Low salivary uric acid levels are independently associated with periodontitis

BACKGROUND

Lower salivary uric acid concentrations, the most abundant antioxidant agent in saliva, have been observed in patients with periodontitis compared to individuals with periodontal health. However, the independent association of salivary uric acid levels with periodontitis, accounting for other risk factors, as well as its association with periodontitis severity, has not been investigated.

AIM

To the independent association of salivary uric acid levels with periodontitis and the association of salivary uric acid levels with the severity of periodontitis.

METHODS

This observational and prospective study measured salivary uric acid levels in subjects with periodontitis (characterized by periodontal loss of tissue) and in subjects without periodontitis (periodontal health or localized gingivitis in < 30% of sites). Multivariate regression analysis was performed to determine independent factors associated with periodontitis. Spearman’s rho correlation coefficient was used to assess the relationship between salivary uric acid levels and periodontitis severity. A receiver operating characteristic analysis was carried out to evaluate the diagnostic performance of salivary uric acid levels in periodontitis, reporting the area under curve (AUC) and its 95%CI.

RESULTS

We included 121 subjects, 61 of them with periodontitis and 60 without periodontitis (39 with periodontal health and 21 with local gingivitis). Subjects with periodontitis compared to those without periodontitis were older (P < 0.001), had higher salivary uric acid levels (P = 0.002), higher rate of arterial hypertension history (P = 0.001) and higher rate of never-smoker history (P < 0.001). The AUC for periodontitis diagnosis by salivary uric acid levels was 66% (95%CI: 57%-75%; P < 0.001) and the better cut-off point was 111 nmol/mL. Multiple logistic regression analysis showed an independent association of salivary uric acid levels < 111 nmol/mL (OR = 6.14; 95%CI: 2.015-18.721; P = 0.001) with periodontitis after controlling for age, never-smoker history and arterial hypertension. A negative correlation of salivary uric acid levels and periodontitis severity was observed (rho = -0.32; P < 0.001).

CONCLUSION

The two novel findings of our research were, first, that low salivary uric acid concentrations are independently associated with periodontitis, even after accounting for established risk factors. Second, salivary uric acid levels show a negative correlation with periodontitis severity.

Association between apical periodontitis and psoriasis vulgaris: A cross-sectional study

AIM

To evaluate the prevalence of apical periodontitis (AP) and caries in subjects with psoriasis vulgaris.

METHODOLOGY

In total, 152 patients with psoriasis vulgaris were included in the study. The severity and extent of psoriasis were assessed according to the Psoriasis Area Severity Index (PASI), the Body Surface Area (BSA) and the Physician's Global Assessment Scale (PGA). Periapical status was assessed through dental examination and periapical radiographs. Data regarding the Periapical Index (PAI), caries experience expressed as the Decayed, Missing, Filled Teeth Index (DMFT) and psoriasis medications were recorded. A predictive logistic regression model for the presence of AP and a linear regression model were then built to relate the severity and extent of AP to the type of drug therapy taken for psoriasis and to the severity and extent of the skin disease.

RESULTS

Subjects with severe/moderate psoriasis showed a significantly higher prevalence of AP (p = .002) and a higher PAI score (p = .0035) than subjects with mild psoriasis. No significant correlation was found between AP and caries experience (p = .76). The logistic regression model showed that moderate/severe psoriasis increased the odds of having AP [odds ratio (OR) = 1.30 ± 1.088, 1.55]. A negative linear relationship between biological drug intake and PAI score value was observed (coefficient = -.54; p = .04).

CONCLUSIONS

The degree of severity of psoriasis is significantly associated with AP, suggesting that psoriasis may play a role in the pathogenesis of AP. However, no significant correlation was observed for caries experience. Furthermore, the immune-modulating drugs taken by these patients did not seem to have different effects on the prevalence of AP.

The Synergetic Effect of Periodontal Therapy and TNF-α Inhibitor for the Treatment of Comorbid Periodontitis and Psoriasis

AIM

To assess the adjunctive effect of periodontal therapy on psoriasis-related outcomes in a combined experimental model of ligature-induced periodontitis and Imiquimod (IMQ)-induced psoriasis. Also, this experiment aimed to study the impact of TNF-α inhibitors on the periodontium.

METHODS

Fifty-six C57/BL6J mice were randomly allocated to seven experimental groups: (a) control group (P-Pso-) with no treatment; (b) periodontitis (P+Pso-) with periodontal therapy; (c) periodontitis (P+Pso-) with TNF-α inhibitor; (d) psoriasis (P-Pso+) with TNF-α inhibitor; (e) periodontitis and psoriasis (P+Pso+) with periodontal therapy; (f) P+Pso+ with TNF-α inhibitor; and (g) P+Pso+ with both periodontal therapy and TNF-α inhibitor. Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis distance between the cemento-enamel junction and alveolar bone crest (CEJ-ABC) and number of osteoclasts and psoriasis (epidermal thickness and infiltrate cells (per 0.03mm2)) severity, as well as systemic inflammation (IL-6, IL-17A and TNF-α) were collected.

RESULTS

In the P+Pso+ group, a significant adjunctive effect of periodontal therapy to TNF-α inhibitors was found in the reduction of epidermal thickening and inflammatory infiltrate of the dorsal skin (p < 0.05). Similarly, treatment with TNF-α inhibitor resulted in a significant adjunctive effect to periodontal therapy in the reduction of alveolar bone loss (p < 0.05). These changes were accompanied by a significant decrease in the circulating levels of IL-6 and IL-17A when both periodontal therapy and TNF-α inhibitor were administered.

CONCLUSIONS

The combination of periodontal therapy and TNF-α inhibitor showed a positive synergetic effect in the treatment of comorbid experimental ligature-induced periodontitis and IMQ-induced psoriasis via the reduction of systemic inflammation.

Cross-sectional associations between vitamin D status and periodontitis in adults in Northern Norway: The Tromsø Study 2015-2016

BACKGROUND

Vitamin D is involved in the immune system by regulating inflammatory processes. Over the recent decades, there has been an increase in studies investigating the potential influence of vitamin D status on inflammatory diseases and conditions. However, research on the link between vitamin D and periodontitis remains scarce. Hence, we aimed to examine the relationship between serum 25(OH)D levels and periodontitis in an adult population in Northern Norway.

METHODS

The study was based on cross-sectional data from a population-based study: the seventh Tromsø study, conducted in 2015 - 2016. Eligible participants were adults ( ≥ 40 years old) who had both a valid periodontal diagnosis and data on serum 25(OH)D levels, giving a total study sample of n = 3,693 participants (51.4% women). Periodontitis was defined according to the 2017 AAP/EFP classification system. Two groups were compared: no-periodontitis/stage I periodontitis versus stages II-III/IV periodontitis. Using a bivariate logistic regression analysis, the association between these two groups and serum 25(OH)D was tested, controlling for age, sex, smoking, toothbrushing frequency, and socioeconomic status. Periodontal pockets of ≥ 5 mm and their association with serum 25(OH)D were also tested.

RESULTS

About 89% were classified as having periodontitis, and 51.6% had stages II-III/IV periodontitis. About 4% of the participants were at deficient levels of serum 25(OH)D (< 30 nmol/L). Levels of serum 25(OH)D of < 30 nmol/L were associated with periodontitis stage II-III/IV (odds ratio [OR] 1.53, 95% confidence interval [CI]: 1.03-2.28). Stratified by when the season serum 25(OH)D was measured (March-September vs October-February), the summer strata was significantly associated with periodontitis II-III/IV (30-50 nmol/L = OR 1.31, 95% CI:1.05-1.63, p = 0.018). Vitamin D deficiency and insufficiency were associated with having at least one periodontal pocket of ≥ 5 mm (< 30 nmol/L = 1.78, 95% CI:1.22-2.60, p = 0.003: 30-50 nmol/L = OR was 1.23, 95% CI:1.03-1.47, p = 0.020, respectively).

CONCLUSION

In this Norwegian adult population, blood 25-hydroxy vitamin D [25(OH)D] levels were associated to periodontitis stage II-III/IV and a periodontal pocket depth of ≥ 5 mm.

Type I Diabetic Patients' Perceptions of the Relationship Between Diabetes Mellitus and Periodontal Disease

Background/Objectives: Knowledge about the relationship between diabetes and periodontitis is lacking in individuals diagnosed with type I diabetes. To enhance oral health and reduce the risk of oral diseases, healthcare professionals, both dentists and endocrinologists, should educate and motivate patients to treat periodontitis and its complications as soon as possible. The aim of this study was to assess the knowledge of type I diabetic patients about the relationship between periodontal disease and diabetes. Methods: A cross-sectional, single-center study was carried out on 80 patients from the Tâmega and Sousa Hospital Center, who were administered a questionnaire before they underwent an oral clinical examination. The data were analyzed using the chi-square test and independent t-test. Results: All participants were aware of at least one of the problems associated with diabetes. Furthermore, 18.8% of the patients reported not receiving any advice from their dentist, and 31.4% stated that they had been informed of its importance. Regarding the diagnosis of diabetes, 87.5% of participants felt that dentists should be involved. Advanced age, lower education levels, and alcohol consumption were associated with a higher prevalence of periodontal disease (35.6%) (p < 0.05). Health practitioners should advise early periodontal disease diagnosis, treatment, and oral health education, particularly for people with type I diabetes. Conclusions: Factors, such as advanced age and lower education levels, were associated with a higher prevalence of periodontal disease. Although many patients recognize the relationship between diabetes and dental problems, most do not discuss this with their dentist.

