highest FPG tertile (>175 mg/dL) after adjusting for confounders (coefficient=167.0, 95% CI 48.60 to 285.4, p=0.006). PISA and PESA were not significantly associated with BMI or VFA.

CONCLUSION

PISA was associated with FPG and HbA1c, but not with obesity parameters, independent from confounders such as full-mouth plaque control level in patients with type 2 diabetes.

Obesity as a risk factor for tooth loss over 5 years: A population-based cohort study

AIM

To assess obesity as a risk factor for tooth loss over 5 years in an urban sample of Brazilian adults.

MATERIALS AND METHODS

A total of 1586 individuals were surveyed using a multistage probabilistic approach. Five years later, 635 individuals 14-64 years old were re-examined. An incident case of tooth loss was determined for a participant that had lost at least one tooth over time. Obesity was evaluated by calculating body mass index at baseline and by the change in obesity status over time.

RESULTS

Incident cases of tooth loss were significantly more frequent among obese (47.1%) than normal-weight individuals (32.4%) (p = .004). Obese individuals had 31% higher risk [relative risk (RR) =1.31; 95% confidence interval (95%CI) 1.04-1.65] for tooth loss than normal-weight individuals adjusting for age, socio-economic status, smoking, dental care and periodontitis. This association was significant for females (RR=1.47, 95%CI 1.08-2.01), but not for males. The risk for tooth loss was also modified by presence of periodontitis at baseline and lifetime smoking exposure. There was an increased risk for tooth loss for those that remained obese than those that remained normal weight.

CONCLUSION

Obesity is associated with higher risk for tooth loss. This association was modified by sex, periodontal status and smoking.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Objective

Obesity is a chronic disease that negatively affects an individual’s general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy.

Methodology

This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used.

Results

In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy.

Conclusions

Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Evaluation of recurrence of periodontal disease after treatment in obese and normal weight patients: Two-year follow-up

BACKGROUND

Obesity may represent a chronic low-grade inflammation, but there is a lack of long-term longitudinal studies. The aim of this longitudinal study was to evaluate the recurrence of periodontal disease in obese and normal weight patients submitted to scaling and root planing.

METHODS

The study included 22 patients who had received periodontal treatment 2 years previously, 13 obese and nine non-obese. The patients were evaluated for anthropometric measurements of body mass index, waist circumference, waist-to-hip ratio, and fat percentage through bioimpedance. The following periodontal parameters were recorded: visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). The immunological evaluation analyzed the proinflammatory cytokines interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in the gingival crevicular fluid (GCF).

RESULTS

Obese and normal weight patients did not differ in relation to the periodontal parameters of VPI, GBI, PD, CAL, or BOP 2 years after completion of the periodontal therapy. Sites with periodontitis in obese individuals showed higher levels of IL-6 and TNF-α in the gingival fluid (P <0.05).

CONCLUSION

Obese and normal weight individuals had similar periodontal behaviors, with low recurrence of the periodontal disease; however, obesity was related to increased inflammatory activity in gingival fluid, which may become a risk indicator for future greater recurrence of the disease in the presence of inadequate plaque control.

Association between obesity and its determinants with chronic periodontitis: A cross-sectional study

Background

Various systemic disorders such as cardiovascular, diabetes, and osteoporosis are linked to periodontitis. Obesity is one such epidemic, and although many studies have addressed its relationship with periodontitis, the mechanism still remains unclear.

Aim

This study aims to assess the association between obesity and its determinants with clinical periodontal parameters in adult patients visiting a dental college in Haryana.

Materials and Methods

This cross-sectional study was performed in 317 patients visiting a dental college in Gurugram. Obesity parameters such as body mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-hip ratio (WHR) were assessed using body fat analyzer (Omron HBF 701). Depending on their BMI, individuals were stratified as overweight (OW), Class 1, Class 2, and Class 3 obese. Periodontal status was assessed by plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level. These periodontal parameters were correlated with BMI, BF%, WC, and WHR. Statistical analysis was done, and P ≤ 0.05 was considered as statistically significant.

Results

The prevalence of periodontitis in OW, Class 1, Class 2, and Class 3 obese was 16.4%, 79.2%, 2.8%, and 1.6%, respectively. PPD was significantly associated with obesity determinants, especially among Class 2 and Class 3 obese individuals. Similarly, BF% was associated with all the periodontal parameters.

