Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases

Hyperbranched Poly-l-Lysine Modified Titanium Surface With Enhanced Osseointegration, Bacteriostasis, and Anti-Inflammatory Properties for Implant Application: An Experimental In Vivo Study

OBJECTIVES

This study aimed to explore multiple effects of hyperbranched poly-l-lysine (HBPL) titanium (Ti) surfaces on osseointegration, bacteriostasis, and anti-inflammation across three different animal models.

METHODS

Ti surfaces were covalently modified with HBPL, with uncoated surfaces as controls. Characterization included scanning electron microscopy (SEM) and surface chemistry and elemental analysis (EDX). Ti and Ti-HBPL implants were placed in conventional canine edentulous sites, post-operative infection canine edentulous sites, and diabetic rat tibias. Implants from canine edentulous models were analyzed using micro-CT and histomorphometry to assess osseointegration at 8 weeks. Post-operative infection beagles were used to evaluate antibacterial efficacy through clinical parameters and bacterial cultures at 1 week. In diabetic rats, micro-CT and histomorphometry were performed at 8 weeks.

RESULTS

HBPL was uniformly grafted on Ti-HBPL surfaces. Ti-HBPL surfaces showed higher bone volume/total volume (BV/TV, p < 0.001), bone-implant contact (BIC%, p < 0.001), and trabecular number (Tb.N, p < 0.01) in beagles. Besides, it displayed higher BIC% (p < 0.001) and bone area fraction occupancy (BAFO%, p < 0.01) in hard tissue sections. In an infected model, Ti-HBPL surfaces exhibited lower bleeding on probing (BOP, p < 0.001), and plaque index (DI, p < 0.01), with reduced bacterial colony formation (p < 0.001) compared to the control group. In diabetic rats, Ti-HBPL surfaces showed an increase in BV/TV (p < 0.01) and Tb.N (p < 0.001), downregulated TNF-α and IL-1β (p < 0.01), and upregulated IL-10 (p < 0.01) and osteocalcin (OCN) expression (p < 0.01).

CONCLUSIONS

HBPL-Ti surfaces demonstrated enhanced osseointegration, bacteriostasis, and anti-inflammatory effects in vivo.

Clinically estimated signs of hyposalivation in older adult residents of long-term care

OBJECTIVE

To assess whether the estimation of clinical signs of hyposalivation is applicable in recognising long-term care facility (LTCF) residents with poor oral health, and which individual characteristics are important in that respect.

BACKGROUND

A common inconvenience among older adults, dry mouth, particularly hyposalivation, can cause many complications, such as greater susceptibility to root caries and oral infections, and it can lead to further deterioration of oral health. However, very little is known about the association of clinically assessed signs of hyposalivation with the oral health status of LTCF residents.

METHODS

The study sample comprised 362 individuals (dentate n = 266, edentate n = 96) aged 65 or older. The examinations included a questionnaire and clinical oral examination. Participants were categorised into three groups based on clinically assessed oral dryness: normal salivation (n = 83, 22.9%), lower salivation (n = 182, 50.3%) and dry mouth (n = 97, 26.8%). The association between signs of dry mouth with aspects to oral health was evaluated and further tested with logistic regression analysis.

RESULTS

The signs of oral dryness were observed among females, those with dementia, and those with longer stays in the current facility. Root caries (odds ratio, OR 1.3) and diagnosis of periodontitis (OR 4.1), together with several individual periodontal parameters, as well as having less than ten occluding pairs of natural teeth (OR 3.5) were associated with dry mouth. Edentate participants showed an increased likelihood of having dry mouth with advancing age, and lesions on the lips were associated with dry mouth with OR 3.0.

CONCLUSION

Clinical estimation of signs of oral dryness can be a useful adjunct in evaluating the oral health status of dentate LTCF residents. Poor oral health was a frequent finding, especially among dentate LTCF residents with signs of dry mouth.

Accumulation and removal of Streptococcus mutans biofilm on enamel and root surfaces in vitro

Objective

This study aimed to quantitatively investigate the accumulation of Streptococcus mutans biofilm on enamel and root surfaces and assess the amount of biofilm removal using (1) experimental toothpaste and (2) water, in a closed system of flow chamber.

Methods

Eight sound premolars were embedded in epoxy resin and polished with silicon carbide grinding papers to display enamel and root surfaces. To mimic biofilm, cultures of Streptococcus mutans were prepared and grown on the tooth surfaces over night before they were exposed to either 2 liters of Milli Q water or 2 liters of 40% experimental toothpaste in the flow chamber. The amount of biofilm was measured and quantified in Fluorescence microscopy. Mean fluorescence values were recorded and analysed using Microsoft® Excel® (MS Excel 2016).

Results

The ability to grow biofilm was equally present at both the enamel and root surfaces. The use of water and 40% experimental toothpaste showed a significant reduction of areas covered with biofilm on both enamel and root dentin in comparison to untreated surfaces (p < 0.01). Significantly more biofilm was removed from enamel compared to root surfaces when treated with either water and toothpaste (p < 0.01). Slightly less biofilm was removed by the use of water compared to toothpaste on both enamel and root dentin surfaces, although the differences were not statistically significant.

Conclusion

The results indicate that less biofilm is removed from the root surfaces than enamel by the use of water and 40% experimental toothpaste in flow chamber. Assessing oral biofilm accumulation and monitoring biofilm formation on enamel and root dentin surfaces give oral health professionals important directions that could strenghten the significance of dental caries prevention. Improving older individuals' oral hygiene practices should therefore be considered an important measure to prevent root caries.

Effectiveness of probiotics compared to antibiotics to treat periodontal disease: Systematic review

OBJECTIVES

Probiotics are promising adjuncts to non-surgical periodontal therapy (scaling and root planing (SRP)) for managing gingival and periodontal diseases. Probiotics are considered alternatives to antibiotics, especially with the emergence of antimicrobial resistance. Hence, the present systematic review aims to generate evidence on the role of probiotics compared to antimicrobial agents for managing periodontal diseases (gingivitis and periodontitis).

METHOD

Six electronic databases (PubMed, SCOPUS, Web of Science, EBSCO, Cochrane, Clinical Trial Registry) were searched to collect studies comparing the effect of probiotics with antibiotics for periodontal disease. In total, 5530 articles were retrieved from all databases, of which 1891 were included for title and abstract screening. After screening, a total of ten clinical studies were included for data extraction and analysis. Probing pocket depth (PPD), Clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), gingival index (GI), and microbial profile were recorded.

RESULTS

Probiotics showed a significant reduction in the PPD and CAL compared to antibiotics. Antibiotics were more effective in reducing the PI and GI. A combination of probiotics and antibiotics superior compared to probiotics and antibiotics alone.

CONCLUSION

Probiotics can be used as an alternative to antibiotics, however, a combination is more effective for managing periodontal disease.

Identification of Swedish caries active individuals aged 30-90 years using a life course perspective and SKaPa longitudinal national registry data over a 10-year period

OBJECTIVE

To describe the occurrence of caries disease from a life course perspective using longitudinal data from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa).  Material and Methods: Data from seven age cohorts (ages 30-90 years), each followed over 10 years, were retrieved from the SKaPa. Using a three-trajectory model, individuals were divided into three trajectories according to their caries development over time: high (15%), moderate (45%), or low (40%). Caries experience was expressed as the mean decayed, missing, and filled surfaces (DMFS) index.