Generalized gingivitis-related salivary proteomic profile in pregnant women with obesity: insights into biological mechanisms assessed by Tandem Mass Spectrometry

AIM

This cross-sectional study investigated the salivary proteomic profile associated with generalized gingivitis in pregnant women with obesity.

METHODOLOGY

Pregnant women in the third trimester (≥27 weeks of gestation) were divided into two groups based on bleeding on probing (BOP): G1 (BOP>50%; n=9) and G2 (BOP 0-30%; n=9). Collected unstimulated saliva samples were individually analyzed using nano liquid chromatography electron spray ionization tandem mass spectrometry. Identified proteins were classified according to gene ontology for biological processes, molecular functions, immune system involvement, and cellular components. Differential protein expression was determined using thresholds of p<0.05 for downregulation and 1-p>0.95 for up-regulation proteins.

RESULTS

Of the 183 identified proteins, 100 were shared between groups, totaling 57 up-regulated and 27 downregulated proteins in G1. Key biological processes included antimicrobial humoral response and hydrogen peroxide catabolism, with proteins linked to immune function and endopeptidase regulation. Functional analysis showed that Lactotransferrin (5-fold increase in G1), Haptoglobin (4-fold), and Immunoglobulin J chain (3-fold) were up-regulated, whereas Statherin (5-fold) and Protein S100-A8 (4-fold) were downregulated in G1.

CONCLUSIONS

Pregnant women with obesity and generalized gingivitis exhibited a distinct salivary proteomic profile characterized by the up-regulation of immune-related proteins and downregulation of tissue-protective proteins. These findings suggest potential salivary biomarkers for detection and targeted management of periodontal inflammation in this high-risk population.

Patients with periodontitis exhibit persistent dysbiosis of the gut microbiota and distinct serum metabolome

Objectives

Animal studies suggest that periodontopathic bacteria induce gut dysbiosis and related pathology, possibly connecting periodontitis to non-oral diseases. However, the effects on the gut ecosystem in periodontitis patients are not fully understood.

Methods

We conducted a comprehensive analysis of the salivary and gut microbiota using 16S rRNA sequencing in periodontitis patients before and after treatment, comparing them to healthy participants. Serum metabolites were also analyzed.

Results

Periodontitis patients showed high alpha diversity in both salivary and gut microbiota with a strong correlation. Significant differences were also observed in the gut microbiota composition between patients before treatment and healthy participants, irrespective of the ectopic colonization of periodontitis-associated bacteria in the gut. Co-abundance group analysis demonstrated that the gut microbiota of healthy participants was enriched with short-chain fatty acid producers. Changes in the gut microbiota coincided with alterations in the serum metabolite profile. While periodontal therapy improved salivary microbiota, it did not significantly affect gut microbiota.

Conclusions

Gut dysbiosis of periodontitis patients may impact systemic metabolite profiles. Given that periodontal therapy alone did not substantially improve the gut microbiota, adjunctive strategies targeting the gut microbiome may be effective in reducing the risk of periodontitis-associated diseases.

The Influence of Genetic Polymorphisms of IL33 and IL1RL1 Genes on the Immunopathogenesis of Periodontitis

Periodontitis (PD) is an inflammatory disease that affects the protective and supporting tissues of teeth. Mutations in cytokines and their receptors may influence the immunopathogenesis of PD, but the role of interleukin-33 (IL-33) and IL1RL1 is not clear. Thus, this study aimed to analyze the polymorphisms in IL33 (rs1929992 and rs7025417) and IL1RL1 (rs11685424 and rs3821204) genes and the IL-33 serum levels in PD patients. A case-control study was performed with 186 PD patients and 189 controls. Genotyping was performed by polymerase chain reaction using sequence-specific primer (PCR-SSP) technique. Serum levels of IL-33 were determined using the immunoenzymatic method. Statistical analyses were performed using SNPStats and OpenEpi. p > 0.05 was considered statistically significant. The IL33 rs7025417 C/C genotype was a risk factor for PD in nonsmokers (p=0.0015) regardless of smoking status and gender. In the general population, the IL1RL1 rs3821204 G/G genotype was protective for PD (p=0.006), regardless of gender. Nevertheless, the IL-33 serum levels were increased in patients compared to controls (p < 0.0001); however, no difference was observed among PD patients. The polymorphisms IL33 rs7025417 and IL1RL1 rs3821204 were associated with risk and protection, respectively, and the production of IL-33 was higher in PD patients than in controls, independent of the extent or severity of the disease.

Intermittent Fasting Regimes Reduce Gingival Inflammation: A Three-Arm Clinical Trial

AIM

To evaluate the effect of religious Bahá'í dry fasting (BF) or 16:8 time-restricted eating (TRE) compared with a regular diet (CG) on periodontal parameters during a modified experimentally induced gingivitis.

MATERIAL AND METHODS

All participants were asked to refrain from oral hygiene (3 sextant) for 9 days (T1-T2) and were followed for a total of 19 days (T3) while adhering to fasting or a regular diet and resuming oral hygiene. The primary outcome was bleeding on probing in the test sextant (BOP_s), Rustogi plaque index (RPI), gingival crevicular fluid (GCF), blood pressure (BP), body weight (BW), HbA1c and C-reactive protein (CRP) were measured (T1-T3) and ANCOVA and post hoc comparison were applied.

RESULTS

Sixty-six healthy participants were recruited. Forty-three were randomly assigned to TRE (n = 22) and CG (n = 21), while 23 followed BF, avoiding food and drinks during the day. At T2, BF demonstrated significantly less increase in BOP_s, and GCF increased in CG only. Analysis revealed significant differences in change for BOP_s between BF and CG (-9.48% [-17.18; -1.79]) and BF and TRE (-9.19% [-15.07; -3.32]) as well as for GCF between BF and CG (-0.06 μL [-7.22; -0.66]) and TRE and CG (-0.08 μL [-0.17; -0.00]).

CONCLUSION

This study indicates beneficial effects of different fasting protocols on oral experimental gingivitis and metabolic parameters, but results are limited by randomisation issues and potential bias in the BF group.

Impact of Various Detectable Interdental Clinical Attachment Loss Thresholds on the Estimated Prevalence, Stage and Extent of Periodontitis Based on the EFP/AAP Definition

AIMS

To investigate the influence of different detectable interdental clinical attachment loss (CAL) thresholds on estimated prevalence, stage and extent of periodontitis and to assess the influence of three methods in upgrading stage III cases to stage IV in completed surveys.

MATERIALS AND METHODS

National Health and Nutrition Examination Survey 2011-2014 data of 7651 adults were used. The CDC/AAP definition and the EFP/AAP definition with interdental CAL of 1, 2, 3 and 4 mm as the detectable threshold were applied. Three methods (< 10 opposing pairs of natural teeth, < 20 remaining natural teeth or < 10 remaining natural teeth in one jaw) were used to upgrade stage III cases to stage IV.

RESULTS

Estimated periodontitis prevalence was 37.0%, 92.6%, 91.7%, 66.7% and 32.9% using the CDC/AAP definition and the EFP/AAP definition, with 1-, 2-, 3- and 4-mm thresholds, respectively. As the threshold increased, stage I/II cases decreased, resulting in higher estimated disease extent in stage II cases. Compared with the use of 20 remaining teeth, the use of 10 opposing pairs yielded a nearly 4% increase in the estimated prevalence of stage IV cases.

CONCLUSIONS

Different detectable thresholds and opposing pair approximation methods could influence estimated periodontitis prevalence, stage and extent.

Systemic Azithromycin as an Adjunct to Non-Surgical Subgingival Instrumentation in the Treatment of Stage III/IV, Grade C Periodontitis: 12-Month Clinical, Microbiological and Cytokine Results of a Randomised Controlled Trial

AIM

To evaluate the clinical, microbial and cytokine changes following the use of oral azithromycin as an adjunct to non-surgical subgingival instrumentation (NSI) in stage III/IV, grade C periodontitis through a triple-blind, parallel-armed, randomised controlled trial.

MATERIAL AND METHODS

A total of 52 patients with stage III/IV grade C periodontitis were randomly allocated to two groups receiving NSI with or without adjunctive azithromycin. The primary outcome was changes in the periodontal inflamed surface area (PISA) values over 12 months, and the secondary outcomes included changes in pocket depth (PD), clinical attachment loss (CAL), percentage of sites with PD of 1-3, 4-5, ≥ 5 and ≥ 6 mm, subgingival periodontal pathogens, cytokine levels and patient-reported outcomes.

RESULTS

At 3 and 12 months, there were no statistically significant differences in the reduction in PISA or other clinical parameters between the groups. At 3 months, the levels of several periodontal pathogens were significantly reduced in the azithromycin group. No significant differences were observed in the levels of periodontal pathogens at 12 months except for Prevotella intermedia. No significant differences were observed for the studied cytokines at 3 and 12 months.

CONCLUSION

The results of this study do not support the use of systemic azithromycin in stage III/IV, grade C periodontitis.

TRIAL REGISTRATION

The trial was registered prospectively in the Australia New Zealand Clinical Trial Registry, ACTRN12619000560190. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374699.

Prevalence of Periodontitis in a 70-Year-Old Population in Western Norway According to the ACES 2018 Classification Framework: A Cross-Sectional Study

AIM

To assess the prevalence and severity of periodontitis in an older adult population in Western Norway using the periodontitis definition by the recently published ACES 2018 Classification Framework.

