Comparison of periodontitis patients' classification in the 2018 versus 1999 classification

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.

Implementation of the 2018 Classification of Periodontal Diseases: A Questionnaire-Based Survey

The new classification of periodontal and peri-implant diseases and conditions (2018) includes definitions of the respective diseases, modifications, and new additions to the 1999 classification. The purpose of the study was to present the opinion and level of understanding of Greek dentists regarding the new classification and to determine the approach for its establishment.A questionnaire consisting of 26 multiple-choice questions was distributed to Greek dentists in paper or digital form.Data were collected, recorded using Microsoft Excel, and were analyzed with SPSS 29.0 (IBM, United States).A total of 203 questionnaires were collected (49.3% male/50.2% female; mean age 39.02 years). 36.8% of the participants exclusively practiced periodontology and 44.8% general dentistry. Seventy-one participants were members of the Hellenic Society of Periodontology (HSP). 58.9% used the old classification system, which is reported as preferred by 53.5% of HSP members. Also, 53.3% of participants characterized the new classification as difficult to be applied, 47.1% of whom were HSP members. The most frequent reason for not using it (63/133) was the convenience of the older system application. A statistically significant higher percentage of HSP members correctly answered the comprehension questions (diagnostic criteria and clinical cases) of the questionnaire (z-test with Bonferroni correction < 0.05). Note that 79.7% of the participants stated that they should improve their knowledge regarding the new classification, mainly through seminars/courses.Most Greek dentists appear not to implement the 2018 classification system due to reported difficulty in understanding, while recognizing the need to comprehend and apply it to their clinical practice.

3D-Bioprinted Oil-Based Hydrogels: A Sustainable Approach for Bone and Dental Regeneration

Recent advancements in 3D bioprinting technology have transformed the development of complex tissue scaffolds, offering significant potential for applications in bone and dental regenerative medicine. Oil-based hydrogels have garnered considerable interest owing to their tunable mechanical properties, biocompatibility, and ability to facilitate cell adhesion, proliferation, and differentiation. This review provides an in-depth review of recent research regarding the utilization of oil-based hydrogels in bone and dental tissue development, focusing on the 3D bioprinting strategies. The review investigates the biological efficacy of the diverse oils used in hydrogel formulations, as well as their physicochemical properties, in promoting osteogenesis and dental tissue regeneration. Significant results from both in vitro and in vivo research are examined, emphasizing their capacity to sustain biological functions and promote tissue regeneration. Challenges such as hydrogel stability, printability, and cytotoxicity efficiency are thoroughly examined, along with strategies to improve these materials for translational and clinical applications. This study highlights the revolutionary potential of oil-based hydrogels in enhancing bone and dental regenerative medicine, providing insights into their current status, as well as future research and development pathways.

Meteorin-like levels of oral fluids in periodontal health and diseases: a comparative cross-sectional study

OBJECTIVES

Cytokines are critical role in the pathogenesis of periodontal diseases. Meteorin-like (Metrnl), a protein released in the oral mucosa, is a novel cytokine associated with various inflammatory diseases. This study aimed to evaluate levels of salivary and gingival crevicular fluid (GCF), interleukin - 1 beta (IL-1β), interleukin - 10 (IL-10), and Metrnl in periodontal disease.

MATERIALS AND METHODS

It was formed three groups of 20 individuals each: the healthy, gingivitis, and periodontitis (Stage III, Grades A and B) groups. The enzyme-linked immunosorbent assay method measured IL-1β, IL-10, and Metrnl levels in salivary and GCF samples. Clinical periodontal measurement including probing pocket depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI) and percentage of bleeding on probing (%BOP); and biochemical parameters were evaluated using statistical analysis.

RESULTS

Salivary concentrations and GCF total amount of IL-1β were significantly higher in the periodontal disease groups (p < 0.001). There was no significant difference among the groups in either salivary concentrations or GCF total amount of IL-10 (p > 0.05). Salivary Metrnl concentrations were significantly lower in the periodontitis group (p = 0.002). Salivary Metrnl concentrations had significant negative correlations with %BOP, PD, and CAL (p < 0.05). GCF total amount of Metrnl had significant negative correlations with GCF total amount of IL-1β (p = 0.03). The receiver operating characteristics curve showed: area under the curve (AUC) = 0.731 for salivary Metrnl concentrations to discriminate periodontitis from periodontal health and gingivitis.

CONCLUSION

Based on the findings of this study, Metrnl, as an immunoregulatory cytokine, may have an important relationship with periodontitis. Additional studies are needed to fully elucidate the functional effect of Metrnl in periodontal disease.

CLINICAL RELEVANCE

Background In knock-out experimental studies, it has been reported that Metrnl acts as an inflammation-related immunoregulatory cytokine. The findings relating it to inflammatory diseases support the idea that Metrnl may play a role in the pathogenesis of a variety of inflammatory diseases.

ADDED VALUE OF THIS STUDY

Although Metrnl is a protein abundantly secreted in the oral mucosa, to the authors' knowledge there has been no study evaluating it in gingivitis and periodontitis, inflammatory diseases. In this study, the levels of Metrnl in oral fluids, such as GCF and saliva, were examined in the presence of different periodontal diseases.

CLINICAL IMPLICATIONS

Metrnl can be useful in distinguishing periodontal destruction from periodontal health.

Clinical attachment loss may serve as a more precise, suitable, and pragmatic grading instrument for periodontitis: A clinical and radiographic validation study

Objective

The present study was aimed at assessing the sensitivity and accuracy of using clinical attachment loss (CAL) as a substitute tool for grading periodontitis, instead of the interdental bone loss (BL) percentage derived from two-dimensional radiographs.

Methods

One hundred patients diagnosed with periodontitis were included in the study. Periodontitis was graded according to the American Academy of Periodontology (AAP) 2017 classification. In the first part of this validation study, the BL percentage was calculated from periapical and panoramic radiographs and compared with cone beam computed tomography (CBCT). CAL was measured and divided by root length, and was subsequently used as a substitute for BL in periodontitis grading. The agreement and percentage agreement among CAL grading, periapical radiographs, panoramic radiographs, and CBCT grading were assessed.