RESULTS

Significant differences were found for all three trajectories and in all age groups over the 10 years. The mean DMFS index increase was significantly larger for the high trajectory group than for the moderate and low trajectory groups across all age cohorts. An increase in caries experience was observed for the older cohorts across all trajectories.

CONCLUSIONS

A three-trajectory model appears useful for identifying and quantifying caries experiences in longitudinal studies. Increased caries disease occurs over time, especially in the highest trajectory group and among older cohorts. These findings emphasise the need for greater attention and more efficient caries prevention methods.

Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study

OBJECTIVE

To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design.

SETTING AND PARTICIPANTS

In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOP).

METHODS

Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

RESULTS

In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality.

CONCLUSIONS

The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.

Virtual reality-based simulation learning on geriatric oral health care for nursing students: a pilot study

BACKGROUND

There is a great need for training and education in the nursing curriculum to improve nurses' knowledge and skills to provide oral health care.

METHODS

A pilot study was conducted to evaluate the use of a virtual reality (VR)-based Oral Health Care Learning System to train geriatric oral health care among nursing students. Fifty undergraduate nursing students were randomly assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received the VR-based simulation training on geriatric oral health care and the training was implemented twice at two weeks apart from March to November 2021. The control group did not receive the training intervention. Knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adults were assessed at the beginning, second, and fourth weeks. Generalized estimating equations were used to analyze the effectiveness of the VR-based simulation training.

RESULTS

After the first round of training, students in the experimental group had significantly greater improvements in knowledge and self-efficacy of geriatric oral health care than in the control group. After the second round of training, students in the experimental group had significantly greater improvements in knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adult than in the control group.

CONCLUSIONS

The VR-based simulation training was effective to improve undergraduate nursing students' knowledge, attitudes and self-efficacy of geriatric oral health as well as the intention to assist oral health care for older adults. The VR-based simulation learning system is an effective tool to provide practice experiences to build confidence and skills and to bridge the gap of understudied geriatric oral health content in entry-level nursing curricula.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05248542; registration date 21/02/2022).

Serum zinc and periodontitis in non-diabetic smoking and non-smoking adults: NHANES 2011-2014

OBJECTIVE

This study aimed to evaluate the association of serum zinc with periodontitis in non-diabetics based on smoking status, using a representative sample of adults in the United States.

METHODS

A total of 1051 participants who underwent full-mouth periodontal examination and serum zinc testing were enrolled from NHANES 2011 to 2014. The covariate-adjusted association of serum zinc concentrations with periodontitis was explored using multivariable logistic regression, restricted cubic spines, and sensitivity analysis.

RESULTS

The mean age of the 1051 adults was 54.5 years, 59.37% were male, and 20.65% had periodontitis. Analysis of the results showed that serum zinc was associated with periodontitis. The overall adjusted odds of periodontitis were 9% (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.83-1.00) and 14% (OR: 0.86; 95% CI: 0.75-0.98) for nonsmokers and smokers, respectively. Smokers with T3 serum zinc exhibited a 53% reduction in the fully adjusted odds of periodontitis (OR: 0.47; 95% CI: 0.23-0.96), when compared to the reference group (T1 serum zinc), with serum zinc as the categorical variable.

CONCLUSIONS

Serum zinc levels were associated with the risk of periodontitis in non-diabetic smokers but not non-smokers.

Association between periodontal disease and coronary heart disease: A bibliometric analysis

Background

Periodontal disease and coronary heart disease are both prevalent diseases worldwide and cause patients physical and mental suffering and a global burden. Recent studies have suggested a link between periodontal disease and coronary heart disease, but there is less research in this field from the perspective of bibliometrics.

Objective

This study aimed to quantitatively analyze the literature on periodontal disease and coronary heart disease to summarize intellectual bases, research hotspots, and emerging trends and pave the way for future research.

Methods

The Science Citation Index Expanded database was used to retrieve study records on periodontal disease and coronary heart disease from 1993 to 2022. After manual screening, the data were used for cooperative network analysis (including countries/regions, institutions and authors), keyword analysis, and reference co-citation analysis by CiteSpace software. Microsoft Excel 2019 was applied for curve fitting of annual trend in publications and citations.

Results

A total of 580 studies were included in the analysis. The number of publications and citations in this field has shown an upward trend over the past 30 years. There was less direct collaboration among authors and institutions in this field but closer collaboration between countries. The United States was the country with the most published articles in this field (169/580, 29.14%). Based on the results of keyword analysis and literature co-citation analysis, C-reactive protein, oral flora, atherosclerosis, infection, and inflammation were previous research hotspots, while global burden and cardiovascular outcomes were considered emerging trends in this field.

Conclusion

Studies on periodontal disease and coronary heart disease, which have attracted the attention of an increasing number of researchers, have been successfully analyzed using bibliometrics and visualization techniques. This paper will help scholars better understand the dynamic evolution of periodontal disease and coronary heart disease and point out the direction for future research.

Clinical significance

This paper presents an overview between periodontal disease and coronary heart disease. Further exploration of the two diseases themselves and the potential causal relationship between the two is necessary and relevant, which may impact basic research, diagnosis, and treatment related to both diseases. This will aid the work of researchers and specialist doctors, and ultimately benefit patients with both diseases.

Changes in oral health during aging in a novel non-human primate model

Oral health plays a significant role in the quality of life and overall well-being of the aging population. However, age-related changes in oral health are not well understood due to challenges with current animal models. In this study, we analyzed the oral health and microbiota of a short-lived non-human primate (i.e., marmoset), as a step towards establishing a surrogate for studying the changes that occur in oral health during human aging. We investigated the oral health of marmosets using cadaveric tissues in three different cohorts: young (aged ≤6 years), middle-aged, and older (>10 years) and assessed the gingival bacterial community using analyses of the V3-V4 variable region of 16S rRNA gene. The oldest cohort had a significantly higher number of dental caries, increased dental attrition/erosion, and deeper periodontal pocket depth scores. Oral microbiome analyses showed that older marmosets had a significantly greater abundance of Escherichia-Shigella and Propionibacterium, and a lower abundance of Agrobacterium/Rhizobium at the genus level. Alpha diversity of the microbiome between the three groups showed no significant differences; however, principal coordinate analysis and non-metric multidimensional scaling analysis revealed that samples from middle-aged and older marmosets were more closely clustered than the youngest cohort. In addition, linear discriminant analysis effect size (LEFSe) identified a higher abundance of Esherichia-Shigella as a potential pathogenic biomarker in older animals. Our findings confirm that changes in the oral microbiome are associated with a decline in oral health in aging marmosets. The current study suggests that the marmoset model recapitulates some of the changes in oral health associated with human aging and may provide opportunities for developing new preventive strategies or interventions which target these disease conditions.