MATERIALS AND METHODS

In the present study, 1298 70-year-old subjects answered a questionnaire and underwent a full-mouth periodontal examination. The prevalence of periodontitis, stages, extents and grades was presented according to the Framework applying the 2018 periodontal classification scheme in epidemiological survey (ACES). Descriptive analyses were used, and results were expressed as percentages of the total number of observations.

RESULTS

According to ACES, periodontitis was detected in 100% of the study population, and Stage II, Stage III and Stage IV were present in 21%, 75% and 4% of the individuals, respectively. The majority of periodontitis cases demonstrated generalised periodontitis and Grade B was the predominant grade in the periodontitis cases. The mean number of teeth in the study population was 25.3.

CONCLUSION

There is a high burden of periodontitis in the present population of old individuals, and the majority of participants were classified as Stage III periodontitis. The cut-offs for interdental clinical attachment loss in the definition of periodontitis affect the estimate of cases, stages and extent of periodontitis in older age groups.

Porphyromonas gingivalis and Human Cytomegalovirus Co-Infection: A Potential Link Between Periodontal Disease and Oral Cancer Development

Periodontal disease (PD) is an inflammatory condition that can contribute to the development of oral cancer. Chronic inflammation from PD can lead to the release of inflammatory mediators and growth factors that promote tumorigenesis. Porphyromonas gingivalis (P. gingivalis) is one of several pathogens implicated in PD and its potential link to oral cancer. However, other viral infections, such as human cytomegalovirus (HCMV), can also contribute to chronic inflammation, creating a favorable environment for oral cancer development.

OBJECTIVES

The present literature review tries to investigate the possible influence of P. gingivalis and HCMV co-infection in fostering the development of oral cancer and chronic periodontitis.

METHODS

A comprehensive search was conducted in PubMed and Google Scholar, focusing on the relevance and significance of articles that examine the role of P. gingivalis and HCMV in periodontal disease and oral cancer.

RESULTS

The evidence suggests that P. gingivalis and HCMV may act synergistically to modulate host immunity, disrupt epithelial integrity, and interfere with key cellular pathways. These interactions may enhance tissue destruction and foster a microenvironment conducive to malignant transformation. However, most of these findings stem from in vitro models and small-scale clinical studies, limiting the generalizability and clinical relevance of current conclusions.

CONCLUSIONS

Although the proposed interaction between P. gingivalis and HCMV provides a compelling framework for understanding how microbial co-infections may influence oral cancer, the evidence remains preliminary and largely associative. To support these mechanistic hypotheses, future studies should give top priority to in vivo models, bigger patient cohorts, and longitudinal clinical studies.

High Salivary Malondialdehyde Levels Are Associated with Periodontitis Independently of Other Risk Factors

Background/Objectives: Patients with periodontitis have been found to have higher salivary concentrations of malondialdehyde, a biomarker of lipid hyperoxidation, compared to healthy subjects. However, the association between salivary malondialdehyde levels and periodontitis, independently of other risk factors, has not been analyzed. Therefore, the novel objective of our study was to explore this possible association by performing a logistic regression analysis. Material and Methods: This observational, prospective study was carried out in a private dental practice. Salivary malondialdehyde levels were measured in subjects with periodontitis (characterized by periodontal tissue loss) and in subjects without periodontitis (either periodontally healthy or with localized gingivitis in <30% of sites). A multivariate regression analysis was carried out to determine the factors associated with periodontitis. Variables with a p-value ≤ 0.05 in the comparison between subjects with and without periodontitis were included in the regression analysis. Results: A total of 119 subjects were included, 63 with periodontitis and 56 without (35 periodontally healthy subjects and 21 patients with localized gingivitis). In the multiple binomial regression analysis, salivary malondialdehyde levels > 0.77 nmol/mL were identified as a predictor of periodontitis (p = 0.03), after controlling for age (p < 0.001), diabetes mellitus (p = 0.81), arterial hypertension (p = 0.43), smoking status (never smoked p = 0.08), and cardiovascular disease (p = 0.88). Conclusions: To our knowledge, this is the first study to report that salivary malondialdehyde levels are associated with periodontitis, independently of other known risk factors.

Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients' awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes-periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations.

Host Markers of Periodontal Diseases: Meta-Analysis of Diagnostic Accuracy Studies

OBJECTIVE

To identify host markers with optimal diagnostic performance for clinical implementation in the diagnosis of periodontal diseases and prediction of future disease progression and/or disease resolution.

MATERIAL AND METHODS

Cross-sectional and prospective studies with ≥ 20 participants per group, reporting diagnostic accuracy (e.g., area under the curve [AUC]) of host markers for periodontal diagnosis (focused question 1 [FQ1]), periodontitis progression/relapse (FQ2) or resolution (FQ3) were searched in three electronic databases. Meta-analyses estimating diagnostic accuracy (DA) for individual host markers and for grouped salivary and gingival crevicular fluid (GCF) markers independently were performed whenever two or more studies were identified.

RESULTS

Sixty-one eligible studies were identified, of which 13 were included in meta-analyses for FQ1 (discrimination between health and periodontitis). Matrix metalloproteinase-8 (MMP-8) was the most reported biomarker in both saliva and GCF, with comparable AUC (0.70-0.90), sensitivity (0.49-0.84) and specificity (0.62-0.79) in both sample types. Cytokines had good ability for discrimination of periodontitis/gingivitis versus health, although they were substantially less accurate for periodontitis versus gingivitis. Combinations of cytokines and MMPs tended to increase overall diagnostic accuracy but without significant improvement in the case of periodontitis/gingivitis discrimination. Bone markers were the best performing group of salivary markers (AUC = 0.91) when compared to cytokines (AUC = 0.86) and MMPs (AUC = 0.77). GCF microRNAs (MiRs) were a singly meta-analysed group of biomarkers demonstrating AUC = 0.79.

CONCLUSION

Reported studies on host periodontal markers exhibit serious limitations regarding clinical and validation standards, being the main cause for lack of progress in clinical implementation of biomarkers in periodontal classification. Disease-specific markers such as bone markers showed better diagnostic performance (from limited number of studies) for the diagnosis of periodontitis when compared to cytokines and MMPs.

Effects of Non-Surgical Treatment on Hematological Indices in Stage III/IV Grade C Periodontitis

OBJECTIVE

To investigate the short-term effects of non-surgical periodontal treatment (NSPT) on clinical and hematological indices in stage III/IV grade C periodontitis patients.

METHODS

A total of 121 systemically healthy patients with generalized stage III/IV, grade C periodontitis were enrolled. Clinical indices (plaque index, probing depth, bleeding index, attachment loss) and hematological biomarkers [white blood cell count (WBC), mean platelet volume (MPV), neutrophil count (NEUT), neutrophil percentage (NEUT%), lymphocyte percentage (LYM%)] were measured before and 6-8 weeks after NSPT. Patients were divided into younger (≤ 35 years) and elder (> 35 years) groups, further stratified by systemic antibiotics usage. Analyses were performed using chi-squared tests, paired t-tests, and Pearson's correlation.

RESULTS

NSPT resulted in clinical indices improvement, as well as a reduction in WBC, NEUT, NEUT%, and an increase in MPV and LYM% in both groups. SRP-with-antibiotics subgroups showed more significant changes. SRP-without-antibiotics subgroups showed six significant correlations in both groups (p < 0.05); SRP-with-antibiotics subgroups showed 11 correlations in the younger and five in the elder group (p < 0.05).

CONCLUSIONS

NSPT improved clinical and hematological outcomes in stage III/IV grade C periodontitis patients over 6-8 weeks. Younger patients exhibited more significant changes than elder patients, especially in the SRP-without-antibiotics subgroup.

Usefulness of the CDC/AAP and the EFP/AAP Criteria to Detect Subclinical Atherosclerosis in Subjects with Diabetes and Severe Periodontal Disease

Background/Objectives: Periodontitis is an inflammatory disease associated with many systemic disorders such as diabetes and cardiovascular disease. The aim was to evaluate the usefulness of the CDC/AAP and the EFP/AAP criteria to detect subclinical atherosclerosis in subjects with diabetes and severe periodontal disease. Methods: This was a cross-sectional study. Atheroma plaque was evaluated by high-resolution carotid and femoral ultrasonography. A dental examination protocol was implemented by a trained periodontist. A full-mouth periodontal clinical examination was carried out at six sites by automated computerized Florida Probe Periodontal Probing. Periodontal disease was defined by CDC/AAP and EFP/AAP criteria. Results: In total, 98 patients were included (60.2% women), of which 50% had diabetes. Subjects with diabetes showed a high prevalence of severe cases of periodontal disease. Both criteria were useful to detect the presence of atheroma plaque only in the presence of diabetes. However, the CDC/AAP criteria had higher correlation with atheroma plaques than EFP/AAP criteria (r = 0.522 vs. r = 0.369, p < 0.001). Conclusions: The CDC/AAP and the EFP/AAP criteria are a useful tool to identify subclinical atherosclerosis in subjects with severe periodontal disease and diabetes. These results show the potential role of the oral healthcare team in the dental office for the identification of subjects with diabetes at risk of developing cardiovascular disease.

A short-term clinical evaluation of immediate implant placement in periodontitis patients

Background

With the advancement of oral implant technology, immediate implant placement is believed to be feasible for periodontitis patients. However, there is a lack of high-quality clinical studies regarding this approach. This study aimed to observe the short-term implant survival rate and conditions of peri-implant tissues in periodontitis patients who received immediate implants without systematic periodontal treatment.