Results

Both the periapical and panoramic radiographs showed a lack of agreement with CBCT grading, whereas CAL grading showed a moderately higher level of agreement (fair agreement) with CBCT grading.

Conclusion

The accuracy of two-dimensional imaging-based BL assessment for grading periodontitis appears questionable. In contrast, the ratio of CAL to root length might be a more accurate, user-friendly, and practical tool for grading periodontitis. However, further well-designed studies remain necessary to confirm the present results.

Alterations in subgingival microbiome and advanced glycation end-products levels in periodontitis with and without type 1 diabetes mellitus: a cross-sectional study

BACKGROUND

Existing studies predominantly focused on the relationship between periodontitis and type 2 diabetes mellitus (T2DM), with limited data on the association between periodontitis and type 1 diabetes mellitus (T1DM). This study aimed to examine the impact of T1DM and periodontitis on the subgingival microbiome and levels of advanced glycation end-products (AGEs).

METHODS

Samples were collected from four groups: T1DM, periodontitis (P), T1DM with periodontitis (DP), and periodontally and systemically healthy controls (Control). Subgingival microbiome composition and AGE levels were assessed using 16S rRNA gene sequencing and enzyme-linked immunosorbent assay (ELISA), respectively. Correlations between clinical indexes, microbiome composition, and AGEs were analyzed using Spearman correlation coefficient.

RESULTS

Alpha and beta diversity analyses revealed significant differences in bacterial diversity between the DP group and other groups. Linear discriminant analysis effect size (LEfSe) analysis identified specific bacteria influencing each group: Acinetobacter, Leptotrichia, Raoultibacter, and Veillonella in the Control group; Tannerella, Porphyromonas, Filifactor, and Treponema in the P group; and Lactobacillales in T1DM individuals. Prevotella and Selenomonas were notably influential in the DP group. PICRUSt2 analysis showed pathways alterations were concentrated in cell motility, translation, cell growth and death and metabolism in the DP and P groups. Spearman correlation analysis indicated a positive correlation between AGEs and periodontitis or diabetes-related parameters and AGEs were positively correlated with Haemophilus and Arachnia.

CONCLUSIONS

The findings suggested that the composition and function of the subgingival microbiome in the P group with or without T1DM were significantly different. Additionally, AGEs were involved in the development of periodontitis even in absence of hyperglycemia.

Structure, governance and delivery of specialist training programs in periodontology and implant dentistry

AIM

To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs).

METHODS

Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates.

RESULTS

Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment.

CONCLUSION

An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Exploring Epigenetic Mechanisms in Aggressive Periodontitis; Unraveling the Molecular Dynamics of Disease Progression: A Narrative Review

Aggressive periodontitis is an inflammation of the periodontal tissue that usually affects adolescents and young adults aged <30 years, caused by attachment loss and fast bone degradation. The correlation between the epigenetic status and the initiation and progression of numerous acquired diseases was documented. Consequently, targeting epigenetic factors within periodontal tissues stands as an appealing prospect for both the diagnosis and treatment of periodontitis. In addition to the role of pathogenic bacteria and their products, alterations in gene expression due to extrinsic and intrinsic factors can cause disturbances in the host's immune response. Epigenetic changes, whether DNA methylation or microRNA (miRNA) dysregulation, can cause changes in gene expression in aggressive periodontitis and lead to more severe and rapid loss of the periodontal tissues. This study aimed to elucidate the relationships between oral hygiene, pathogenic bacteria, and genetics in periodontitis development to promote targeted prevention and treatment for enhanced oral health in individuals at risk of aggressive periodontitis. The method employed in this study entailed a comprehensive review and analysis of scholarly literature on the relationship between epigenetic mechanisms and the development of aggressive periodontitis. In conclusion, epigenetic regulation plays an important role in the pathogenesis of periodontitis through DNA methylation mechanisms that begin with Toll-like receptors (TLRs), cytokine signaling pathways, promoter genes, and progress to pro-inflammatory cells. When periodontal tissue inflammation occurs, miRNA inhibits protein translation from messenger ribonucleic acid (mRNA), which contributes to its aggressiveness.

The Clinical Incorporation of the 2017 Classification of Periodontal Disease Conditions Part II: The Association Between Clinical Parameters and Gender

Background The implementation of the new classification system guided clinicians in the best way for disease diagnosis and patient management. The advent of definitions such as clinical gingival health additionally helped in distinguishing between intact and reduced periodontium. The purpose behind introducing new systems was to guide practitioners to improve on managing the requirements of the patients effectively. It also enables professionals to concentrate on clinical practice, and it can be suggested that readers who are concentrating on research make use of the global classification system. In this study, we present a diagnostic approach for periodontal diseases that supports the innovative classification system in relation to gender while remaining compatible with previous guidelines. Aim The present study focuses on the relationship between gender association and the clinical parameters in periodontitis patients that would support the new classification system. Materials and methods This was a retrospective, cross-sectional, observational study consisting of patient data obtained from past patient records who were diagnosed with periodontitis. Results The data analysis results showed that 95% of the population was similarly distributed across the genders in terms of frequency, and there was minimal statistically significant difference between the genders when compared to the clinical parameters. However, there was a statistically significant difference in the specific clinical characteristics, such as recession, which impacted 48.6% of male patients, and the presence of local factors, which affected 43.2% of female patients, in addition to the 59.4% localized involvement of periodontitis. All the data were analyzed using the SPSS software version 20 (IBM SPSS Statistics, Armonk, NY). The chi-square test was used to evaluate the descriptive analysis and frequency tables. Conclusion The addition of correlating clinical parameters with data based on gender had no effect on the new classification system. Meanwhile, it can be used as an adjunct to evaluate the distribution and extent of disease progression among genders.