Enhancing Oral Hygiene in Children With Hearing Impairment: The Impact of Skit Video Interventions -A Randomized Controlled Trial

Aim. This study aimed to assess the effectiveness of 3 interventions-skit video, pictorial, and sign language-in improving the oral hygiene of children with hearing impairment. Materials and Methods. Sixty children randomly divided into 3 groups: Skit video, Pictorial, and Sign language. The mean gingival and Oral Hygiene Index scores were recorded before and after interventions. A 1-way ANOVA was used for statistically significant difference between pre and post intervention scores. Results. A significant difference in mean oral hygiene and gingival index scores before and after interventions was found in Group A (P < .005). A statistically significant difference was also found between group A and B in inter group comparison of OHI and GI scores post intervention (P < .004). Conclusion. Skit video and pictorial intervention effectively improves oral health resulting in reduced mean oral hygiene and gingival scores.

Are periodontitis and dental caries associated? A systematic review with meta-analyses

AIM

The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'.

MATERIALS AND METHODS

Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses.

RESULTS

A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I2  = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I2  = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I2  = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I2  = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means  [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I2  = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown.

CONCLUSIONS

Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis.

Translation and validation into Spanish of the oral health self-efficacy scale in Chilean older adults

BACKGROUND

Population ageing poses a challenge to improving the well-being of older adults, particularly in terms of oral health. Promoting self-efficacy in oral health behaviours is crucial for maintaining this population's health and quality of life. The Oral Health Self-Efficacy Scale (OHSES) has been widely used to assess dental self-efficacy and is considered comprehensive and reliable. However, there is a need to validate OHSES for Spanish-speaking older adults. This study aimed to assess the reliability and validity of the translated questionnaire for use in the older Chilean population.

METHODS

A sample of 188 older adults, aged 60 years and above residing independently in the community, were recruited by accessing databases from the National Senior Citizen Service and various community organisations within the region of La Araucanía. The participants underwent comprehensive oral examinations and oral health interviews, focusing on variables such as OHSES, Oral health-related quality of life (OHIP-14Sp), assessment of remaining teeth, knowledge and attitudes toward oral health, and sociodemographic characteristics. The validity of the translated questionnaire was assessed through translation and cross-cultural adaptation, cognitive debriefing, and face and content validation. The psychometric properties of the questionnaire were evaluated through measures of internal consistency (Cronbach's alpha), content validity (Content validity index), construct validity (factor analysis and Pearson correlation analysis), and test-retest reliability (intraclass correlation).

RESULTS

The Spanish version of OHSES demonstrated adequate face and content validity. The confirmatory factor analysis confirmed a two-factor scale with 7 items for a better fit. The scale demonstrated high internal consistency (Cronbach's alpha = 0.821) and acceptable test-retest reliability (ICC = 0.411). Correlations were found between the OHSES score, the number of remaining teeth, knowledge and attitudes towards oral health, and the OHIP-14Sp (p < 0.01).

CONCLUSIONS

This study confirms the validity of the Spanish version of the Oral Health Self-Efficacy Scale for older adults in Chile. The scale is expected to be helpful in assessing self-efficacy in dental interventions and collecting data for international comparisons. This research opens new dimensions in patient-reported assessment of oral health.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Factors predicting different times for brushing teeth during the day: multilevel analyses

BACKGROUND

The most effective and simple intervention for preventing oral disease is toothbrushing. However, there is substantial variation in the timing of brushing teeth during the day. We aimed to identify a comprehensive set of predictors of toothbrushing after lunch and after dinner and estimated contextual (i.e., geographic) variation in brushing behavior at different times of the day.

METHODS

We constructed a conceptual framework for toothbrushing by reviewing health behavior models. The main data source was the 2017 Community Health Survey. We performed a four-level random intercept logistic regression to predict toothbrushing behavior. (individual, household, Gi/Gun/Gu, and Si/Do).

RESULTS

Individuals under 30 years of age had higher likelihood of brushing after lunch, while brushing after dinner was higher among those aged 40-79 years. People engaged in service/sales, agriculture/fishing/labor/mechanics, as well as student/housewife/unemployed were 0.60, 0.41, and 0.49 times less likely to brush their teeth after lunch, respectively, compared to those working in the office, but the gap narrowed to 0.97, 0.96, 0.94 for brushing after dinner. We also found significant area-level variations in the timing of brushing.

CONCLUSIONS

Different patterns in association with various factors at individual-, household- and Si/Gun/Gu-levels with toothbrushing after lunch versus toothbrushing after dinner suggests a need for tailored interventions to improve toothbrushing behavior depending on the time of day.

Accuracy of periodontitis diagnosis obtained using multiple molecular biomarkers in oral fluids: A systematic review and meta-analysis

AIM

To determine the accuracy of biomarker combinations in gingival crevicular fluid (GCF) and saliva through meta-analysis to diagnose periodontitis in systemically healthy subjects.

METHODS

Studies on combining two or more biomarkers providing a binary classification table, sensitivity/specificity values or group sizes in subjects diagnosed with periodontitis were included. The search was performed in August 2022 through PUBMED, EMBASE, Cochrane, LILACS, SCOPUS and Web of Science. The methodological quality of the articles selected was evaluated using the QUADAS-2 checklist. Hierarchical summary receiver operating characteristic modelling was employed to perform the meta-analyses (CRD42020175021).

RESULTS

Twenty-one combinations in GCF and 47 in saliva were evaluated. Meta-analyses were possible for six salivary combinations (median sensitivity/specificity values): IL-6 with MMP-8 (86.2%/80.5%); IL-1β with IL-6 (83.0%/83.7%); IL-1β with MMP-8 (82.7%/80.8%); MIP-1α with MMP-8 (71.0%/75.6%); IL-1β, IL-6 and MMP-8 (81.8%/84.3%); and IL-1β, IL-6, MIP-1α and MMP-8 (76.6%/79.7%).

CONCLUSIONS

Two-biomarker combinations in oral fluids show high diagnostic accuracy for periodontitis, which is not substantially improved by incorporating more biomarkers. In saliva, the dual combinations of IL-1β, IL-6 and MMP-8 have an excellent ability to detect periodontitis and a good capacity to detect non-periodontitis. Because of the limited number of biomarker combinations evaluated, further research is required to corroborate these observations.

The co-occurrence of the two main oral diseases: periodontitis and dental caries

OBJECTIVES

Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population.

MATERIALS AND METHODS

A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake.

RESULTS

In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated.

CONCLUSIONS

In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related.

CLINICAL RELEVANCE

In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.

Critical review of 16S rRNA gene sequencing workflow in microbiome studies: From primer selection to advanced data analysis

The multi-batch reanalysis approach of jointly reevaluating gene/genome sequences from different works has gained particular relevance in the literature in recent years. The large amount of 16S ribosomal ribonucleic acid (rRNA) gene sequence data stored in public repositories and information in taxonomic databases of the same gene far exceeds that related to complete genomes. This review is intended to guide researchers new to studying microbiota, particularly the oral microbiota, using 16S rRNA gene sequencing and those who want to expand and update their knowledge to optimise their decision-making and improve their research results. First, we describe the advantages and disadvantages of using the 16S rRNA gene as a phylogenetic marker and the latest findings on the impact of primer pair selection on diversity and taxonomic assignment outcomes in oral microbiome studies. Strategies for primer selection based on these results are introduced. Second, we identified the key factors to consider in selecting the sequencing technology and platform. The process and particularities of the main steps for processing 16S rRNA gene-derived data are described in detail to enable researchers to choose the most appropriate bioinformatics pipeline and analysis methods based on the available evidence. We then produce an overview of the different types of advanced analyses, both the most widely used in the literature and the most recent approaches. Several indices, metrics and software for studying microbial communities are included, highlighting their advantages and disadvantages. Considering the principles of clinical metagenomics, we conclude that future research should focus on rigorous analytical approaches, such as developing predictive models to identify microbiome-based biomarkers to classify health and disease states. Finally, we address the batch effect concept and the microbiome-specific methods for accounting for or correcting them.