Conclusion

Within the restrictions of the study, it can be concluded that obesity and chronic periodontitis are interlinked.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

BACKGROUND

A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

METHODS

Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

RESULTS

Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

CONCLUSION

An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations

OBJECTIVES

This review proposes case definitions and diagnostic considerations of systemic disorders and conditions that affect the periodontal attachment apparatus.

IMPORTANCE

Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors, and affected patients may show manifestations of both diseases. Characterizing these diseases and the nature of the association between them could have important diagnostic value and therapeutic implications for patients.

FINDINGS

Numerous systemic disorders and certain medications can affect the periodontal attachment apparatus and cause loss of periodontal attachment and alveolar bone. Although many of these disorders are rare or uncommon, they often cause significant loss of periodontal tissue by influencing periodontal inflammation or through mechanisms distinct from periodontitis. Most of these disorders are due to innate mechanisms and some are acquired via environmental factors or lifestyle. Several disorders affect periodontal inflammation through alterations in the host immune response to periodontal infection; others cause defects in the gingiva or periodontal connective tissue, instigate metabolic changes in the host that affect various tissues of the periodontal apparatus, or operate by other mechanisms. For some systemic disorders that are more common, their contribution to the loss of periodontal tissue is modest, while for others, contribution is not supported by clear evidence. Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies.

CONCLUSIONS

This review identifies systemic diseases and conditions that can affect the periodontal attachment apparatus and cause loss of periodontal supporting tissues and, where possible, presents case definitions for these. Many of these diseases are associated with a profound loss of periodontal attachment and alveolar bone, and for some of these disorders the periodontal manifestations may be among the first signs of the disease. These case definitions may be useful in the early diagnosis of these diseases and may contribute to an improvement in the management of periodontal manifestations and improve the quality of life for these patients.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

BACKGROUND

A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

METHODS

Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

RESULTS

Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

CONCLUSION

An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Periodontal complications with obesity

The purpose of this paper was to identify and summarize current evidence describing periodontal complications associated with obesity. Electronic searches supplemented with manual searches were carried out to identify relevant systematic reviews. Identification, screening, eligibility, and inclusion of studies were performed independently by two reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess the quality and risk of bias of the included reviews. From 430 titles and abstracts screened, 14 systematic reviews were considered as eligible for inclusion in this meta-review. Eight reviews reported on cross-sectional studies investigating the association of obesity and periodontal diseases, 4 included longitudinal studies, 5 addressed response to periodontal therapy, 5 reported on studies investigating biomarkers, and only 2 were related to pediatric population samples. Systematic review summaries in the various study design domains (cross-sectional, longitudinal and experimental) report that obese individuals are more likely to have periodontal diseases, with more severe periodontal conditions, than nonobese individuals, with cross-sectional evidence congruent with longitudinal studies showing that obesity or weight gain increases the risk of periodontitis onset and progression. Published research on the effect of obesity on responses to periodontal therapy, or systemic or local biomarkers of inflammation, is variable and therefore inconclusive based on the evidence currently available, which suggests that overweight/obesity contributes to periodontal complications independently of other risk factors, such as age, gender, smoking, or ethnicity. This evidence supports the need for risk assessments for individual patients to facilitate personalized approaches in order to prevent and treat periodontal diseases.

Melatonin expression in periodontitis and obesity: An experimental in-vivo investigation

BACKGROUND AND OBJECTIVE

Melatonin deficiency has been associated with obesity and systemic inflammation. This study aims to evaluate whether melatonin could interfere with the mechanisms of co-morbidity linking obesity and periodontitis.

MATERIAL AND METHODS

Twenty-eight male Wistar rats were randomly divided in 4 groups: control group (Con) (fed with standard diet); high-fat diet group (HFD) (fed with a diet containing 35.2% fat); Con group with induced periodontitis (Con-Perio) and HFD group with induced periodontitis (HFD-Perio). To induce periodontitis, the method of oral gavages with Porphyromonas gingivalis ATCC W83K1 and Fusobacterium nucleatum DMSZ 20482 was used. Circulating melatonin levels were analyzed by multiplex immunoassays. Periodontitis was assessed by alveolar bone loss (micro-computed tomography and histology) and by surrogate inflammatory outcomes (periodontal pocket depth, modified gingival index and plaque dental index).