Clinical Incorporation of the 2017 Classification of Periodontal Diseased Conditions: Part I (Diagnosis of Periodontitis Involving Data From 4,993 Patients)

Background The new classification system for periodontal and peri-implant diseases mentioned a few key points, including (1) "clinical gingival health," which was defined for the first time, and (2) staging and grading system. Thus, the present study defines the practicability of using the current classification system in day-to-day practice. Aim The primary aim of this study is to determine the effectiveness of the new classification system for periodontal and peri-implant diseases and its application in routine dental practices. Materials and methods This is a cross-sectional retrospective, non-interventional study consisting of 4,993 patients who were under active periodontal therapy as well as supportive periodontal therapy. Results Among patients diagnosed with dental biofilm-induced gingivitis with no underlying risk factors, 1105 (73.3%) exhibited bleeding on probing and 897 (45%) showed supragingival or subgingival calculus. Among the stage II grade B periodontitis group, 488 (28.9%) showed beginning destructive periodontal disease and 197 (50.4%) showed established destructive periodontal disease. Conclusion The implementation of the new classification system in routine dental practice has been readily accepted by clinicians. Staging and grading system of classification helps in assessing the severity, extent, and progression of disease.

Ease and practicability of the 2017 classification of periodontal diseases and conditions: a study of dental electronic health records

BACKGROUND

A new classification for Periodontal and Peri-implant Diseases and Conditions was introduced in the 2017 World Workshop. In the past the 1999 Armitage Classification was commonly used in practice. This study aimed to assess the ease and practicability of retroactively diagnosing a subset of patients formerly diagnosed using the 1999 AAP/CDC classification with the 2017 AAP/EFP disease classification.

METHODS

A random subset of 10% of all patients referred over a 7-year period (2011-2018) to the Post-Doctoral Periodontics Clinic at Columbia University College of Dental Medicine were reviewed by accessing the Electronic Health Records (EHRs) on axiUm. Patients diagnosed with periodontal disease based on the 1999 AAP/CDC classification (including chronic and aggressive Periodontitis) were reclassified using the 2017 classification (stage: I, II, III and grade: A, B, C).

RESULTS

A sample of 336 patient records were examined. 132 were diagnosed with gingivitis, and 204 with periodontitis. Of these 204 patients, 68 (33.3%) were diagnosed with aggressive and 136 (66.7%) with chronic periodontitis. Patients diagnosed with aggressive periodontitis, 10% were reclassified as stage II, 47% as stage III, and 43% as stage IV periodontitis, and 100% were reclassified as grade C. Among patients with chronic periodontitis, 7% were reclassified as stage I, 65% as stage II, 21% as stage III, and 7% as stage IV; 11% of these were reclassified as grade A, 63% grade B, and 26% grade C.

CONCLUSIONS

The majority of those originally diagnosed with aggressive (90%) and chronic (80%) periodontitis were reclassified as either molar/incisor pattern stage III grade C or stage IV grade C periodontitis, and stage II or III periodontitis, respectively. The study demonstrated that it is practical to retroactively reassign a diagnosis according to the new 2017 classification using available information included in dental EHRs.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user's perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty ("gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.

Long-term exposure to ambient fine particulate matter and periodontitis: An observational study using nationally representative survey data

AIM

The rising prevalence of periodontitis imposes substantial burdens on individuals and society. Identifying environmental risk factors for periodontitis may contribute to tackling the global public health burden of it. This study aimed to assess the association between long-term exposure to PM2.5 and periodontitis in a nationally representative population from China.

MATERIALS AND METHODS

In this multi-centre cross-sectional study of 372 communities in 31 provinces of Mainland China, we used data from the Fourth National Oral Health Survey of China in 2015-2016, in combination with high-resolution gridded concentrations of fine particulate matter (PM2.5). Logistic regression was applied to assess the relationship between long-term PM2.5 exposure and the risk of periodontitis. In addition, we examined whether the association varied by individual characteristics, and estimated the exposure-response relationship and the risk of damaged tooth in each tooth quadrant.

RESULTS

A total of 8391 participants from 96 cities were diagnosed with periodontitis, accounting for 60.04% (8391/13,459) of the participants. For each 10 μg/m3 increment in 1-, 3- and 5-year average concentrations of PM2.5, the risk of total periodontitis increased by 9.0% (95% confidence interval: 6.0%, 12.0%), 8.0% (6.0, 11·0) and 7.0% (5.0, 10.0), respectively. Mild periodontitis was more strongly associated with PM2.5 exposure than moderate and severe periodontitis. The teeth in the lower anterior, lower posterior or upper anterior are more susceptible to the effect of PM2.5 on the periodontal pocket, calculus and bleeding gums.

CONCLUSIONS

Long-term exposure to PM2.5 is significantly associated with an increased risk of periodontitis in the nationally representative Chinese population. Considering the rising prevalence of periodontitis, considerable costs of treatment, and substantially adverse effects on individuals and society, these findings suggest that stricter air quality regulations may help ease the burden of periodontal disease.

ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data

AIM

To propose a framework for consistently applying the 2018 periodontal status classification scheme to epidemiological surveys (Application of the 2018 periodontal status Classification to Epidemiological Survey data, ACES).

PROPOSED FRAMEWORK

We specified data requirements and workflows for either completed or planned epidemiological surveys, utilizing commonly collected measures of periodontal status (clinical attachment levels [CAL], probing depths, bleeding on probing), as well as additional necessary variables for the implementation of the 2018 periodontal status classification (tooth loss due to periodontitis and complexity factors). Following detailed instructions and flowcharts, survey participants are classified as having periodontal health, gingivitis or periodontitis. Rates of edentulism must also be reported. In cases of periodontitis, instructions on how to compute the stage and extent are provided. Assessment of grade can be derived from CAL measurements (or from radiographic alveolar bone loss data) in relation to root length and the participant's age.

CONCLUSIONS

ACES is a framework to be used in epidemiological studies of periodontal status that (i) have been completed, and in which stage and grade according to the 2018 classification are inferred retroactively, or (ii) are being planned. Consistent use of the proposed comprehensive approach will facilitate the comparability of periodontitis prevalence estimates across studies.

Comparison of deep learning methods for the radiographic detection of patients with different periodontitis stages

OBJECTIVES

The objective of this study is to assess the accuracy of computer-assisted periodontal classification bone loss staging using deep learning (DL) methods on panoramic radiographs and to compare the performance of various models and layers.