Antibacterial Properties of the Antimicrobial Peptide Gallic Acid-Polyphemusin I (GAPI)

A novel antimicrobial peptide, GAPI, has been developed recently by grafting gallic acid (GA) to polyphemusin I (PI). The objective of this study was to investigate the antibacterial effects of GAPI on common oral pathogens. This laboratory study used minimum inhibitory concentrations and minimum bactericidal concentrations to assess the antimicrobial properties of GAPI against common oral pathogens. Transmission electron microscopy was used to examine the bacterial morphology both before and after GAPI treatment. The results showed that the minimum inhibitory concentration ranged from 20 μM (Lactobacillus rhamnosus) to 320 μM (Porphyromonas gingivalis), whereas the minimum bactericidal concentration ranged from 80 μM (Lactobacillus acidophilus) to 640 μM (Actinomyces naeslundii, Enterococcus faecalis, and Porphyromonas gingivalis). Transmission electron microscopy showed abnormal curvature of cell membranes, irregular cell shapes, leakage of cytoplasmic content, and disruption of cytoplasmic membranes and cell walls. In conclusion, the GAPI antimicrobial peptide is antibacterial to common oral pathogens, with the potential to be used to manage oral infections.

Oral Health Disparities and Inequities in Older Adults

The number of individuals 65 and older living in the United States is increasing substantially and becoming more racially and ethnically diverse. This shift will affect the demographics of the patient population seeking dental care. It will also impact the future treatment needs of older adults. In older adults, similar to the general adult population, oral health disparities continue to exist related to race, ethnicity, gender, and socioeconomic level. Dental practitioners must understand these changes in order to meet the challenges of providing oral health care to the increasing numbers of diverse, medically compromised, and cognitively impaired older adults.

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

Long-term trends in the burden of edentulism in China over three decades: A Joinpoint regression and age-period-cohort analysis based on the global burden of disease study 2019

Background

To investigate secular trends in edentulism incidence, prevalence, and years lived with disability (YLDs) rates in Chinese men and women from 1990 to 2019.

Methods

Data were obtained from the Global Burden of Disease Study 2019. The annual percentage change and average annual percentage change were calculated using Joinpoint regression analysis. The age-period-cohort (APC) analysis estimated the independent age, period, and cohort effects.

Results

From 1990 to 2019, the crude incidence, prevalence, and YLDs of edentulism in the Chinese population increased year by year, while the age-standardized incidence, prevalence, and YLDs decreased, and the latter was higher in women than in men. The APC analysis showed that the age effect increased in men and women from age 20 to 74 and decreased thereafter. The risk of tooth loss increased with age. However, the relationship was not linear. The temporal effect showed a gradual increase; the risk of missing teeth gradually increased with the changing modern living environment. The cohort effect showed a single decreasing trend, with the early birth cohort having a higher risk of tooth loss than the later birth cohort population. The age, period, and cohort effects were consistent for both sexes.

Conclusion

Although the standardized incidence, prevalence, and YLD rate and cohort effect of dentition loss in China are declining, they are still causing a severe burden to China due to the continued aging of the population and the rising period effect. Despite the decreasing trends of the standardized incidence and prevalence of dentition loss and the rate of YLDs, China should develop more effective oral disease prevention and control strategies to reduce the increasing burden of edentulism in the older adult, especially in older women.

Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists

BACKGROUND

Providing dental services to dependent older adults might be challenging because of physical and cognitive decline. The present study aimed to explore current practices, knowledge, and experienced challenges related to the treatment of older adults in home health care services (HHCS) among dentists and dental hygienists in Norway.

METHODS

An electronic questionnaire survey was distributed to Norwegian dentists and dental hygienists, inquiring about background characteristics, current practices, self-perceived knowledge, and challenges when providing oral health care for older HHCS patients.

RESULTS

Four hundred and sixty-six dentists and 244 dental hygienists treating older HHCS patients responded to the survey. The majority were female (n=620; 87.3%) and worked in the public dental service (PDS) (n=639; 90%). When older HHCS adults attended the dental practice, the treatments provided were most frequently aimed at relieving acute oral problems, although dental hygienists reported to focus on improving oral health more often than dentists. Dentists reported to have more self-perceived knowledge than dental hygienists regarding patients with complex treatment needs, cognitive or physical impairment. Exploratory Factor Analysis (EFA) was carried out on the 16 items related to challenges, three factors were extracted and Structural Equation Models (SEMs) were performed. Challenges related to dental care for older HHCS adults were related to time, practical organization and communication. Variation within these categories was associated with sex, graduation year and country, as well as time used per patient and work sector, but not with professional status.

CONCLUSIONS

The results indicate that dental care for older HHCS patients is time-demanding and more often aimed at relieving symptoms than improving oral health. A substantial proportion of dentists and dental hygienists in Norway lack confidence when providing dental care for frail elderly.

Differences in periodontal parameters between SPT patients who regularly and irregularly visited the dental clinic analyzed at tooth level: a 14-year retrospective cohort study

The purpose of this study was to evaluate the periodontal status of patients who routinely did SPT, when compared to patients that did not SPT. This retrospective cohort study was conducted at a general dental office from 2001 to 2019. Patients aged 18 to 81 years who visited the dental office over a 10-year period were assigned into two groups: an SPT group, which included patients who continually visited the dental office for SPT one or more times every year, and an irregular group, consisting of patients who did not visit the dental office at least once a year. A total of 7307 teeth (SPT group) and 4659 teeth (irregular group) were evaluated, and the periodontal conditions were compared between the first and latest visits. Multiple regression analysis was used to analyze the results. The mean follow-up time was 13.74 years. The risk factors for improvements in probing pocket depth included age, sex, smoking, diabetes mellitus, molar tooth, and irregular SPT group (p < 0.001), and that for a positive bleeding on probing site was the irregular group (odds ratio 2.94; 95% confidence interval 2.63-3.29). This study showed that lack of routine in attending the SPT program significantly decreased the periodontal parameters, thus highlighting the importance of continuing with the program to maintain the periodontal health.

In silico evaluation and selection of the best 16S rRNA gene primers for use in next-generation sequencing to detect oral bacteria and archaea

BACKGROUND

Sequencing has been widely used to study the composition of the oral microbiome present in various health conditions. The extent of the coverage of the 16S rRNA gene primers employed for this purpose has not, however, been evaluated in silico using oral-specific databases. This paper analyses these primers using two databases containing 16S rRNA sequences from bacteria and archaea found in the human mouth and describes some of the best primers for each domain.