Methods

This retrospective study included 95 patients and 234 implants treated at the Stomatological Hospital of Jinan University from June 2017 to December 2022. Patients were classified according to the 2018 AAP/EFP periodontal classification system, with Stage determined by CBCT-assessed marginal bone loss (MBL) and Grade estimated based on annual bone loss rate, smoking status, and diabetes history. Immediate implant placement was performed following atraumatic tooth extraction, with bone defects augmented using Bio-Oss bone graft and covered with Bio-Gide collagen membrane as needed. Patients were followed up for 12 months, during which implant survival, modified sulcus bleeding index (mSBI), modified plaque index (mPLI), marginal bone loss (MBL), and peri-implant probing depth (PPD) were assessed.

Results

A total of 95 patients (234 implants) were included, with a mean age of 58.59 years. The distribution of Stage II-IV and Grade A-C periodontitis was recorded. Preoperative assessments showed a significant increase in P-PDD, CAL, and MBL with greater disease severity (p < 0.001). One-year follow-up data indicated an implant survival rate of 97.86%, with Kaplan-Meier survival analysis revealing significantly lower survival rates in Stage IV and Grade C patients (p < 0.05). Postoperative soft tissue health assessment showed significant differences in mSBI and mPLI between stages (p = 0.002, p = 0.007) but not grades (p > 0.05). PPD did not differ significantly among groups (p > 0.05), whereas MBL was significantly higher in Stage IV than in Stage II and III (p < 0.001), though no significant differences were observed across grades (p > 0.05). Clinical and radiographic evaluations demonstrated favorable implant outcomes, with most patients reporting high satisfaction. These findings reinforce the viability of immediate implant placement in periodontitis patients, demonstrating high short-term success rates across different disease severities. While disease severity and progression rate may influence clinical outcomes, appropriate case selection, meticulous surgical techniques, and comprehensive postoperative care can lead to predictable and favorable implant success, even in patients with periodontitis.

Survival analysis of root-resected molars from 1 to 13.4 years: A retrospective cohort study

STATEMENT OF PROBLEM

While root resective therapy may extend the longevity of a molar, data on patient selection and outcomes of root resection are scarce.

PURPOSE

The purpose of this retrospective cohort study was to analyze the survival of root-resected molars and investigate factors affecting the decision and outcomes of the therapy.

MATERIAL AND METHODS

Patient- and tooth-related data from participants who had received root resection between 1999 and 2022 were collected. Cox regression was used to build predictive models for time-to-tooth loss based on predictors-initial diagnoses (carious, endodontic, periodontal, or endodontic-periodontal lesions), the presence of a complete-coverage crown, and the location of the tooth in the arch (P<.001).

RESULTS

Of 60 teeth, all from different participants, 31 molars were resected because of endodontic lesions. The failure rate was 35% with 21 teeth extracted. At 5 years, the survival probability was 0.58, considering all predictors. The survival of molars resected because of carious or endodontic lesions was significantly lower than those because of periodontal or endodontic-periodontal lesions (P<.05). The hazard ratio for tooth loss in the resected teeth was 15.6, 95% confidence interval (CI) (3.7 to 83.2) without complete-coverage crowns and 8.6, 95% CI (2.2 to 43.2) at the most posterior location.

CONCLUSIONS

Root resection provided to manage a localized periodontal lesion had the highest prognosis. The absence of a crown and the location as the most posterior tooth in the arch were associated with poor survival following resection.

Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitutes for the Treatment of Isolated Intrabony Defects: A 3-Year Follow-Up of a Prospective Case Series

Background: This study aimed to assess the effectiveness of a modified entire papilla preservation technique (MEPPT) for treating isolated intrabony defects in patients with stage III periodontitis. Material and Methods: Fifteen patients with 15 interdental intrabony defects were treated with a MEPPT using enamel matrix derivative and allogenic bone. Their probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), keratinized tissue width (KTW), defect depth (DD), full-mouth plaque score (FMPS), full mouth bleeding score (FMBS), radiographic images (radiographic angles, BF and LDF) and intrasurgical parameters were assessed at baseline and 3 years postsurgery. Standardized measurements were taken to evaluate the defect characteristics and treatment outcomes. Results: At 3 years, significant improvements from baseline were maintained. Probing pocket depth (PPD) decreased from 7.03 ± 1.61 mm to 3.33 ± 0.89 mm (p < 0.0001), clinical attachment level (CAL) improved to 3.08 ± 1.16 mm (p < 0.001) and defect depth (DD) decreased from 4.59 ± 1.24 mm to 0.38 ± 0.31 mm (p < 0.001). The changes in gingival recession and keratinized tissue were not statistically significant. The results demonstrate sustained clinical stability over a 3-year period. Conclusions: Within the limitations of this study, the findings suggest that the modified entire papilla preservation technique (MEPPT) in conjunction with enamel matrix proteins and allogenic bone grafting is an effective approach for the treatment of intrabony defects, leading to statistically significant and sustained clinical improvements over a 3-year period. The study protocol was registered in ClinicalTrials.gov ID NCT05029089.

Comparison of the Effects of Virtual Reality and Traditional Jaw Model in Undergraduate Periodontal Teaching

BACKGROUND

This study aims to investigate the impact of virtual reality (VR) simulation training and jawbone models on dental students' proficiency in periodontal skills.

METHODS

The 90 dental undergraduates were randomly divided into the VR teaching group (VR group), the traditional jaw model teaching group (model group), and the combined group that received both VR teaching and model teaching. All the students in these groups learned scaling and root planing (SRP) techniques taught in class. The students would be tested by a final operation examination, invited to fill out a teaching survey questionnaire after the examination, and voted on which examination items were helpful for learning through different teaching methods.

RESULTS

The combined group achieved the highest total scores and the force mode, direction, and motion amplitude scores (p <  0.05). The model group performed better than the VR group in terms of fulcrum scores but showed contrasting results in instrument angle scores (p < 0.05). In terms of the questionnaire scores, the VR group scored higher than the model group in fully grasping course knowledge while showing contrasting results in terms of integration with practice (p < 0.05). The votes revealed that students in the VR group mostly preferred "instrument angle," while those in the model group favored "instrument grip and fulcrum," and the combination group showed a preference for both "instrument angle" and "force mode, direction, and motion amplitude."

CONCLUSIONS

VR teaching and traditional model teaching have their own advantages in SRP. It is suggested that dental SRP teaching should adopt a combination of VR and the traditional model.

HLA Polymorphisms Linked to the Severity and Extent of Periodontitis in Patients with Type 1 Diabetes from a Brazilian Mixed Population

This study aimed to investigate the relationship between Class II human leukocyte antigen (HLA) alleles (DRB1, DQA1, and DQB1) and the severity and extent of periodontitis in patients with Type 1 diabetes (T1D). A cross-sectional study was conducted with 49 patients with T1D. Demographic data and diabetes history were collected. A clinical examination was performed to assess periodontal variables. The patients were categorized by the periodontitis severity and the extent of periodontitis. Peripheral blood samples were analyzed to identify the percentage of autosomal ancestry (Native American, European, and African) and the HLA-DRB1*, HLA-DQA1*, and HLA-DQB1* alleles. The DRB1*03 and DRB1*15 haplogroups were significantly associated with an increased risk of generalized periodontitis (OR = 19.8, 95% CI = 1.14-346, p = 0.003; OR = 41.2, 95% CI = 1.85-917, p < 0.001) and severe periodontitis (OR = 7.7, 95% CI = 1.68-35.5, p = 0.003; OR = 21.2, 95% CI = 0.97-461, p = 0.005). No associations were observed between the HLA-DQA1 and HLA-DQB1 alleles and periodontitis. These findings suggest that patients with T1D from a highly mixed Brazilian population carrying the DRB1*03 and DRB1*15 haplogroups are at higher risk for developing more severe and generalized forms of periodontitis.

Comparison Between the 2017 EFP/AAP and CDC/AAP Case Definitions on Periodontal Status and Their Association With Risk Factors in an Adult Norwegian Population-Insights From the Tromsø Study: Tromsø7

OBJECTIVES

To describe the prevalence, extent and severity of periodontitis in an adult Norwegian population, using the 2017 EFP/AAP and CDC/AAP case definitions, and their associations with potential risk factors for periodontitis. A secondary aim was to explore how the stage and grade of periodontitis shifted when complexity and risk factors were added.

MATERIAL AND METHODS

A subsample of participants (≥ 40 years, n = 21,083) in a cross-sectional health study (Tromsø7, 2015-2016) was invited to an oral health examination (n = 3946). Radiographic bone loss and four site measurements of periodontal probing depth (PPD) and bleeding on probing were recorded for 3701 adults.

RESULTS

According to EFP/AAP, 89% of participants had periodontitis (21% stage III-IV), while 74% had periodontitis defined by CDC/AAP (12% severe periodontitis). Five percent of stage III/IV cases and 22% of severe cases had generalised disease. Higher age, frequent use of dental care, smoking and higher body mass index were associated with periodontitis for both definitions. PPD contributed to a shift to more severe stages. Smoking contributed the most to the shifting of grade, with 7% of cases shifting to grade C.

CONCLUSIONS

Periodontitis was highly prevalent according to both case definitions. Associations with known risk factors remained relatively consistent between the two case definitions. Complexity and risk factors played a significant role in the shifting of stage and grade of periodontitis.