METHODS

Panoramic radiographs were diagnosed and classified into 3 groups, namely "healthy," "Stage1/2," and "Stage3/4," and stored in separate folders. The feature extraction stage involved transferring and retraining the feature extraction layers and weights from 3 models, namely ResNet50, DenseNet121, and InceptionV3, which were proposed for classifying the ImageNet dataset, to 3 DL models designed for classifying periodontal bone loss. The features obtained from global average pooling (GAP), global max pooling (GMP), or flatten layers (FL) of convolutional neural network (CNN) models were used as input to the 8 different machine learning (ML) models. In addition, the features obtained from the GAP, GMP, or FL of the DL models were reduced using the minimum redundancy maximum relevance (mRMR) method and then classified again with 8 ML models.

RESULTS

A total of 2533 panoramic radiographs, including 721 in the healthy group, 842 in the Stage1/2 group, and 970 in the Stage3/4 group, were included in the dataset. The average performance values of DenseNet121 + GAP-based and DenseNet121 + GAP + mRMR-based ML techniques on 10 subdatasets and ML models developed using 2 feature selection techniques outperformed CNN models.

CONCLUSIONS

The new DenseNet121 + GAP + mRMR-based support vector machine model developed in this study achieved higher performance in periodontal bone loss classification compared to other models in the literature by detecting effective features from raw images without the need for manual selection.

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis stage and grade: An exploratory sub-analysis of the ABPARO trial

AIM

Assessment of treatment response after systemic amoxicillin/metronidazole adjunctive to subgingival instrumentation (SI) according to stages and grades of the 2018 classification of periodontal diseases.

MATERIALS AND METHODS

We carried out exploratory re-analysis of the placebo-controlled, multi-centre ABPARO trial (52; 45/60 years of age; 205 males, 114 active smokers). Patients were randomized to SI with systemic amoxicillin 500 mg/metronidazole 400 mg (three times a day for 7 days, n = 205; ANTI) or placebo (n = 200; PLAC) and maintenance therapy every 3 months. Patients were reclassified according to the 2018 classification (stage/extent/grade). Treatment effect was the percentage of sites per patient with new attachment loss ≥1.3 mm (PSAL ≥ 1.3 mm) at 27.5 months post-baseline/randomization.

RESULTS

All patients were assigned according to the stage (n = 49 localized stage III, n = 206 generalized stage III, n = 150 stage IV). Because of missing radiographs, only 222 patients were assigned to grades (n = 73 B, n = 149 C). Treatment (PLAC/ANTI) resulted in PSAL ≥ 1.3 mm (median; lower/upper quartile) in localized stage III (PLAC: 5.7; 3.3/8.4% vs. ANTI: 4.9; 3.0/8.3%; p = .749), generalized stage III (8.0; 4.5/14.3% vs. 4.7; 2.4/9.0%; p < .001), stage IV (8.5; 5.1/14.4% vs. 5.7; 3.3/10.6%; p = .008), grade B (4.4; 2.4/6.7% vs. 3.6; 1.9/4.7%; p = .151) and grade C (9.4; 5.3/14.3% vs. 4.8; 2.5/9.4%; p < .001).

CONCLUSIONS

In generalized periodontitis stage III/grade C, a clinically relevant lower percentage of disease progression after adjunctive systemic amoxicillin/metronidazole was observed compared to placebo (PLAC: 9.7; 5.8/14.3% vs. ANTI: 4.7; 2.4/9.0%; p < .001).

Association of severely damaged endodontically infected tooth with carotid plaque and abnormal carotid intima-media thickness: a retrospective analysis

OBJECTIVE

We investigated the association of severely damaged endodontically infected tooth with carotid artery plaque and abnormal mean carotid intima-media thickness (CIMT) ≥ 1.0 mm.

METHODS

A retrospective analysis of 1502 control participants and 1552 participants with severely damaged endodontically infected tooth who received routine medical and dental checkup in Health Management Center, Xiangya Hospital was performed. Carotid plaque and CIMT were measured with B-mode tomographic ultrasound. Data were analyzed using logistic and linear regression.

RESULTS

Severely damaged endodontically infected tooth group had a significantly higher prevalence of carotid plaque (41.62%) compared to 32.22% of carotid plaque in control group. Participants with severely damaged endodontically infected tooth had a significantly higher prevalence of abnormal CIMT (16.17%) and a significantly increased level of CIMT (0.79 ± 0.16 mm) in comparison to 10.79% of abnormal CIMT and 0.77 ± 0.14 mm CIMT in control participants. Severely damaged endodontically infected tooth was significantly related with formation of carotid plaque [1.37(1.18-1.60), P < 0.001], top quartile length [1.21(1.02-1.44), P = 0.029] and top quartile thickness [1.27(1.08-1.51), P = 0.005] of carotid plaque and abnormal CIMT [1.47(1.18-1.83), P < 0.001]. Severely damaged endodontically infected tooth was significantly associated with both single [1.277(1.056-1.546), P = 0.012] and multiple carotid plaques [1.488(1.214-1.825), P < 0.001] and instable carotid plaques [1.380(1.167-1.632), P < 0.001]. Presence of severely damaged endodontically infected tooth increased 0.588 mm of carotid plaque length (P = 0.001), 0.157 mm of carotid plaque thickness (P < 0.001) and 0.015 mm of CIMT (P = 0.005).

CONCLUSION

Severely damaged endodontically infected tooth was associated with carotid plaque and abnormal CIMT.

CLINICAL RELEVANCE

Early treatment of endodontically infected tooth is warranted.

Polysaccharide-protein microparticles based-scaffolds to recover soft tissue loss in mild periodontitis

Periodontal regeneration is extremely limited and unpredictable due to structural complications, as it requires the simultaneous restoration of different tissues, including cementum, gingiva, bone, and periodontal ligament. In this work, spray-dried microparticles based on green materials (polysaccharides - gums - and a protein - silk fibroin) are proposed to be implanted in the periodontal pocket as 3D scaffolds during non-surgical treatments, to prevent the progression of periodontal disease and to promote the healing in mild periodontitis. Arabic or xanthan gum have been associated to silk fibroin, extracted from Bombyx mori cocoons, and loaded with lysozyme due to its antibacterial properties. The microparticles were prepared by spray-drying and cross-linked by water vapor annealing, inducing the amorphous to semi-crystalline transition of the protein component. The microparticles were characterized in terms of their chemico-physical features (SEM, size distribution, structural characterization - FTIR and SAXS, hydration and degradation properties) and preclinical properties (lysozyme release, antibacterial properties, mucoadhesion, in vitro cells adhesion and proliferation and in vivo safety on a murine incisional wound model). The encouraging preclinical results highlighted that these three-dimensional (3D) microparticles could provide a biocompatible platform able to prevent periodontitis progression and to promote the healing of soft tissues in mild periodontitis.