RESULTS

A total of 369 distinct individual primers were identified from sequencing studies of the oral microbiome and other ecosystems. These were evaluated against a database reported in the literature of 16S rRNA sequences obtained from oral bacteria, which was modified by our group, and a self-created oral archaea database. Both databases contained the genomic variants detected for each included species. Primers were evaluated at the variant and species levels, and those with a species coverage (SC) ≥75.00% were selected for the pair analyses. All possible combinations of the forward and reverse primers were identified, with the resulting 4638 primer pairs also evaluated using the two databases. The best bacteria-specific pairs targeted the 3-4, 4-7, and 3-7 16S rRNA gene regions, with SC levels of 98.83-97.14%; meanwhile, the optimum archaea-specific primer pairs amplified regions 5-6, 3-6, and 3-6, with SC estimates of 95.88%. Finally, the best pairs for detecting both domains targeted regions 4-5, 3-5, and 5-9, and produced SC values of 95.71-94.54% and 99.48-96.91% for bacteria and archaea, respectively.

CONCLUSIONS

Given the three amplicon length categories (100-300, 301-600, and >600 base pairs), the primer pairs with the best coverage values for detecting oral bacteria were as follows: KP_F048-OP_R043 (region 3-4; primer pair position for Escherichia coli J01859.1: 342-529), KP_F051-OP_R030 (4-7; 514-1079), and KP_F048-OP_R030 (3-7; 342-1079). For detecting oral archaea, these were as follows: OP_F066-KP_R013 (5-6; 784-undefined), KP_F020-KP_R013 (3-6; 518-undefined), and OP_F114-KP_R013 (3-6; 340-undefined). Lastly, for detecting both domains jointly they were KP_F020-KP_R032 (4-5; 518-801), OP_F114-KP_R031 (3-5; 340-801), and OP_F066-OP_R121 (5-9; 784-1405). The primer pairs with the best coverage identified herein are not among those described most widely in the oral microbiome literature. Video Abstract.

Baby boomers in Europe: demography, socioeconomic, and health status and oral health needs

The European countries are aging fast. Baby boomers in Europe constitute a diverse population group with several differences in life events and living conditions. The fiscal effects of the aging of European population have led to changes in policies and legislation that largely affect the lives of baby boomers necessitating an increase in their working lives. Furthermore, reforms are planned in the existing health and long-term care systems. Although some baby boomers in Europe face chronic medical conditions, the majority perceive their general health as good or very good. However, approximately one quarter have reported unmet needs for medical care, mainly due to cost or long waiting lists with large variability among different countries. The oral health of baby boomers has improved compared to previous generations particularly related to tooth loss. However, older groups in many countries face an increase in dental caries and periodontal disease. Some baby boomers may enter very old age with many natural teeth, functional impairment, limited ability to perform oral hygiene and an increased demand for more complex dental care as well as domiciliary care. However, in contrast to medical care, dental expenses in Europe are mainly financed with out-of-pocket payments while domiciliary dental care is rarely provided leading to unmet dental care needs for the most vulnerable individuals. Educational interventions for all healthcare professionals, as well as formal and informal carers and the public are required, and appropriate policies and legislations are needed to promote the oral health of the aging European population.

Epidemiological and sociodemographic transitions of severe periodontitis incidence, prevalence, and disability-adjusted life years for 21 world regions and globally from 1990 to 2019: An age-period-cohort analysis

BACKGROUND

Severe periodontitis is one of the most prevalent diseases and a global public health problem due to its high incidence and prevalence. However, there are few studies on the burden of periodontitis in different regions of the world.

METHODS

We extracted data on the incidence, prevalence, and disability-adjusted life years (DALYs) from the Global Burden of Disease study as severe periodontitis burden measures. We also explored the global burden of severe periodontitis according to 21 world regions and Socio-Demographic Index (SDI) quintiles. The joinpoint model was used to analyze temporal trends of major regions from 1990 to 2019, and the age-period-cohort model was used to estimate age, period, and cohort trends in severe periodontitis.

RESULTS

Globally, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and disability-adjusted life years (DALYs) rate increased from 1990 to 2019 (percentage change: 5.77%, 7.78%, and 8.01%, respectively), with average annual percent changes of 0.2%, 0.3%, and 0.3%, respectively. The region with the highest DALY rate was western sub-Saharan Africa with a value of 142.5 (95% uncertainty interval: 56.3, 303.7) per 100,000 in 2019. For the ASIR, ASPR, and DALY, the age effect of severe periodontitis showed an increase followed by a decrease, the period effect showed an upward trend, the cohort effect showed an overall decreasing trend, and the cohort relative risk for incidence for some SDI quintiles showed a slight increase in recent years.

CONCLUSIONS

Oral health varies significantly across regions, and it is essential to address inequalities in oral health between countries. Effective measures to prevent severe periodontitis risk factors should also be taken in regions with low SDI.

Integration of Oral Health into General Health Services for Older Adults

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.

Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation

Introduction

Pituitary pars intermedia dysfunction (PPID) and dental disorders are of major concern in horses older than 15 years. Although PPID in geriatric horses and dental disorders in all age groups are well described, a connection between this endocrine disease and pathological changes in equine dental structures has not yet been investigated. In humans, periodontitis is considered to be a complication of systemic diseases like diabetes mellitus type 2, obesity and various conditions leading to an impaired immune response. In PPID, cross links to insulin and immune dysregulations are proven. The aim of this study was to compare histological findings of the gingiva and the sub gingival periodontal ligament of PPID affected horses with control horses.

Methods

In a case-control morphometric descriptive study, 145 dental locations of 10 PPID affected horses (27.3 ± 2.06 years) were compared with 147 dental locations of 10 controls (21.4 ± 4.12 years). Histological parameters were leukocyte infiltration, keratinization of gingival epithelium, blood vessel supply of the periodontium and structure of cementum.

Results

The distribution and localization of gingival leukocyte infiltrations (LI) in PPID affected horses was more often multifocal to coalescing (p = 0.002) and reached into deeper parts of the periodontium, sometimes down to the sub gingival periodontal ligament (PDL). Aged animals of both groups showed higher prevalence (PPID: OR 1.66; controls: OR 1.15) for severe leukocyte infiltration in the PDL. PPID was not significantly associated with increased LI. The cementum bordering the soft tissue in interdental locations showed four times more irregularities in PPID affected horses than in controls which predisposes for interdental food impaction and periodontal diseases.

Discussion

In summary, multifocal to coalescing leukocytes and irregular cementum are seen more often in PPID than in controls - however our findings mainly reflect an association of older age with periodontal disease.

Number of Teeth and Denture Use Are Associated with Frailty among Chinese Older Adults: A Cohort Study Based on the CLHLS from 2008 to 2018

OBJECTIVES

The aim of this study was to determine the association between oral health and the development of frailty over a 10-year period in older Chinese adults.

DESIGN

This was a cohort study.

SETTING AND PARTICIPANTS

The data in this study were derived from the 2008, 2011, 2014 and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The final analysis included 1155 older adults who had complete data for the Frailty Index (FI) and the other factors(oral health, sociodemographics, etc) that were analyzed in the study.

MEASUREMENTS

Frailty was assessed by the FI, which consists of 40 deficits(self-health assessments, diseases, physical functions,etc). Multivariable logistic regression was carried out to calculate the odds ratios (ORs) of the independent variables,which were obtained from investigator surveys and self-reports, in association with the development of frailty.