Estimating Periodontal Stability Using Computer Vision

Periodontitis is a severe infection affecting oral and systemic health and is traditionally diagnosed through clinical probing-a process that is time-consuming, uncomfortable for patients, and subject to variability based on the operator's skill. We hypothesized that computer vision can be used to estimate periodontal stability from radiographs alone. At the tooth level, we used intraoral radiographs to detect and categorize individual teeth according to their periodontal stability and corresponding treatment needs: healthy (prevention), stable (maintenance), and unstable (active treatment). At the patient level, we assessed full-mouth series and classified patients as stable or unstable by the presence of at least 1 unstable tooth. Our 3-way tooth classification model achieved an area under the receiver operating characteristic curve of 0.71 for healthy teeth, 0.56 for stable, and 0.67 for unstable. The model achieved an F1 score of 0.45 for healthy teeth, 0.57 for stable, and 0.54 for unstable (recall, 0.70). Saliency maps generated by gradient-weighted class activation mapping primarily showed highly activated areas corresponding to clinically probed regions around teeth. Our binary patient classifier achieved an area under the receiver operating characteristic curve of 0.68 and an F1 score of 0.74 (recall, 0.70). Taken together, our results suggest that it is feasible to estimate periodontal stability, which traditionally requires clinical and radiographic examination, from radiographic signal alone using computer vision. Variations in model performance across different classes at the tooth level indicate the necessity of further refinement.

Anti-inflammatory and antimicrobial efficacy of coconut oil for periodontal pathogens: a triple-blind randomized clinical trial

OBJECTIVES

To evaluate the effect of coconut oil on the oral bacteriome and inflammatory response in patients with periodontitis by integrating next-generation sequencing analyses of pathogenic bacterial shifts and quantification of inflammatory markers, thereby assessing its potential as a natural adjunct to standard nonsurgical periodontal therapy.

MATERIALS AND METHODS

A triple-blind clinical trial was conducted with 30 participants diagnosed with periodontitis, randomized into 3 groups: (1) coconut oil, (2) chlorhexidine and (3) placebo. Saliva and gingival crevicular fluid (GCF) samples were collected before treatment, one month after treatment, and one month post-non-surgical periodontal therapy. Bacterial DNA was extracted, and the V3-V4 region of the 16 S rRNA gene was PCR-amplified and sequenced using Illumina MiSeq technologies. Inflammatory biomarkers, including Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were quantified from GCF samples.

RESULTS

Coconut oil treatment significantly reduced pathogenic bacterial families such as Spirochaetaceae and Tannerellaceae while promoting beneficial bacteria such as Streptococcaceae. At the genus and species levels, coconut oil reduced pathogens such as Tannerella forsythia and Treponema denticola along with increase in beneficial bacteria such as Streptococcus. The subgingival microbial dysbiosis index improved significantly in both coconut oil and chlorhexidine groups. Furthermore, the coconut oil demonstrated a reduction in IL-6 and TNF-α levels, indicating decreased local inflammation.

CONCLUSIONS

Coconut oil treatment significantly modulated the oral microbiome and reduced inflammatory markers in patients with periodontitis, suggesting its potential as a natural and effective adjunct in periodontal therapy.

CLINICAL RELEVANCE

This study highlights coconut oil's potential as a natural adjunct in periodontal therapy, effectively reducing pathogenic bacteria and inflammatory markers (IL-6, TNF-α). It offers a safe alternative to chlorhexidine, promoting microbiome balance and improved periodontal health.

The Potential Effect of Periodontal Disease on the Development of Metabolic Syndrome: A 10-Year Observational Study in a Thai Adult Cohort

AIM

As data are sparse on the long-term association between periodontal diseases and development of metabolic syndrome (MetS), we investigated their relationship in a Thai cohort over a 10-year observational period.

METHODS

Medical records and data on periodontal assessments of 2161 employees of the Electricity Generating Authority of Thailand collected at two time points, 2003 and 2013, were used. Experienced periodontists used standard national and international criteria to define periodontitis and MetS. The impact of baseline periodontitis on subsequent MetS incidence and its components was evaluated using regression analyses.

RESULTS

The severity and extent of periodontitis significantly predicted MetS incidence over a decade, with a higher incidence of MetS in individuals with poorer periodontal health. A single percentage increase in the periodontitis extent raised the risk of MetS incidence by 0.4% and the risk of developing individual components of MetS by 0.2%. Independent of periodontal health, age of an individual emerged as a factor impacting MetS development.

CONCLUSION

This study highlights the potential effect of the severity and extent of periodontitis on the increased incidence and progression of MetS. Hyperglycaemia and hypertension were the two MetS components most significantly affected by the existence of periodontitis.

Identifying Undiagnosed Diabetes and Prediabetes in the Dental Setting in an Asian Population-A Clinical Risk Model

AIM

To assess the glycaemic status of Asian patients in a tertiary care dental setting and develop a risk model for undiagnosed diabetes mellitus (DM).

MATERIAL AND METHODS

A total of 1074 participants completed a diabetes risk test questionnaire, full-mouth periodontal examination and a point-of-care HbA1c finger-prick blood test. Univariable logistic regression was performed to assess the effect of potential factors to predict DM, with confirmed diabetes as the outcome. Subsequently, multivariable logistic regression analysis with stepwise variable selection was employed to develop the final models for predicting DM.

RESULTS

Sixty-five (6.1%) and 83 (7.7%) of the 1074 participants were medically confirmed with T2DM and prediabetes, respectively. The 'best' predictive risk model for DM included body mass index (BMI), family history of diabetes, smoking and a diagnosis of Stage III/IV or severe periodontitis with an area under the curve (AUC) of 0.717 (95% confidence interval, CI [0.689-0.744]) and 0.721 (95% CI [0.693-0.748]), respectively. Including the oral health measure marginally increased the AUC.

CONCLUSIONS

Dental patients clinically diagnosed with advanced periodontitis in combination with high BMI, positive family history of DM and smoking are potentially at high risk for DM and should be screened for DM and referred for medical confirmation and management.

Impact of smoking habit on the subgingival proteome in patients with periodontitis

BACKGROUND

Few investigations evaluated smoking's impact on the periodontal proteome. Therefore, this study aimed to analyse the influence of tobacco on the overall periodontal proteome and the differential expression of gingival crevicular fluid (GCF) proteins using sequential window acquisition of all theoretical mass spectra (SWATH-MS).

METHODS

GCF samples were collected from 40 periodontitis subjects (stages III-IV). These were separated based on smoking status into smokers (17), ex-smokers (10), and non-smokers (13). Samples were analysed using SWATH-MS, and proteins were identified using the UniProt human-specific database. Data are available via ProteomeXchange with the identifier PXD043474. Principal component analysis (PCA) was employed to examine the spectral mass distribution of the proteome. Protein expression was different for a p-value <0.05 and a log2 fold change ≥0.3 (upregulated) or ≤-0.3 (downregulated).

RESULTS

The distribution of overall proteome did not differ between non-smokers, smokers, and ex-smokers. Considering protein expression, 23 were differentially expressed in smokers vs. non-smokers (16 upregulated and 7 downregulated), 17 in ex-smokers vs. non-smokers (2 upregulated and 15 downregulated), and only 8 in smokers vs. ex-smokers (7 upregulated and 1 downregulated). Smoking increased the expression of proteins related to epithelial hyperkeratinization (keratins type II cytoskeletal 4, type I cytoskeletal 13 and type I cytoskeletal 19, cornulin, and fatty acid-binding protein 5). However, multiple immunoglobulins were underexpressed when comparing smokers and ex-smokers to non-smokers.

CONCLUSION

Although smoking does not significantly modify the overall GCF proteome associated with periodontitis, it alters the expression of several proteins compared to never-smokers and ex-smokers.

PLAIN LANGUAGE SUMMARY

Smoking is a critical risk factor for the development and progression of periodontitis. However, evidence of the effect of smoking on the subgingival proteome is scarce. Therefore, this study aimed to determine the impact of smoking on the overall proteome and differential expression of gingival crevicular fluid (GCF) proteins using the sequential window acquisition of all theoretical mass spectra (SWATH-MS) proteomic technique. For this purpose, GCF samples were collected from 40 subjects with periodontitis, of which 17 were smokers, 10 were ex-smokers, and 13 were non-smokers. These samples were analysed by SWATH-MS, and proteins were identified using the UniProt human-specific database. Analysis of the overall proteome showed that its distribution was not significantly different between smokers, ex-smokers, and non-smokers. However, several proteins were found to be differentially expressed according to the smoking status. Smoking can increase the expression of several keratins and proteins related to hyperkeratinization of the epithelium. However, in ex-smokers, these proteins return to similar levels to those of non-smokers. Moreover, smoking may induce a lower expression of proteins related to adaptive immunity, such as immunoglobulins. This immunosuppressive effect may persist in ex-smokers.

Combined application of Er:YAG laser and low-level laser in non-surgical treatment of periodontitis

BACKGROUND

To compare the efficacy of combined treatment of Er:YAG laser (ERL) and low-level laser therapy (LLLT) with single laser applications, and scaling and root planing (SRP) for non-surgical periodontal treatment.

METHODS

In a randomized controlled trial, 25 non-smoking Stage II or Stage III periodontitis patients were recruited. The four intraoral quadrants were randomly assigned to four different treatments: (1) combined application with ERL plus SRP plus LLLT; (2) ERL plus SRP; (3) SRP plus LLLT; and (4) SRP. We assessed periodontal indexes, including probing depth (PD), clinical attachment level (CAL), bleeding index (BI), and plaque index (PLI), along with three cytokines (IL-1β, TNF-α, IL-10) from gingival crevicular fluid and red complex pathogens from subgingival dental plaque at baseline, 3 months, and 6 months.