RESULTS

Plasma melatonin levels were significantly decreased (P < .05) in the obese rats with periodontitis when compared with controls or with either obese or periodontitis rats. Alveolar bone loss increased 27.71% (2.28 µm) in HFD-Perio group compared with the Con group. The histological analysis showed marked periodontal tissue destruction with osteoclast activity, particularly in the HFD-Perio group. A significant negative correlation (P < .05) was found between periodontal pocket depth, modified gingival index and circulating melatonin levels.

CONCLUSION

Obese and periodontitis demonstrated significantly lower melatonin concentrations when compared with controls, but in obese rats with periodontitis these concentrations were even significantly lower when compared with either periodontitis or obese rats. These results may indicate that melatonin deficiency could be a key mechanism explaining the co-morbidity effect in the association between obesity and periodontitis.

Designing an Effective, Small-Scope Practice-based Study

OBJECTIVE

Present a methodology to promote good practices in designing small-scale, practice-based studies.

STUDY DESIGN

We propose the following methods to assist clinicians and other practice-based researchers in designing and conducting good quality, small-scale studies in a clinical setting.

METHODS

Research projects applied to a limited, practice-based study may require modification to increase the consistency of patient research.

RESULTS

Although common requests to collaborative methodologists mirror methods for experimental design, clinic-based studies may face different limitations. Each participant enrolled consumes resources, including time, and personnel. If practice-based studies have a different goal, to learn about the health outcomes of patients in a medical practice with limited intent for generalization, should the same methods be used?

CONCLUSIONS

When limitations are clearly stated and the findings are described within the study context, these limitations may not be so severe to discourage the research. We propose a systematic method to conduct practice-based research intended for small-scale study use. Relying heavily on existing research from similar areas, the incorporation of data from the practice, and the a priori defined timelines and resources, we set forth some guiding principles to assist clinic-based investigators. Individualized focus and small-scale studies are growing in use and acceptance especially given the focus on personalized health.

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever

BACKGROUND AND OBJECTIVE

Familial Mediterranean fever (FMF) and chronic periodontitis are inflammatory diseases leading to an increase in the number of inflammasomes. To date, no published studies have reported on mutations in the Mediterranean fever (MEFV) gene in patients with chronic periodontitis, although the roles of MEFV gene mutations in FMF and FMF-associated amyloidosis (FMF-A) are well known. Therefore, the aim of this study was to evaluate the frequencies of MEFV gene mutations and serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic periodontitis, FMF and FMF-A.

MATERIAL AND METHODS

The study population included 122 patients with FMF and 128 subjects who were systemically healthy. Clinical periodontal parameters, including the plaque index, gingival index, probing pocket depth, clinical attachment level and percentage of bleeding on probing were recorded. Blood samples were obtained from patients with FMF and systemically healthy controls, and all mutations located on exons 2 and 10 of the MEFV gene were analyzed by DNA Sanger Sequencing, which is the gold standard. SAA and high-sensitive CRP levels were also assessed.

RESULTS

Mean gingival index, percentage of bleeding on probing, probing pocket depth and clinical attachment level, and the levels of SAA and hs-CRP were higher in the FMF-A group than those in the FMF and control groups. The two most relevant mutations in patients with FMF were heterozygous M694V (46.2%), and heterozygous R202Q (32.7%). The frequencies of the homozygous M694V and R202Q mutations in the FMF-A group were 53.8% and 46.1%, respectively. The complex R202Q/M694V homozygous state led to an increased risk of chronic periodontitis (odds ratio: 3.6), and FMF-A (odds ratio: 7.6).

CONCLUSION

This is the first study to report the R202Q mutation in patients with periodontitis. Furthermore, the MEFV gene-mediated inflammatory pathway increased serum acute phase reactants, and the changes in the R202Q and M694V could play a role in inflammatory-genetic diseases, such as FMF, FMF-associated amyloidosis and chronic periodontitis.

Relationship between periodontal disease and cardiovascular risk factors among young and middle-aged Brazilians. Cross-sectional study

CONTEXT AND OBJECTIVE:

It has been suggested in the literature that periodontal disease (PD) is associated with cardiovascular risk. The objective of this study was to appraise the relationship between periodontal disease (gingivitis and periodontitis) and traditional cardiovascular risk factors (obesity, hypertension, dyslipidemia, diabetes and metabolic syndrome) among young and middle-aged adults attended at a health promotion and check-up center in the city of São Paulo, Brazil.

DESIGN AND SETTING:

Cross-sectional study at the Health Promotion and Check-up Center of Hospital Sírio-Libanês, São Paulo, Brazil.