RESULTS

The prevalence of frailty at baseline was 22.94%, and the 10-year incidence of frailty was 24.16% (215/890). Age, number of natural teeth, use of dentures, toothache and sex were independent risk factors for frailty at baseline. After full adjustment, multivariate logistic regression analysis indicated that compared with having ≥21 teeth, edentulism (ORs 3.575; 95% CI 2.095,6.101) and partial tooth loss (ORs 2.448; 95% CI 1.592,3.766) were associated with progression to frailty. Compared with those with ≥21 teeth, those with <21 teeth and without dentures (ORs 2.617; 95% CI 1.713,3.999) were more likely to progress to frailty.

CONCLUSION

The loss of natural teeth is associated with the progression of frailty in older Chinese adults and denture using can help lower the odds of being frailty. Further research on maintain natural teeth and the appropriate use of dentures may help to establish effective frailty prevention strategies for the older adults.

A Multimodal Deep Learning Approach to Predicting Systemic Diseases from Oral Conditions

Background: It is known that oral diseases such as periodontal (gum) disease are closely linked to various systemic diseases and disorders. Deep learning advances have the potential to make major contributions to healthcare, particularly in the domains that rely on medical imaging. Incorporating non-imaging information based on clinical and laboratory data may allow clinicians to make more comprehensive and accurate decisions. Methods: Here, we developed a multimodal deep learning method to predict systemic diseases and disorders from oral health conditions. A dual-loss autoencoder was used in the first phase to extract periodontal disease-related features from 1188 panoramic radiographs. Then, in the second phase, we fused the image features with the demographic data and clinical information taken from electronic health records (EHR) to predict systemic diseases. We used receiver operation characteristics (ROC) and accuracy to evaluate our model. The model was further validated by an unseen test dataset. Findings: According to our findings, the top three most accurately predicted chapters, in order, are the Chapters III, VI and IX. The results indicated that the proposed model could predict systemic diseases belonging to Chapters III, VI and IX, with AUC values of 0.92 (95% CI, 0.90-94), 0.87 (95% CI, 0.84-89) and 0.78 (95% CI, 0.75-81), respectively. To assess the robustness of the models, we performed the evaluation on the unseen test dataset for these chapters and the results showed an accuracy of 0.88, 0.82 and 0.72 for Chapters III, VI and IX, respectively. Interpretation: The present study shows that the combination of panoramic radiograph and clinical oral features could be considered to train a fusion deep learning model for predicting systemic diseases and disorders.

Bioactive Materials for Next-Generation Dentistry

Teeth were some of the first organs whose function was effectively restored by inert refilling materials that have become widely known to the general public; amalgams, polymeric resin composites, and gutta-percha are some such examples [...].

Understanding the role of smoking and chronic excess alcohol consumption on reduced caloric intake and the development of sarcopenia

This narrative review provides mechanistic insight into the biological link between smoking and/or chronic excess alcohol consumption, and increased risk of developing sarcopenia. Although the combination of excessive alcohol consumption and smoking is often associated with ectopic adipose deposition, this review is focused on the context of a reduced caloric intake (leading to energy deficit) that also may ensue due to either lifestyle habit. Smoking is a primary cause of periodontitis and chronic obstructive pulmonary disease that both induce swallowing difficulties, inhibit taste and mastication, and are associated with increased risk of muscle atrophy and mitochondrial dysfunction. Smoking may contribute to physical inactivity, energy deficit via reduced caloric intake, and increased systemic inflammation, all of which are factors known to suppress muscle protein synthesis rates. Moreover, chronic excess alcohol consumption may result in gut microbiota dysbiosis and autophagy-induced hyperammonemia, initiating the up-regulation of muscle protein breakdown and down-regulation of muscle protein synthesis via activation of myostatin, AMPK and REDD1, and deactivation of IGF-1. Future research is warranted to explore the link between oral healthcare management and personalised nutrition counselling in light of potential detrimental consequences of chronic smoking on musculoskeletal health outcomes in older adults. Experimental studies should investigate the impact of smoking and chronic excess alcohol consumption on the gut-brain axis, and explore biomarkers of smoking-induced oral disease progression. The implementation of behavioural change interventions and health policies regarding smoking and alcohol intake habits may mitigate the clinical and financial burden of sarcopenia on the healthcare system.

Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis

OBJECTIVE

The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years.

DATA

Inclusion criteria; participants aged ≥ 45 years, community-dwellers. Exclusion criteria; participants aged < 45 years, in nursing homes, data obtained from dental clinics or pre-2005. The quality assessment tool by The National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies was used. Meta-analysis using the random-effects model (95% confidence interval) was done with data on participants who were edentulous and/or had active dental caries and stratified by regions of the world, age and Gross National Income per capita. Limitations in the data arose from several factors such as design of the studies included differences in socioeconomic status and access to health care among different countries.

SOURCES

Embase, MEDLINE via Pubmed and Scopus, manual searches, from January 2016, restricted to English. Experts from different countries were contacted to identify National oral health surveys (NOHS) conducted from 2010 onwards.

STUDY SELECTION

Eighty-six papers and seventeen NOHS were selected for data extraction. Majority of the studies (n = 69) were cross-sectional and of fair quality. 1.1%-70%, 4.9% - 98% prevalence of edentulism and dental caries, respectively. 22%, 45% estimated random-effects pooled prevalence of edentulism and dental caries, respectively.

CONCLUSIONS

Within the limitations of this study, the findings indicate that untreated dental caries and tooth loss are prevalent on a global level with wide variations among different countries, age groups and socioeconomic status.

CLINICAL SIGNIFICANCE

The findings demonstrate the reality of the new cohort of older adults, with higher tooth retention implying more dental caries incidence and the need for different care strategies to ensure better oral health. Large variations and difficulty in making comparisons among different countries highlight the need for more standardized, regular research.

Association between total body bone mineral density and periodontitis: A Mendelian randomization study

BACKGROUND

The purpose of the study was to examine the association between total body bone mineral density (BMD) and periodontitis using Mendelian randomization (MR) analysis.

METHODS AND MATERIALS

We used 81 single nucleotide polymorphisms (SNPs) associated with BMD at a p-value of < 5 × 10^-8 from a genome-wide association study (GWAS) of 66,628 individuals of European descent. The GWAS for periodontitis was derived from a meta-analysis of seven cohort studies that included 17,353 cases and 28,210 controls of European ancestry.

RESULTS

MR showed no association between BMD and periodontitis (odds ratio per standard deviation increment in genetically predicted BMD = 1.00; 95% confidence interval: 0.92-1.08). Leave-one-out analyses and pleiotropy-robust methods did not indicate any bias.

CONCLUSIONS

The MR study provided no evidence that BMD might be causally linked to periodontitis. Hence it may be concluded as the key finding that BMD depletion does not increase the risk of periodontitis.

Antibiotic prescription after tooth extraction in adults: a retrospective cohort study in Austria

BACKGROUND

Broad spectrum antibiotics are often used for the prophylaxis of infectious endocarditis and treatment of odontogenic infections, but there are limited data related to antibiotic use and adherence to prescription guidelines.  METHODS: Data from patients with tooth extraction between 2014 and 2018 were selected from a database of a regional health insurance fund. We created three data sets, one based on all tooth extractions, one on multiple teeth extractions, and one including only single tooth extraction. After data collection, descriptive analysis was carried out. The differences in prescription pattern of antibiotic medicine were tested by χ2 test, Student´s t-test or ANOVA.