Association of GSTTI, M1 and Polymorphism in GSTPI with Chronic Periodontal Disease in a Pakistani Population

OBJECTIVE

Chronic periodontal disease (CP) is a multifactorial infectious and inflammatory disease that occurs due to the challenge between the immune response of the host and specific periodontal bacteria, and that can lead to tooth loss due to damage inflicted to the supporting tissue. The current study investigates the genotypes of the GSTM1 and GSTT1 genes, along with the allelic frequency of the single nucleotide polymorphism [SNP; rs1695] in the GSTP1 gene and correlates them individually or in various combinations with the incidence of CP.

METHODS

A total of 203 clinically confirmed CP patients and 201 control subjects were enrolled from Multan and Dera Ghazi Khan Districts in Pakistan from April to July 2022. Multiplex Polymerase Chain Reaction (PCR) and tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) approaches were applied to determine the genotypes of the studied GSTs. The association of rs1695 in GSTP1 with CP was studied both individually and in various combinations with GSTM1 and T1.

RESULTS

The absence of GSTM1, the presence of GSTT1 and the presence of the mutant allele (G) at rs1695 in GSTP1 were found to be significantly associated with CP. Patients aged between 10 and 30 years were more affected by CP.

CONCLUSION

Our results indicate that the genotypes of the analyzed GSTs affect the levels of protection from oxidative stress and may therefore influence the disease progression in CP.

Aggregatibacter actinomycetemcomitans and Filifactor alocis as Associated with Periodontal Attachment Loss in a Cohort of Ghanaian Adolescents

The aims of the present study were to document the presence of Aggregatibacter actinomyctemcomitans and the emerging oral pathogen Filifactor alocis, as well as to identify genotypes of these bacterial species with enhanced virulence. In addition, these data were analyzed in relation to periodontal pocket depth (PPD) and the progression of PPD from the sampled periodontal sites during a two-year period. Subgingival plaque samples were collected from 172 periodontal pockets of 68 Ghanaian adolescents. PPD at sampling varied from 3-14 mm and the progression from baseline, i.e., two years earlier up to 8 mm. The levels of A. actinomycetemcomitans and F. alocis were determined with quantitative PCR. The highly leukotoxic JP2-genotype of A. actinomycetemcomitans and the ftxA a gene of F. alocis, encoding a putative Repeats-in-Toxin (RTX) protein, were detected with conventional PCR. The prevalence of A. actinomycetemcomitans was 57%, and 14% of the samples contained the JP2 genotype. F. alocis was detected in 92% of the samples and the ftxA gene in 52%. The levels of these bacterial species were significantly associated with enhanced PPD and progression, with a more pronounced impact in sites positive for the JP2 genotype or the ftxA gene. Taken together, the results indicate that the presence of both A. actinomycetemcomitans and F. alocis with their RTX proteins are linked to increased PPD and progression of disease.

Periodontal maintenance: individual patient responses and discontinuations

Aim

There is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting.

Methods

A sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation.

Results

For both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints.

Conclusion

Considering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT.

Trial registration: The clinical trial was retrospectively registered in the DRKS—German Clinical Trials Register (https://www.drks.de) with registration DRKS00030092 (26/08/2022).

Evaluation of periodontitis-related tooth loss according to the new 2018 classification of periodontitis

The new 2018 classification of periodontal diseases is reported to be related to tooth loss due to periodontal disease (TLPD) during supportive periodontal therapy (SPT). However, few reports have evaluated this relationship for Asians or have analyzed the association of the new classification and TLPD by distinguishing between active periodontal therapy (APT) and SPT. In this study, we retrospectively applied the new classification to 607 Japanese periodontitis patients and examined the relationship between the new classification and annual TLPD rates per patient during the respective periods. TLPD rates were higher in patients in stage IV and/or grade C during both APT and SPT. TLPD during SPT was not associated with the presence or absence of TLPD during APT. Multivariate analysis revealed that stage IV and grade C as independent variables were significantly associated with the number of instances of TLPD not only during the total treatment period, but also during APT or SPT. Our results suggest that the new classification has a significantly strong association with TLPD during both APT and SPT, and that patients diagnosed with stage IV and/or grade C periodontitis had a higher risk of TLPD during both periods.

Intra- and inter-examiner reliability in classifying periodontitis according to the 2018 classification of periodontal diseases

Aim

To evaluate the inter‐examiner reliability in classifying periodontitis using the 2018 classification of periodontal diseases, when used by postgraduate students, academics, and specialist clinicians trained in European Federation of Periodontology (EFP) and American Academy of Periodontology (AAP) postgraduate‐accredited programmes.

Materials and Methods

An online survey including five patients with periodontitis was sent twice to seven specialists in periodontology to provide the staging and grading characteristics. After agreeing on a “gold‐standard” classification, the same questionnaire was sent to 16 EFP and 73 AAP postgraduate programmes, to be answered by their faculty, graduates, and students. The responses were compared with the gold‐standard classification, and the inter‐examiner agreement was calculated.

Results

One‐hundred and seventy‐four participants completed the survey. The inter‐examiner agreement resulted in 68.7% in assigning the stage, 82.4% in assigning the grade, and 75.5% in assigning the extent. The academic position and the experience of the participants did not have any significant influence on classifying periodontitis as the gold standard.

Conclusions

The use of the 2018 periodontitis classification resulted in high inter‐examiner reliability when used by a specialist group of clinicians, postgraduate students, and academicians, irrespective of their current position and experience. Given the low response rate and potential selection bias, results pertaining to the use of this system in classifying periodontitis should be interpreted with caution.