RESULTS

For initial moderate pockets (4 mm ≤ PD ≤ 6 mm), quadrants treated with ERL+SRP+LLLT, ERL+SRP, and SRP+LLLT exhibited greater PD improvement compared to the control (SRP) quadrants at the 3-month follow-up (1.25 ± 1.06, 1.23 ± 1.12, 1.00 ± 1.21 vs. 0.98 ± 1.21 mm) and the 6-month follow-up (1.35 ± 1.06, 1.23 ± 1.17, 1.35 ± 0.98 vs. 0.98 ± 1.23 mm) (p = 0.002). Quadrants treated with ERL+SRP+LLLT and SRP+LLLT showed more CAL gain means than the control quadrants at the 3-month follow-up (0.96 ± 1.42, 0.61 ± 1.39 vs. 0.55 ± 1.57 mm) and the 6-month follow-up (0.84 ± 1.54, 0.89 ± 1.49 vs. 0.48 ± 1.68 mm) (p = 0.008). For initial deep pockets (PD ≥ 7 mm), the ERL+SRP+LLLT quadrants had more PD improvement and CAL gain compared to the control quadrants at follow-up. There were no significant differences in BI, PLI, inflammatory cytokines, and periodontal pathogens among the four groups.

CONCLUSION

The combined application of ERL and LLLT demonstrated potential efficacy in reducing PD, particularly for deep pockets.

PLAIN LANGUAGE SUMMARY

To compare the therapy effect of combined use of Er:YAG laser (ERL) and low level laser therapy (LLLT) with single laser applications, and traditional periodontal treatment (SRP). A total of 25 non smoking patients with periodontitis were involved, and their mouths were divided into four sections, each receiving a different treatment: ERL+SRP+LLLT, ERL+SRP, SRP+LLLT, and SRP. Clinical indexes and laboratory indicators were assessed at baseline, 3 months, and 6 months. After six months, for initial moderate pockets, combined laser group and single laser group showed better improvements than traditional group in reducing the depth of periodontal pockets and increasing attachment levels. But for initial deep pockets, only combined laser group showed better improvement than traditional group. There were no significant differences in bleeding, plaque, inflammation, or harmful bacterial levels among the groups. These findings suggest that the integration of Er:YAG laser and low level laser therapy into standard periodontal treatment may enhance the treatment's benefits in reducing pocket depth, especially for severe conditions.

Utilization of Prognosis Assignment: A Cross-Sectional Survey of Military Periodontists

INTRODUCTION

Prognosis is a forecast of the likely course of a disease and its future implications on treatment outcomes. The significance of periodontal prognosis in clinical practice is evident by its influence on treatment planning, communication, and in the retrospective evaluation of treatment results. While there are multiple well-known prognosis systems reported in the periodontal dental literature, there is an absence of data on the actual use of prognosis assignment among practicing clinicians. The purpose of this study was to survey military periodontists regarding their utilization of periodontal prognosis and associated systems and to evaluate prognosis' influence on treatment planning as well as its implications on operational dental readiness.

METHODS

A 19-question internet survey was disseminated to military periodontists in the U.S. Air Force, Army, and Navy via their respective Periodontal Consultants to the Surgeon Generals. The survey inquired on provider-specific demographic information, the provider's favored periodontal prognosis system, when and how prognosis is applied, and on the relationship between prognosis and operational dental readiness.

RESULTS

Fifty-five percent (n = 65 out of 120) of eligible survey participants completed the survey. Army (94.4%, n = 17) and Air Force (72.2%, n = 13) respondents preferred utilizing the Kwok and Caton periodontal prognosis system compared to 37.9% (n = 11) of Navy periodontists. Most respondents assigned prognosis at multiple time points in a patient's overall course of treatment (68%, n = 44), identified the severity of the periodontal presentation and the predictability of treatment outcomes as the most important factors involved in assigning a prognosis (82%, n = 55), and indicated that periodontal prognosis did not influence their dental readiness classification and vice versa.

CONCLUSIONS

Kwok and Caton and McGuire periodontal prognosis systems were utilized by the majority of respondents but differed in utilization by military service branch. Respondents considered periodontal presentation severity and treatment outcome predictability the most important factors when assigning a prognosis. There was minimal influence between operational dental readiness and periodontal prognosis. Future research will evaluate prognosis system utilization in a broader population and will assess the impact of system standardization in education and clinical practice.

Assessment of Systemic and Periodontal Conditions in Pregnant Women and Their Impact on Neonatal Birth Weight: A Prospective Cohort Study

The aim of this study was to assess some variables of women in the 27th week of pregnancy and after childbirth, in addition to determining which of these variables were associated with low birth weight during the coronavirus disease (COVID-19) pandemic. The patients were divided into two groups: mothers with normal-weight babies (G1 = 60) and mothers with below-normal-weight babies (G2 = 16). The variables assessed were education, monthly family income, anthropometric parameters, systemic health, periodontal condition, oral hygiene habits, Oral Health Impact Profile-14 results, data from the babies at birth, and a COVID-19 diagnosis during pregnancy. The mothers in G1 showed greater weight gain during pregnancy. There was an increase in tooth plaque percentage, probing pocket depth, and clinical attachment level during the study period for both groups and an increase in periodontitis cases in the patients from G1. The mothers from G1 had longer pregnancy periods and delivered taller babies with a higher body mass index. A one-unit increase in weight during pregnancy decreases the likelihood of having a below-normal-weight baby by 11.3% [confidence interval = 2.4-20.4%]. Weight gain during pregnancy is a protective factor that decreases the likelihood of babies being born with below-normal weights.

The Association Between Periodontitis and the Prevalence and Prognosis of Metabolic Syndrome

Objective

Periodontitis and metabolic syndrome (MetS) are both linked to inflammation, but their association remains unclear. This study aimed to explore the association between periodontitis and MetS prevalence and evaluate its impact on the prognosis of all-cause and cardiovascular mortality in MetS.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) database. Logistic regression analysis was used to investigate the association between periodontitis and the prevalence of MetS, while Cox regression analysis was applied to assess the association between periodontal status and the poor prognosis in individuals with MetS. Furthermore, restricted cubic spline (RCS) analysis was performed to evaluate the linear and nonlinear associations between periodontal parameters, including attachment loss (AL) and probing depth (PD), and the prevalence and mortality of MetS.

Results

A total of 9,270 individuals were included in the analysis. Individuals with periodontitis had a higher prevalence of MetS compared to those without periodontitis (OR=1.24, 95% CI: 1.08-1.43). Cox regression analysis revealed that periodontitis was associated with an increased risk of all-cause mortality (HR=2.03, 95% CI:1.40-2.92) and cardiovascular mortality (HR=2.32, 95% CI:1.05-5.10) among individuals with MetS. Furthermore, the RCS analysis demonstrated that AL had a nonlinear association with the risk of prevalence, all-cause mortality and cardiovascular mortality in MetS (P for nonlinearity < 0.05). However, PD was linearly associated with the increased risks of these outcomes (P overall < 0.05).

Conclusion

Periodontitis is associated with an increased risk of MetS, as well as higher risks of all-cause and cardiovascular mortality.

Bone mineral density in patients using aromatase inhibitors: a clinical, nutritional, and quality of life assessment

The use of aromatase inhibitors (AIs) leads to an imbalance in bone remodeling and can cause osteoporosis. This study aimed to identify clinical, periodontal, nutritional, and biochemical determinants of bone mineral density (BMD) changes in patients using AIs. The sample consisted of 40 women using AIs and 32 controls. BMD was assessed by dual X-ray absorptiometry (DXA). Data on nutritional, anthropometric, oral and periodontal status, and oral health-related quality of life (OHRQoL) were collected. Cytokines and adipokines were quantified in saliva and serum. Thirty-nine of the 72 women had low BMD, with a similar distribution in the control and AIs groups. BMD was lower in older women using AIs (p = 0.009) and in smokers (p = 0.034). Anthropometric assessment demonstrated that women with low BMD who used AIs had lower weight (p = 0.028). Although the frequency of periodontitis was similar in all groups, higher IL-6 (p = 0.004), IL-1β (p = 0.002), and IL-33 (p = 0.006) levels were associated with poor periodontal status. Women who used AIs were 1.18 times more likely to report better OHRQoL than controls. While advanced age, smoking, and lower weight are factors associated with low BMD, the use of antiresorptive agents was a protective factor for maintaining BMD in women using AIs.

Tissue autofluorescence system as an aid for Dental Hygienist to screening oral mucosa alterations during supportive periodontal care. An observational single-arm study

OBJECTIVES

To evaluate a tissue autofluorescence (AF) system as an aid for Dental Hygienist (DH) to screening oral mucosa alterations during supportive periodontal care (SPC).

MATERIALS AND METHODS

Two hundred patients in regular SPC with no previous oral mucosa lesions were enrolled. The oral cavity of each patient was examined by a DH without and with the AF system. Afterward, the patient was examined by a General Dentist (GD) by means of conventional visual inspection alone. The primary outcome was the sensitivity of AF system used by a DH. Furthermore, the specificity, predictive values and likelihood ratios were also evaluated. Receiver operating characteristic (ROC) curves were generated and area under ROC (AUROC) was estimated to overall evaluate the ability of DH to detect oral mucosa lesions with and without an AF system.

RESULTS

After completion of intraoral screening, 111 and 66 oral mucosa alterations were detected by DH without and with the AF system. A total of 83 lesions were instead recorded by GD with conventional inspection. The sensitivity and specificity of AF system used by a DH were 61.5% and 90.6% while the conventional visual inspection showed a sensitivity of 81.3% and specificity of 97.6%. AUROC values of 0.760 and 0.894 were found for AF system and for conventional visual inspection respectively.