RESULTS

From 43,863 patients with tooth extraction, 53% were female, and 3,983 patients (9.1%) filled a prescription for antibiotic medicine. From 43,863 patients, 157 patients (0.4%) had endocarditis risk, but only 8 patients of these (5.1%) filled an antibiotic prescription. In total, 9,234 patients had multiple and 34,437 patients had only one tooth extraction. Patients with more than one tooth extraction received more often antibiotic treatment (10.7%) compared to those with single tooth extractions (χ2 = 36; p < 0,001). Patients with more than one tooth extraction were older, however, younger patients received antibiotics more frequently (t = 28,774, p = 0.001). There was no relationship with endocarditis risk status. Clindamycin and amoxicillin/clavulanic acid were the most frequently prescribed antibiotic medicines.

CONCLUSIONS

In this retrospective cohort study, dentists did not discriminate prophylactic antibiotic prescription with regard to endocarditis risk status. A factor influencing prescribing behaviour of antibiotic medicines was the number of extracted teeth.

Next-Generation Examination, Diagnosis, and Personalized Medicine in Periodontal Disease

Periodontal disease, a major cause of tooth loss, is an infectious disease caused by bacteria with the additional aspect of being a noncommunicable disease closely related to lifestyle. Tissue destruction based on chronic inflammation is influenced by host and environmental factors. The treatment of periodontal disease varies according to the condition of each individual patient. Although guidelines provide standardized treatment, optimization is difficult because of the wide range of treatment options and variations in the ideas and skills of the treating practitioner. The new medical concepts of “precision medicine” and “personalized medicine” can provide more predictive treatment than conventional methods by stratifying patients in detail and prescribing treatment methods accordingly. This requires a new diagnostic system that integrates information on individual patient backgrounds (biomarkers, genetics, environment, and lifestyle) with conventional medical examination information. Currently, various biomarkers and other new examination indices are being investigated, and studies on periodontal disease-related genes and the complexity of oral bacteria are underway. This review discusses the possibilities and future challenges of precision periodontics and describes the new generation of laboratory methods and advanced periodontal disease treatment approaches as the basis for this new field.

Periodontitis and peri-implantitis in elderly people experiencing institutional and hospital confinement

An increasing number of elderly people retain their natural teeth into old age and further, the prevalence of endosseous implants for supporting oral prosthesis is ever increasing. These teeth and implants now present a considerable challenge in terms of maintenance, especially when patients become dependent on care. Periodontal and peri-implant diseases are more prevalent in elderly than in younger age cohorts. There are distinct differences related to the inflammatory response between periodontal and peri-implant tissues, both in young and old age. The age-related reasons for the increase in periodontal infections may be related to poor oral hygiene because of a loss of dexterity or vision, but also to immunosenescence. This term describes the aging of the immune system and the decline of its effectiveness with age. Low-grade infections, like chronic periodontitis, may cause low-grade inflammation and subsequently increase the likelihood of developing chronic diseases. In return, treatment of periodontitis may improve general health, as demonstrated for diabetes. A second mechanism illustrating how poor oral health translates into systemic disease is the risk of developing aspiration pneumonia. The treatment options in old age should be evaluated with regard to the issues of general health and maintenance. Systematic periodontal maintenance therapy, as performed in younger age cohorts, may be difficult to implement in elderly people experiencing institutional or hospital confinement because of logistics, barriers related to patients and caregivers, or cost. The scale of periodontal disease in old age represents a public health issue.

Awareness and Attitudes of Dental Students toward Older Adults in Indonesia

In this study, we aimed to analyse the awareness and attitudes of dental students (DS) toward older adults (OAs) in Indonesia. Compromised oral health (OH) among OAs is a significant public health problem that is a global health burden. Furthermore, appropriate education can provide DS with information about strategic and efficient treatments for OAs. An online invitation was provided to every dental student in Indonesia in the third to sixth year of study to answer a web-based questionnaire as a part of a survey on awareness and attitudes (14 questions) towards OAs. From 1288 valid forms submitted, it was evident that most students (87%) expressed a positive attitude toward OAs. Female students showed a more positive attitude compared to males, with an odds ratio of 1.539 (p = 0.036), and students who had a connection to an older adult demonstrated a more positive attitude than those who did not (OR = 2.076; p < 0.001). The majority of the DS (98%) were conscious of the importance of geriatrics in dentistry, with female students showing more awareness than their male counterparts (OR = 2.553; p = 0.033). Positive awareness and attitudes must be accompanied by knowledge so that DS can offer appropriate and effective oral care to geriatric patients.

Does social support predict increased use of dental services in older men?

BACKGROUND

Past research on social support and dental visits in older people has been limited by cross-sectional design, limited social support dimensions and non-representative samples.

METHODS

Data came from men with natural teeth completing Waves 3 and 4 of the Concord Health and Ageing in Men Project in Sydney, Australia. The relationship between social support at Wave 3 (2011-2012) and at least one dental visit per year at Wave 4 (2014-2016) was examined by Poisson regression. Social support was measured by structural (marital status, living arrangements, family support and social interaction) and functional (social support satisfaction) domains.

RESULTS

About 673 men were analysed. Structural and functional social support were not associated with the pattern of usual dental visits 5 years later in univariable or multivariable analyses. The only consistent significant factor was income source, with older men who had other sources of income more likely to regularly visit the dentist than older men solely reliant on the pension for income (prevalence ratio: 1.31, 95% CI: 1.13-1.52).

CONCLUSIONS

We found no differences in the pattern of usual dental visits between older men with different levels and types of social support. For older Australian men, income source seems to be the most important determinant of regular dental visits. © 2022 Australian Dental Association.

The impact of smoking on periodontal status and dental caries

INTRODUCTION

Investigations to explore the relationship between smoking and its oral manifestations are important to clinicians. Among these oral manifestations, periodontal diseases and dental caries have still a controversial association. This study aims to analyze the effect of smoking on periodontal disease and caries and their relevance to each other.

METHODS

Data on demographic and clinical features were retrieved from 7028 patients. Smoking status was categorized as a smoker, non-smoker, former smoker and passive smoker. Each patient received a diagnosis according to the new classification system for periodontal disease, in which periodontal disease is divides into stages (PS). The carries status was diagnosed by evaluating the decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the patients, 66.6% were non-smoker women, whereas 53.7 % of passive smokers were women. Being a worker and having a Bachelor’s degree was associated with a higher likelihood of getting diagnosed with periodontal disease and caries in smokers. Smoking significantly influences periodontal disease severity and DMFT values (p<0.001). This becomes more evident in former smokers by showing the highest severe periodontal problems (PS3: 29.7% and PS4: 18.9%), and the highest DMFT mean (16.4 ± 7.4) Accordingly, persons having high DMFT had significantly the most severe periodontal disease, namely PS4 (p<0.05).

CONCLUSIONS

Smoking is associated with higher caries prevalence and more severe periodontal disease, and DMFT tend to increase with the severity of periodontitis in the same subjects.

Functional dentition and associated factors

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim: The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods: Crosssectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the selfperception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results: Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI´s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI´s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion: Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship.