Oral Health Status in Patients with Head and Neck Cancer before Radiotherapy: Baseline Description of an Observational Prospective Study

(1) Background: The general hypothesis that HNC patients show compromised oral health (OH) is generally accepted, but it is not evidence-based. The objective of this baseline report of a prospective observational study was to describe the oral health of a cohort of patients with HNC at the time of dental evaluation prior to radiotherapy (RT). (2) Materials and Methods: Two hundred and thirteen patients affected by HNC who had received an indication for RT were examined with the support of orthopantomography (OPT). The DMFt of all included subjects, their periodontal status and the grade of mouth opening were recorded. (3) Results: A total of 195 patients were ultimately included: 146/195 patients (74.9%) showed poor OH (defined as having a DMFt score ≥ 13 and severe periodontitis). The following clinical characteristics were correlated with poor oral health in the univariate analysis: tumor site, smoking habit and age of the patients (in decades); χ2 test, p < 0.05. (4) Conclusions: This study confirms that the OH of HNC patients is often compromised even before the beginning of cancer treatment and, consequently, highlights how important it is to promptly schedule a dental evaluation at the moment of diagnosis of the cancer.

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Diagnostic value of microbiome biomarkers of the periodonite microbiome in patients with the association of chronic periodontitis and diabetes mellitus type 2

The place of high-tech methods of molecular biology in clinical laboratory diagnostics of various diseases and the development of a system of biomarkers as an important component of diagnostic research is currently attracting the closest attention of the scientific community. In this paper, an attempt is made to use high-tech metagenomic analysis to solve problems that arise due to the high frequency of association of periodontal diseases with systemic pathology, in particular, with type 2 diabetes mellitus. The aim of the study was to determine the taxonomic and metabolic features of the microbiome of periodontal tissues in periodontal diseases associated with type 2 diabetes mellitus, as a model of the ratio of local and systemic effects of periodontal pathogenic bacteria. The study included 16S shotgun sequencing of bacterial DNA as part of biological material from periodontal pockets/dentoalveolar furrows of 46 people - 15 patients with chronic periodontitis associated with type 2 diabetes mellitus, 15 patients with chronic periodontitis unrelated to systemic pathology, as well as 16 healthy people in the control group, followed by bioinformatic processing of the data obtained. The obtained data allowed us to establish the taxonomic features of the periodontal microbiome in the association of chronic periodontitis with type 2 diabetes mellitus, which included the predominance of representatives of the families Prevotellaceae and Spirochaetaceae in its composition. The features of metabolic processes in periodontal tissues with the participation of the microbiome were also revealed, which consisted in an increase in the exchange of cysteine and methionine against the background of a decrease in the metabolism of pyrimidine, methane, sphingolipids, and the synthesis of fatty acids, which are of diagnostic value in assessing the condition of patients with type 2 diabetes mellitus.

Role of Inhibitor SMADs in Stage 3 Grade B periodontitis before and after periodontal treatment

OBJECTIVE

This study aimed to examine the levels of transforming growth factor-beta (TGF-β) and inhibitory-Smads (I-Smads) in saliva and gingival crevicular fluid (GCF) in patients with Stage 3 Grade B periodontitis before and after non-surgical periodontal treatment.

BACKGROUND

Recently, it has been stated that Smads play an active role in all conditions where TGF-β is involved, including periodontal inflammation.

METHODS

Twenty healthy participants (control) and 20 patients with Stage 3, Grade B periodontitis were recruited. GCF and saliva samples and clinical periodontal recordings were investigated at the baseline and 1 month after treatment. TGF-β and I-Smads (Smads 6 and 7) were determined by ELISA.

RESULTS

Salivary Smad6 and Smad7 levels were significantly lower in the periodontitis group than healthy controls (p < .05), while there was no difference in salivary TGF-β levels between groups at baseline (p > .05). The total amounts and concentrations of GCF TGF-β, Smad6, and Smad7 were significantly lower in the periodontitis group than healthy controls at baseline (p < .05), and then decreased in concentration levels with treatment (p < .001). Positive correlations were found between total amounts and concentrations of GCF TGF-β, Smad6, and Smad7 (p < .05).

CONCLUSION

Our findings revealed that Smad6 and Smad7 in GCF and saliva decreased in periodontitis and then increased after periodontal treatment. Our study suggests that I-Smads act in parallel with TGF-β in periodontal inflammation and may have a role in the development of periodontitis.

Periodontal breakdown inter-tooth relationships in estimating periodontitis-related tooth loss

OBJECTIVES

The reasons for tooth extraction are rarely recorded in epidemiological datasets. It poses a diagnostic challenge to determine if tooth loss is related to periodontal disease (TLPD). The present study aimed to assess the inter-tooth relationships based on the periodontal characteristics of existing teeth.

METHODS

A cross-sectional dataset of 8,978 participants with complete periodontal examination (including probing pocket depth [PPD] and clinical attachment loss [CAL]) in the NHANES 2009-2014 was used in this study. Spearman rank correlation was applied to assess the inter-tooth correlations of PPD/CAL among 28 teeth after adjustment for relevant confounders. We further verify our findings in the Java Project on Periodontal Disease with TLPD information available (the number of TLPD = 12).

RESULTS

Strong PPD/CAL correlations were observed in adjacent teeth (r for PPD = 0.652, r for CAL = 0.597; false discovery rate [FDR] <0.05) rather than those on non-adjacent teeth (r for PPD = 0.515, r for CAL = 0.476; FDR <0.05). The correlations increased among severe periodontitis cases (CAL ≥5 mm or PPD ≥6 mm). In line with this, we further observed that the teeth adjacent to the TLPD tooth had the most alveolar bone loss in the Java dataset.

CONCLUSION

The periodontitis parameters (PPD/CAL) of adjacent teeth could be a potential indicator to estimate TLPD when actual reasons for tooth extraction are unknown.

CLINICAL SIGNIFICANCE

Periodontally compromised teeth adjacent to a lost tooth may help estimate whether the loss could be related to periodontal disease when the actual extraction reasons are unknown.