CONCLUSIONS

Whitin the limitations of present study, the results showed for DH an increase of specificity and a loss of sensitivity in detection of oral mucosa alterations using the AF system.

CLINICAL RELEVANCE

The use of AF system may be considered an aid for DH to improve screening of oral mucosal alterations during SPC.

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

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

Accuracy of Ionizing-Radiation-Based and Non-Ionizing Imaging Assessments for the Diagnosis of Periodontitis: Systematic Review and Meta-Analysis

AIMS

To evaluate the diagnostic accuracy of periapical, bitewing or panoramic radiographs (standard 2D radiographs) in detecting and monitoring periodontitis (PICO 1) and to assess the clinical relevance of alternative and emerging diagnostic methods (e.g., cone-beam computed tomography [CBCT], magnetic resonance imaging [MRI], ultrasound imaging [USG]) compared to standard 2D radiographs or clinical/intra-surgical examination in the diagnosis and surveillance of the disease (PICO 2).

MATERIALS AND METHODS

A systematic literature search was conducted through MEDLINE EMBASE, Scopus and Cochrane Library. When feasible (n > 2 comparable studies), a meta-analysis of diagnostic accuracy was performed.

RESULTS

For PICO 1, 26 studies met the inclusion criteria. Pooled-data analysis from three studies showed a sensitivity of 0.77 (95% confidence interval, CI: 0.66-0.85), specificity of 0.76 (95% CI: 0.64-0.84) and accuracy of 0.82, with a diagnostic odds ratio (DOR) of 137.99 (95% CI: 6.99-368.90). For PICO 2, 51 articles were included dealing with different techniques. The meta-analysis for CBCT (three studies) showed a pooled sensitivity and specificity of 0.98 (95% CI: 0.96-1.00) and 0.98 (95% CI: 0.95-1.00), respectively, and a diagnostic accuracy of 0.99 in the detection of furcation involvement compared to intra-surgical measurements.

CONCLUSIONS

Standard 2D radiographs appear to have adequate diagnostic accuracy for periodontitis, while CBCT is highly sensitive and specific to detect and classify furcation involvement. The role of non-ionizing techniques (MRI and USG) in diagnosing periodontitis remains under investigation.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Non-Surgical Treatment of Moderate Periodontal Intrabony Defects With Adjunctive Cross-Linked Hyaluronic Acid: A Single-Blinded Randomized Controlled Clinical Trial

AIM

To evaluate the clinical outcomes of moderate intrabony defects treated with minimally invasive non-surgical technique (MINST) with or without adjunctive delivery of cross-linked hyaluronic acid (xHyA) gel.

MATERIALS AND METHODS

Forty-two patients with 42 interdental intrabony defects were randomly assigned to test (MINST + xHyA) or control procedures (MINST alone). Probing depth (PD), clinical attachment level (CAL), gingival recession (GR) and bleeding on probing (BOP) at the treated sites were assessed at baseline and at 3 and 6 months. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS) were recorded at baseline and after 6 months. Radiographic evaluation was performed at baseline and after 6 months, assessing the defect fill (DF) and radiographic defect angle (RDA). The primary outcome variable was PD change.

RESULTS

Thirty-eight patients completed the trial without any adverse events. At 6 months, a statistically significant improvement (p < 0.05) was measured in all clinical parameters except GR (p > 0.05). However, no statistically significant differences were found between the experimental and control procedures (p > 0.05). Statistically significant differences between the test and control sites were observed at 3 months for PD and CAL changes (p < 0.05). The DF change was statistically significant when comparing experimental and control procedures at 6 months (p < 0.05). Both procedures failed to show statistically significant differences in terms of RDA changes at 6 months (p > 0.05).

CONCLUSION

Within their limitations, the present results indicate that (a) treatment of intrabony defects with MINST, with or without application of xHyA gel, resulted in statistically significant improvements in the investigated clinical parameters at 3 and 6 months after therapy, and (b) although the adjunctive use of xHyA gel to MINST improved the clinical outcomes compared with MINST alone up to 3 months, statistically significant differences were not observed at 6 months. The study protocol was registered in ClinicalTrial.gov (NCT05188898).

Prognostic Impact of Microbiome Dysbiosis: A Prospective Study

AIMS

To determine the relationship between microbiome dysbiosis indices and biofilm immunogenicity and their prognostic implications on periodontal treatment response.

MATERIALS AND METHODS

Thirty periodontally healthy controls and 30 periodontitis cases (stage III) were recruited. Cases received non-surgical periodontal therapy (NSPT), and their treatment response at 6 months was evaluated using a treat-to-target endpoint (≤ 4 sites with probing depths ≥ 5 mm). Pooled subgingival biofilm samples were obtained from controls and cases. The V3-4 hypervariable region of the 16S rRNA gene was sequenced and two compositional indices (subgingival microbiome dysbiosis index, SMDI, and dysbiosis ratio, DR) were calculated. Nuclear factor kappa-B (NF-κB) activation elicited by biofilm samples in monocytic reporter cells was quantified to assess biofilm immunogenicity.

RESULTS

SMDI, DR and biofilm immunogenicity were highly diagnostic for periodontitis (area under curves [AUC] > 0.90, p < 0.001). Among periodontitis cases, all three microbial parameters were significantly reduced after NSPT (p < 0.001). Cases achieving the treat-to-target endpoint had lower pre-treatment SMDI and biofilm immunogenicity (p < 0.05) and different microbial recolonization patterns from poor responders. Both measures predicted treatment response (AUC of 0.767 and 0.835, respectively, p < 0.05).

CONCLUSION

Subgingival biofilm dysbiosis quantified using SMDI and biofilm immunogenicity was diagnostic of periodontitis and predictive of NSPT outcomes.

Subgingival 0.75% boric acid vs 1% povidone-iodine adjunctive to subgingival instrumentation in stage II and III periodontitis-A double-blind randomized clinical trial

PURPOSE

To compare the effects of subgingival irrigation with 0.75% boric acid (BA) and 1% povidone-iodine (PVP-I) as an adjunct to scaling and root planing (SRP) on clinical and microbiologic parameters in the management of patients with periodontitis after a 12-month follow-up.

METHODS

Sixty systemically healthy individuals diagnosed with periodontitis were included in this double-blind randomised clinical trial. The patients were randomly allocated to treatment groups: (1) SRP plus 0.75% BA and (2) SRP plus 1% PVP-I. Whole-mouth periodontals were clinically examined, and the counts of bacteria including Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), Solobacterium moorei (Sm) and Streptococcus salivarius (Ss) were tested by real-time polymerase chain reaction (PCR).

RESULTS

All periodontal parameters and the counts of Aa, Fn, Pg, Td, Tf, Sm and Ss in both groups showed statistically significant reductions at T3, T6 and T12 compared to T0. Whole-mouth or moderate or severe PD and CAL improvements were significantly found in the 0.75% BA group compared to the 1% PVP-I group at T3, T6 and T12. The reduction in Aa or Fn and the reduction in Ss were significantly higher in the 0.75% BA group at T6 and T12 than in the 1% PVP-I group.

CONCLUSION

This study shows that subgingival irrigation with 0.75% BA may be an alternative to 1% PVP-I because it promotes greater PD reductions and CAL gain, particularly up to 12 months after treatment.

U-shaped association between pan-immune-inflammation value and periodontitis: NHANES 2009-2014

BACKGROUND

This study aimed to investigate the relationship between the pan-immune-inflammation value (PIV) and periodontitis based on a large national survey.

METHODS

In the present cross-sectional study, data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, which included a total of 10,300 participants. The categorization of periodontitis was based on the 2017 classification scheme. The PIV was determined using the formula: (neutrophils count × monocyte count × platelet count)/lymphocytes count. Restricted cubic spline and weighted multivariable logistic regression analyses were employed to evaluate the associations between the PIV with periodontitis.

RESULTS

The associations between PIV and stage III/IV periodontitis followed a U-shaped pattern (Pnon-linearity < 0.001). The risk of developing stage III/IV periodontitis showed an increasing trend among participants in the first quartile (odds ratio [OR] = 1.21; 95% confidence interval [CI]: 1.01-1.46), third quartile (OR = 1.34; 95% CI: 1.11-1.61), and fourth quartile (OR = 1.47; 95% CI: 1.25-1.73) compared to those in the second quartile. Subgroup analysis indicated stronger associations of PIV with periodontitis in males (ORQ4vs2 = 1.72, 95% CI: 1.36-2.18) and individuals with hypertension (ORQ4vs2 = 1.78, 95% CI: 1.38-2.28) with significant interactions (Pinteraction < 0.05).

CONCLUSIONS

There is a U-shaped association between PIV and stage III/IV periodontitis, which suggests a potential adjunctive treatment strategy for periodontitis. Higher PIV values were found to have a stronger correlation with stage III/IV periodontitis in males and individuals with hypertension. Further prospective trials are needed to confirm the validity of our results.

PLAIN LANGUAGE SUMMARY

A U-shaped association exists between the pan-immune inflammation value and periodontitis in US adults, suggesting that maintaining a moderate immune inflammation response is crucial for periodontal health.