Mechanical and Thermal Stress Analysis of Cervical Resin Composite Restorations Containing Different Ratios of Zinc Oxide Nanoparticles: A 3D Finite Element Study

Due to an increase in prevalence of cervical lesions, it is important to use appropriate restorative materials to reduce the incidence of secondary lesions. Owing to having antibacterial properties, cervical composite restorations containing different ratios of Zinc Oxide nanoparticles (ZnO NPs) have been analyzed using the Finite Element method to determine the optimal incorporation ratio from mechanical and thermal perspectives. A numerical simulation is conducted for a mandibular first premolar with a cervical lesion (1.5 × 2 × 3 mm³) restored with composites containing 0 to 5% wt. ZnO NPs. Subsequently, the samples are exposed to different thermo-mechanical boundary conditions, and stress distributions at different margins are examined. The accumulated stress in the restoration part increases for the 1% wt. sample, whereas the higher percentage of ZnO NPs leads to the reduction of stress values. In terms of different loading conditions, the least and most stress values in the restoration part are observed in central loading and lingually oblique force, respectively. The change in the surface temperature is inversely correlated with the ratio of ZnO NPs. In conclusion, the composite containing 5% wt. ZnO NPs showed the most proper thermo-mechanical behavior among all samples.

Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review

OBJECTIVE

To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS).

BACKGROUND

The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services.

MATERIALS AND METHODS

Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria.

RESULTS

Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS.

CONCLUSION

This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

Cross-sectional analysis of the association of periodontitis with carotid intima media thickness and atherosclerotic plaque in the Hamburg City health study

BACKGROUND

Previous epidemiological studies regarding the association between chronic periodontitis (CP) and carotid intima-media thickness (cIMT) and subclinical atherosclerosis have been inconclusive.

OBJECTIVE

The aim of this study was to determine whether CP is associated with subclinical atherosclerosis in a large population-based cohort study conducted in northern Germany (the Hamburg City Health study).

METHODS

Baseline data from 5781 participants of the Hamburg City Health Study with complete oral health and carotid ultrasound data (50.7% female, mean age: 62.1 ± 8.4 years) were evaluated. A standardized duplex sonography of the carotid artery was performed with measurement of carotid intima-media thickness (cIMT) and atherosclerotic plaques. Oral health was assessed by recording the decayed, missing, and filled teeth (DMFT) index, clinical attachment loss (CAL), bleeding on probing (BOP), and the dental plaque index (PI). Correlations were tested for statistical significance by means of descriptive statistics and multivariate regression analyses.

RESULTS

Moderate and severe CP were associated with the prevalence of cIMT ≥ 1 mm (none or mild CP: 5.1%, moderate CP: 6.1%, severe CP: 10%) and mean cIMT (none or mild CP: 0.72 mm, moderate CP: 0.75 mm, severe CP: 0.78 mm) in bivariate analyses (p < .001). Additionally, severe and moderate CP were associated with higher prevalence of carotid atherosclerotic plaques (plaque = yes: none or mild CP: 23.9%, moderate CP: 29%, severe CP: 40.2%,). After adjustment for age, sex, smoking, diabetes, hypertension, educational level, hypercholesterolemia, and hsCRP, severe CP still correlated significantly with cIMT and the prevalence of cIMT ≥1 mm and/or presence of carotid atherosclerotic plaques.

CONCLUSION

In this study, severe CP was associated with increased cIMT and higher prevalence of carotid plaques independent of common risk factors.

Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial

Background

Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences.

Objective

To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism.

Methods

A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed.

Discussion

We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy.

Clinical Trials Registration

NCT05334407.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3 min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3 min), buccal mucosa (at 1 min), mouth floor (at 1 min), and tongue (at 2 and 3 min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Global, regional, and national burden of periodontitis from 1990 to 2019: results from the Global Burden of Disease study 2019

AIM

To evaluate the prevalence and incidence of periodontitis and associated disability-adjusted life years (DALYs) from 1990 to 2019.

METHODS

We collected data on periodontitis between 1990-2019 from the Global Burden of Disease (GBD) 2019 Study. The global prevalence, incidence, and DALYs attributed to periodontitis were analyzed. The age-standardized rate (ASR) and estimated annual percentage changes (EAPCs) were calculated to quantify the burden of the disease and temporal trends.

RESULTS

The ASR of the prevalence, incidence, and DALYs increased worldwide from 1990 to 2019. In 2019, Western Sub-Saharan Africa carried the heaviest burden of periodontitis, while the nation with the highest periodontitis burden was Gambia. The burden of periodontitis was negatively associated with the level of socioeconomic development. While, the majority of periodontitis burden was observed among those aged 55-59 years, the incidence of periodontitis has shown an increasing trend among younger individuals.

CONCLUSION

Periodontitis continue to be a global public health problem. Current prevention and control strategies should be enhanced to prevent an increase in periodontitis. This article is protected by copyright. All rights reserved.

Acute Myocardial Infarction and Periodontitis: Importance of Awareness and Prevention in Latin America

By 2030, non-communicable diseases will have accounted for more than three-quarters of deaths worldwide. Cardiovascular diseases (CVDs) have been the leading cause of death worldwide for several years. Acute myocardial infarction (AMI) is a CVD characterized by necrosis of the heart at the myocardial level due to prolonged ischemia caused by the reduction or sudden absence of coronary blood supply. The prevalence of AMI is higher in men at all ages. The incidence of AMI has decreased in industrialized nations; however, it has been on the rise in Latin America (LATAM) due to lifestyle changes. These changes have caused the combined incidence of CVDs and unresolved health concerns in LATAM, such as infections and malnutrition. It is well known that periodontitis, a highly prevalent chronic infectious inflammatory disease, has been associated with systemic diseases, such as diabetes, kidney diseases, and AMI. This review addresses proposed aspects of the correlation between periodontitis and AMI, explains the importance of preventing periodontitis and CVDs, and analyzes the preventative measures being implemented in LATAM, particularly in Mexico.

Clinical Assessment of the Hyperbaric Oxygen Therapy Efficacy in Mild to Moderate Periodontal Affections: A Simple Randomised Trial

Background and Objectives: Gum disease represents the condition due to the dental plaque and dental calculus deposition on the surfaces of the teeth, followed by ulterior destruction of the periodontal tissues through the host reaction to the pathogenic microorganisms. The aim of study was to present aspects regarding the efficacy of hyperbaric oxygen therapy (HBOT) as an adjuvant therapy for the treatment of periodontal disease, started from the already certified benefits of HBOT in the general medicine specialties. Materials and Methods: The participant patients in this study (71) required and benefited from specific periodontal disease treatments. All patients included in the trial benefited from the conventional therapy of full-mouth scaling and root planing (SRP) within 24 h. HBOT was performed on the patients of the first group (31), in 20 sessions, of one hour. The patients of the control group (40) did not benefit from HBO therapy. Results: At the end of study, the included patients in HBOT group presented significantly better values of oral health index (OHI-S), sulcus bleeding index (SBI), dental mobility (DM), and periodontal pocket depth (PD) than the patients of the control group. Conclusions: HBOT had beneficial effects on the oral and general health of all patients, because in addition to the positive results in periodontal therapy, some individual symptoms of the patients diminished or disappeared upon completion of this adjuvant therapy.