The 2018 classification of periodontal diseases. Its predictive value for tooth loss

BACKGROUND

Predictive models and assessment tools for disease susceptibility and progression are necessary to enhance personalized medicine. The aim of this study is to assess the predictive accuracy of using the 2018 classification to predict likelihood of tooth loss.

MATERIAL AND METHODS

134 patients were screened 10 years after periodontal therapy. Data were extracted from 82 patients' records and periodontal diagnoses were assigned according to the 1999 and 2018 classifications at baseline, whereas patient- and tooth-related parameters were documented at baseline and at reexamination. Statistical analysis included descriptive statistics, hurdle regression with a zero and count model as well as logistic regression.

RESULTS

Significantly more teeth were lost during SPT in patients with Stage IV or Grade C (p<0.05). Patients' adherence seems to have an impact on the predictability of the 2018 classification (p<0.001). In comparison, neither classification system alone (1999 vs. 2018) showed a high predictive value for tooth loss (Area under the curve (AUC) = 59.2% vs. 58.2%).

CONCLUSION

Class III and IV/grade C of the 2018 classification of periodontal diseases show similar predictive accuracy for tooth loss as severe cases in the former classification. Patients adherence seems to influence the prognostic value of the classification. This article is protected by copyright. All rights reserved.

New classification of periodontal diseases (NCPD): an application in a sub-Saharan country

Purpose

To determine the clinical and radiological profile of periodontitis according to the 2018 NCPD, in a Dakar (Senegal) based periodontal clinic.

Methods

This is a descriptive study based on patient’s records in the periodontology clinic. The study was conducted between November 2018 and February 2020 (15 months). All periodontitis cases were included in the study. Incomplete records (due to lack of radiographic workup or unusable periodontal charting) were excluded. Periodontitis diagnosis was established based on criteria used in the 2018 NCPD. Statistical analysis was carried out using SPSS version 20.0, with the significance threshold set at 0.05.

Results

A total number of 517 patient records were collected during the study period but only 127 periodontitis records were complete. The mean age of participants was 46.8 ± 13.8 years and 63.8% of participants were males. The mean plaque index and bleeding on probing (BOP) were 74% ± 21.3 and 58.1% ± 25.1, respectively. The mean maximum clinical attachment loss was 8.7 mm ±2.7, with a probing depth greater than 6 mm present in 50.4% of the sample. The median number of missing teeth was 3 (interquartile range 5–1). Pathological mobility was present in 60.6% of the patients and 78.0% had occlusion problems. Bone crest defect at the most affected site was moderate in 52.8% of cases. The ratio of bone loss to age greater than one concerned 66.1% of the sample. Generalised (81.9%), Stage IV (70.1%) and grade C (69.3%) were the most encountered diagnosis. The disease severity was associated with age (r = 0.241; P < 0.001), BOP (r = 0.230; P = 0.013) and the number of teeth with pathological mobility (r = 0.318; P < 0.001).

Conclusion

Patients with periodontitis in this study had advanced forms of the disease and required multidisciplinary care. Clinical hindsight is necessary to improve this classification.

Drift of the Subgingival Periodontal Microbiome during Chronic Periodontitis in Type 2 Diabetes Mellitus Patients

Since periodontitis and type 2 diabetes mellitus are complex diseases, a thorough understanding of their pathogenesis requires knowing the relationship of these pathologies with other disorders and environmental factors. In this study, the representability of the subgingival periodontal microbiome of 46 subjects was studied by 16S rRNA gene sequencing and shotgun sequencing of pooled samples. We examined 15 patients with chronic periodontitis (CP), 15 patients with chronic periodontitis associated with type 2 diabetes mellitus (CPT2DM), and 16 healthy subjects (Control). The severity of generalized chronic periodontitis in both periodontitis groups of patients (CP and CPT2DM) was moderate (stage II). The male to female ratios were approximately equal in each group (22 males and 24 females); the average age of the subjects was 53.9 ± 7.3 and 54.3 ± 7.2 years, respectively. The presence of overweight patients (Body Mass Index (BMI) 30–34.9 kg/m²) and patients with class 1–2 obesity (BMI 35–45.9 kg/m²) was significantly higher in the CPT2DM group than in patients having only chronic periodontitis or in the Control group. However, there was no statistically significant difference in all clinical indices between the CP and CPT2DM groups. An analysis of the metagenomic data revealed that the alpha diversity in the CPT2DM group was increased compared to that in the CP and Control groups. The microbiome biomarkers associated with experimental groups were evaluated. In both groups of patients with periodontitis, the relative abundance of Porphyromonadaceae was increased compared to that in the Control group. The CPT2DM group was characterized by a lower relative abundance of Streptococcaceae/Pasteurellaceae and a higher abundance of Leptotrichiaceae compared to those in the CP and Control groups. Furthermore, the CP and CPT2DM groups differed in terms of the relative abundance of Veillonellaceae (which was decreased in the CPT2DM group compared to CP) and Neisseriaceae (which was increased in the CPT2DM group compared to CP). In addition, differences in bacterial content were identified by a combination of shotgun sequencing of pooled samples and genome-resolved metagenomics. The results indicate that there are subgingival microbiome-specific features in patients with chronic periodontitis associated with type 2 diabetes mellitus.

The 2018 EFP/AAP periodontitis case classification demonstrates high agreement with the 2012 CDC/AAP criteria

AIM

To investigate the agreement between the 2018 EFP/AAP periodontitis case classification and the 2012 CDC/AAP criteria.

MATERIALS AND METHODS

This cross-sectional study assessed a population-based sample from a rural area in southern Brazil. A complete periodontal examination was performed at six sites/tooth. The periodontitis case definition was estimated and compared according to the 2018 EFP/AAP classification and the 2012 CDC/AAP criteria (reference). Diagnostic tests included sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC).

RESULTS

Five hundred and eighty-eight subjects with ≥6 teeth each were included. Based on the 2018 EFP/AAP classification, 71.1% of the subjects were classified as stage III/IV showing 100% agreement with 2012 CDC/AAP criteria for the severe category. For the moderate and severe classification, the 2018 EFP/AAP SN was 99.8% and 100%, SP 13.6% and 43.6%, PPV 83.4% and 47.4%, and NPV 93.7% and 100%, respectively. The AUC was 0.9059 (95% CI = 0.879-0.933) and the optimal cut-off based on the curve was stage III.