METHODS:

We consecutively evaluated 539 subjects without prior cardiovascular disease who were seen within a health promotion program that included cardiovascular and dental evaluation between February and November 2012. Odds ratios (OR) with respective 95% confidence intervals (95% CI) for the association between PD and cardiovascular risk factors were ascertained through multinomial logistic regression.

RESULTS:

In this sample of mean age 45 years (standard deviation, SD ± 8.8), which was 82% male, we found PD in 63.2% (gingivitis 50.6% and periodontitis 12.6%). Individuals with PD were older, more obese (without PD 15.2%; versus gingivitis 22.1% and periodontitis 32.4%) and more diabetic (without PD 5.1%; versus gingivitis 4.8% and periodontitis 13.2%), compared with those without PD. Among all cardiovascular risk factors evaluated, obesity was associated with periodontitis (multivariate OR, 2.36; 95% CI, 1.23-4.52). However, after additional adjustment for oral hygiene, this finding was no longer significant (multivariate OR, 1.63; 95% CI, 0.79-3.37).

CONCLUSIONS:

We did not find any significant associations between cardiovascular risk factors and periodontal disease in this sample.

Association between underweight and tooth loss among Korean adults

There is growing interest in the relationship between body mass index and oral health. Previous study showed that being underweight was significantly associated with having lower masticatory performance. This study was performed to assess the relationship between an underweight body mass index lower than 18.5 and the number of natural teeth using nationally representative data. Initially, a total of 25,534 individuals were candidates in the Korean National Health and Nutrition Examination Survey. The analysis in this study was confined to 17,870 subjects who were 19 years or older and without missing values for outcome variables. Body mass index and number of natural teeth were evaluated. Multiple regression analysis was used to evaluate the risk of tooth loss in relation to body mass index. Adjusted odds ratios and their 95% confidence intervals for chewing discomfort in individuals who were underweight, normal, overweight, obese, and extremely obese were 1.712(1.156–2.535), 1.111(0.939–1.315), 1(reference), 0.949(0.798–1.128), and 1.172(0.807–1.700), respectively, after adjustment. The association between underweight and tooth loss was proven by multiple logistic regression analyses after adjusting for confounding factors. Underweight may be considered a potential risk indicator for tooth loss in Korean adults.

Periodontitis and Systemic Disease: Association or Causality?

PURPOSE OF REVIEW

The aim was to assess recent evidence that diabetes, metabolic syndrome (MetS) and obesity impact the progression of periodontitis.

RECENT FINDINGS

Electronic searches using Embase, Medline, and Web of Science were carried out for epidemiological studies on humans, published between 2014 and 2016. A small number of prospective studies and systematic reviews were identified that in general provide further support for the hypothesis that diabetes, metabolic syndrome and obesity can adversely affect the periodontal condition.

SUMMARY

Confounding remains the most challenging issue in the interpretation of the associations found between diabetes, MetS, obesity and periodontal disease. Recent research applying a Mendelian randomisation approach concluded that the association between obesity and periodontitis is confounded and questioned a role for obesity in causation. Further studies are warranted to assess the issue of causality.

Preventive Effects of Drinking Hydrogen-Rich Water on Gingival Oxidative Stress and Alveolar Bone Resorption in Rats Fed a High-Fat Diet

Obesity induces gingival oxidative stress, which is involved in the progression of alveolar bone resorption. The antioxidant effect of hydrogen-rich water may attenuate gingival oxidative stress and prevent alveolar bone resorption in cases of obesity. We examined whether hydrogen-rich water could suppress gingival oxidative stress and alveolar bone resorption in obese rats fed a high-fat diet. Male Fischer 344 rats (n = 18) were divided into three groups of six rats each: a control group (fed a regular diet and drinking distilled water) and two experimental groups (fed a high-fat diet and drinking distilled water or hydrogen-rich water). The level of 8-hydroxydeoxyguanosine was determined to evaluate oxidative stress. The bone mineral density of the alveolar bone was analyzed by micro-computerized tomography. Obese rats, induced by a high-fat diet, showed a higher gingival level of 8-hydroxydeoxyguanosine and a lower level of alveolar bone density compared to the control group. Drinking hydrogen-rich water suppressed body weight gain, lowered gingival level of 8-hydroxydeoxyguanosine, and reduced alveolar bone resorption in rats on a high-fat diet. The results indicate that hydrogen-rich water could suppress gingival oxidative stress and alveolar bone resorption by limiting obesity.