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

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

Revolutionizing oral care: Reactive oxygen species (ROS)-Regulating biomaterials for combating infection and inflammation

The human oral cavity is home to a delicate symbiosis between its indigenous microbiota and the host, the balance of which is easily perturbed by local or systemic factors, leading to a spectrum of oral diseases such as dental caries, periodontitis, and pulp infections. Reactive oxygen species (ROS) play crucial roles in the host's innate immune defenses. However, in chronic inflammatory oral conditions, dysregulated immune responses can result in excessive ROS production, which in turn exacerbates inflammation and causes tissue damage. Conversely, the potent antimicrobial properties of ROS have inspired the development of various anti-infective therapies. Therefore, the strategic modulation of ROS by innovative biomaterials is emerging as a promising therapeutic approach for oral infection and inflammation. This review begins by highlighting the state-of-the-art of ROS-regulating biomaterials, which are designed to generate, scavenge, or modulate ROS in a bidirectional manner. We then delve into the latest innovations in these biomaterials and their applications in treating a range of oral diseases, including dental caries, endodontic and periapical conditions, periodontitis, peri-implantitis, and oral candidiasis. The review concludes with an overview of the current challenges and future potential of these biomaterials in clinical settings. This review provides novel insights for the ongoing development of ROS-based therapeutic strategies for oral diseases.

Diagnostic Accuracy of Novel Protein Biomarkers in Saliva to Detect Periodontitis Using Untargeted 'SWATH' Mass Spectrometry

AIM

To discover new salivary biomarkers to diagnose periodontitis and evaluate the impact of age and smoking on predictive capacity.

MATERIAL AND METHODS

Saliva samples were collected from 44 healthy periodontal individuals and 41 with periodontitis. Samples were analysed by sequential window acquisition of all theoretical mass spectra (SWATH-MS), and proteins were identified by employing the UniProt database. The diagnostic capacity of the molecules was determined with generalized additive models. The models obtained were single-protein unadjusted and adjusted for age and smoking status, besides two-protein combinations.

RESULTS

Eight single salivary proteins had a bias-corrected accuracy (bc-ACC) of 78.8%-86.8% (bc-sensitivity/bc-specificity of 62.5%-86.9%/60.9%-98.1%) to diagnose periodontitis. Predictive capacity increased more by adjusting for age (bc-ACC: 94.1%-98.2%; bc-sensitivity/bc-specificity: 90.2%-98.6%/93.6%-97.2%) than smoking (bc-ACC: 83.9%-90.4%; bc-sensitivity/bc-specificity: 73.6%-89.9%/76.2%-96.4%). These proteins were keratin, type II cytoskeletal 1, protein S100-A8, β-2-microglobulin, neutrophil defensin 1, lysozyme C, ubiquitin-60S ribosomal protein L40, isoform 2 of tropomyosin α-3 chain and resistin. Two dual combinations showed bc-sensitivity/bc-specificity of > 90%: β-2-microglobulin with profilin-1, and lysozyme C with zymogen granule protein 16 homologue B.

CONCLUSIONS

New salivary biomarkers show good or excellent ability to diagnose periodontitis. Age has a more significant influence on the accuracy of the single biomarkers than smoking, with results comparable to two-protein combinations.

Trimethylamine N-Oxide (TMAO) and TNF-α Levels in Periodontal Disease Associated With Smoking

AIMS

Trimethylamine N-oxide (TMAO) is a compound involved in the pathogenesis of various systemic inflammatory diseases, including cardiovascular conditions. The aim of this study was to determine differences in saliva and serum levels of TMAO between periodontitis and healthy patients according to smoking status.

METHODS

The study included four systemically healthy groups: periodontally healthy non-smokers (NS-Control; n = 25), non-smokers with Stage-III-Grade-B periodontitis (NS-Periodontitis; n = 25), periodontally healthy smokers (S-Control; n = 25), and smokers with Stage-III Grade-C periodontitis (S-Periodontitis; n = 25). Periodontal parameters were recorded. TMAO levels were determined in saliva and serum samples using liquid chromatography-mass spectrometry (LC-MS/MS). TNF-α levels were measured by the ELISA method.

RESULTS

Salivary TNF-α and TMAO levels were significantly elevated in the smoking periodontitis group compared to other groups (p < 0.001 and p = 0.003, respectively). Serum TMAO levels were also significantly higher in the smoking periodontitis group compared to non-smoking controls and non-smoking periodontitis. TMAO/SFR ratios were notably higher in the smoking periodontitis group compared to other groups, and a strong positive correlation was observed between salivary TMAO and TNF-α levels (r = 0.892, p < 0.001).

CONCLUSION

The data suggested that TMAO and TNF-α are associated with inflammatory mechanisms of periodontitis in cases where periodontitis coexists with smoking.

TRIAL REGISTRATION

NCT06580431.

Expression Levels of miR-181 Family Members in Oral Biofluids as Biomarkers for Periodontitis Severity

This study aimed to assess the diagnostic potential of microRNA-181 (miR-181) family members in oral biofluids, namely saliva and gingival crevicular fluid (GCF), as biomarkers for periodontitis severity. A cohort of 150 patients with periodontitis, including 82 with mild to moderate and 68 with advanced periodontitis, along with 90 healthy controls, were recruited. Analysis of miR-181 family expression using quantitative real-time polymerase chain reaction (qRT-PCR) revealed differential expression levels in oral biofluids among the study groups. Salivary miRNAs, particularly miR-181a, displayed significant discriminatory ability in distinguishing periodontitis patients from healthy controls and between different stages of periodontitis severity, with high sensitivity and moderate to high specificity. In GCF samples, miR-181a and miR-181b exhibited robust discriminatory ability, while miR-181c showed moderate discriminatory ability. Conversely, miR-181d demonstrated lower discriminatory power in both saliva and GCF. Additionally, combination diagnosis using miR-181 family showed superior performance compared to individual miRNAs. Furthermore, enzyme-linked immunosorbent assay (ELISA) analysis of inflammatory biomarkers (TNF-α, IL-6, and IL-1β) in GCF revealed elevated levels in periodontitis patients compared to healthy controls, with a further increase observed in advanced periodontitis. Spearman correlation analysis demonstrated a significant negative correlation between miR-181 family expression in GCF and inflammatory biomarker levels, indicating their potential role in modulating periodontal inflammation. Overall, these findings suggest that miR-181 family members in oral biofluids, particularly saliva, hold promise as diagnostic biomarkers for periodontitis severity. Additionally, their negative correlation with inflammatory biomarkers highlights their potential as modulators of periodontal inflammation, providing valuable insights into the pathogenesis of periodontitis.

Potential Impact of Microbial Variations After Peri-Implantitis Treatment on Peri-Implant Clinical, Radiographic, and Crevicular Parameters: A Systematic Review

Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens' counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.

Clinical and Radiographic Parameters for Early Periodontitis Diagnosis: A Comparative Study

Background/Objective: Early periodontitis diagnosis is challenging due to varying staging and grading systems. While clinical parameters like bleeding on probing (BoP) and pocket depth (PD) are commonly used, periapical radiographs provide valuable information about bone loss and periodontal ligament changes. However, a clear definition of early periodontitis, particularly regarding alveolar bone crest changes, remains elusive. Methods: This cross-sectional study involved 21 participants aged 20-30 with clinical signs of periodontitis and radiographic evidence of alveolar bone changes and periodontal ligament widening. Four dentists assessed 40 cases for BoP, 40 for PD, and 40 for periapical radiographs. Results: Statistical analysis revealed that the pocket depth measurement was the most significant factor in diagnosing early periodontitis (Fisher's exact test, p-value = 0.000). Additionally, the irregularity of the alveolar crest proved to be a significant marker compared to periodontal ligament width (Fisher's exact test, p-value = 0.000). A Kendall Tau_b test (p-value = 0.000, r = 1.000) confirmed pocket depth to be the most influential parameter among the assessed factors. Conclusions: While this study highlights the importance of clinical and radiographic assessments in early periodontitis detection, integrating these findings into a definitive diagnosis can be complex. The standardization of diagnostic techniques and the development of advanced radiographic interpretation methods are crucial to improve accuracy. Further research is needed to refine diagnostic criteria and explore additional tests for early periodontitis detection.

Artificial Intelligence in Dentistry: A Descriptive Review

Artificial intelligence (AI) is an area of computer science that focuses on designing machines or systems that can perform operations that would typically need human intelligence. AI is a rapidly developing technology that has grabbed the interest of researchers from all across the globe in the healthcare industry. Advancements in machine learning and data analysis have revolutionized oral health diagnosis, treatment, and management, making it a transformative force in healthcare, particularly in dentistry. Particularly in dentistry, AI is becoming increasingly prevalent as it contributes to the diagnosis of oro-facial diseases, offers treatment modalities, and manages practice in the dental operatory. All dental disciplines, including oral medicine, operative dentistry, pediatric dentistry, periodontology, orthodontics, oral and maxillofacial surgery, prosthodontics, and forensic odontology, have adopted AI. The majority of AI applications in dentistry are for diagnoses based on radiographic or optical images, while other tasks are less applicable due to constraints such as data availability, uniformity, and computational power. Evidence-based dentistry is considered the gold standard for decision making by dental professionals, while AI machine learning models learn from human expertise. Dentistry AI and technology systems can provide numerous benefits, such as improved diagnosis accuracy and increased administrative task efficiency. Dental practices are already implementing various AI applications, such as imaging and diagnosis, treatment planning, robotics and automation, augmented and virtual reality, data analysis and predictive analytics, and administrative support. The dentistry field has extensively used artificial intelligence to assist less-skilled practitioners in reaching a more precise diagnosis. These AI models effectively recognize and classify patients with various oro-facial problems into different risk categories, both individually and on a group basis. The objective of this descriptive review is to review the most recent developments of AI in the field of dentistry.