CONCLUSIONS

The 2018 EFP/AAP periodontitis case classification showed high agreement with the 2012 CDC/AAP criteria in a rural sample with high periodontitis occurrence.

A questionnaire-based crossover study on the association of microbiological testing with prescription of systemic antibiotics following initial periodontal therapy

AIM

(1) To assess prescription of systemic antibiotics following initial periodontal therapy with and without the availability of microbiological information; (2) To identify factors associated with prescription of systemic antibiotics following initial periodontal therapy.

MATERIALS AND METHODS

Twenty-four clinicians were invited to complete a questionnaire on 20 patient records with respect to periodontal treatment planning, once with microbiological information available and once without. Randomization determined when the microbiological information was provided, and a 3-month washout period was respected between scoring sessions. Regression analysis was performed to identify factors associated with prescription of systemic antibiotics.

RESULTS

Twenty-one clinicians completed both scoring sessions. Clinicians prescribed systemic antibiotics in on average 56% (95% Confidence Interval (CI) [0.51; 0.61]) of the cases having microbiological information, and in 52% (95% CI [0.47; 0.57]) of the same cases not having that information (p = 0.094). The odds for prescribing systemic antibiotics were 3.34 (95% CI [2.06; 5.42]) times higher when the clinician had at least 3 years of experience, 2.55 (95% CI [1.40; 4.66]) times higher for patients diagnosed with periodontitis stage IV when compared to stage III, 1.08 (95% CI [1.04; 1.11]) times higher for younger patients, 2.78 times (95% CI [1.37; 5.56]) times higher for non-smokers and 2.22 (95% CI [1.27; 3.85]) times higher when less than three teeth would require extraction. No significant associations with the prescription of systemic antibiotics were found for detection of A.actinomycetemcomitans (p = 0.287), grade of periodontitis (p = 0.499) and gender of the patient (p = 0.067).

CONCLUSIONS

Based on a limited number of cases and clinicians, several patient and clinician related factors were associated with prescription of systemic antibiotics following initial periodontal therapy. However, microbiological testing was not.

Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification

BACKGROUND

This cross-sectional study evaluated the utility of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classifications of epidemiological studies in terms of periodontitis severity, prevalence and associated risk factors and the 2012 American Academy of Periodontology/Centers for Disease Control and Prevention (AAP/CDC) case definitions.

METHODS

We included 488 participants aged 35-74 years. Measurements were recorded at six sites per tooth by two qualified examiners. The evaluated parameters included pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP). Periodontitis prevalence and severity were reported using the 2018 EFP/AAP classification and the AAP/CDC case definitions. The data were stratified by recognized risk factors (age, diabetes and smoking status).

RESULTS

The 2018 EFP/AAP classification indicated that all patients suffered from periodontitis. When CAL served as the main criterion, the frequency of patients with severe (Stages III-IV) periodontitis was 54%. When the AAP/CDC case definitions were applied, the prevalence of periodontitis was 61.9% and that of severe periodontitis 16.8%. Age was the most significant risk factor, regardless of the chosen case definition.

CONCLUSION

It is essential to employ a globalized standard case definition when monitoring periodontitis and associated risk factors.

The influence of the interaction between staging, grading and extent on tooth loss due to periodontitis

AIM

To assess the ability of two-way interactions between baseline stage, grade and extent to predict tooth loss due to periodontitis (TLP) over a long-term follow-up period.

MATERIALS AND METHODS

Patients treated for periodontal disease with a complete medical history, baseline periodontal chart, full mouth radiographs and a minimum of ≥10 years follow-up were recruited. Supportive periodontal therapy (SPT) visits were recorded during the entire follow-up period. Patients were categorized according to their stage, grade and extent. The absolute survival at 10-, 20-, and 30-year follow-up was calculated for TLP. Kaplan-Meier survival curves were plotted at the tooth-level and multilevel Cox regression frailty models were constructed in order to assess the association among predictive variables and TLP by taking into account the hierarchical patient-teeth structure.

RESULTS

442 patients (11,125 teeth) with a mean follow-up of 23 years met the inclusion criteria and were included in this study. The most prevalent diagnosis at baseline was stage III grade B (30.3%), followed by stage II grade B (23.5%). Among the parameters analysed, stage and grade were found to be the best predictors of TLP. Statistically significant differences were observed for extent only in patients with severe disease (stage IV or grade C). The multilevel Cox regression analysis demonstrated that patients with higher concomitant baseline staging and grading developed greater TLP over the follow-up period.

CONCLUSIONS

Higher concomitant staging and grading corresponded to greater risk for TLP and generalized extent only became a significant predictor in patients with stage IV or grade C disease.

Are there correlations between radiographic grade levels and modified grade levels of periodontitis?

BACKGROUND

At the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, periodontitis was reclassified according to a multidimensional staging and grading system. Grading takes variabilities in the rate of disease progression into account, relying on recognized progression risk factors, and is based on the assessment of bone loss at the worst-affected tooth in the dentition as a function of age, which is then modified by factors such as smoking and diabetes mellitus. In this context, the aim of this study was to determine whether there are correlations between radiographically calculated grades and grades modified by the presence of smoking or diabetes.

MATERIALS AND METHODS

In this descriptive study, individuals diagnosed with periodontitis according to the 2017 classifications were examined. The grade of periodontitis was measured using periapical radiography. A modified-grade level was assigned to the patients according to their glycated hemoglobin levels (in diabetics) or their smoking status.

RESULTS

The study included 341 individuals. No statistically significant relationship was revealed by Chi-square testing (P > 0.05) or in the kappa agreement index between the modified grades and the radiographic grades.

CONCLUSIONS

Although there was no correlation between radiographic grade and modified grade in smokers and diabetic individuals, increasing the grade score in these individuals in accordance with the 2017 classification provides clinicians the opportunity to develop a risk-based treatment plan, commensurate with the severity of periodontal disease and the level of risk.

Natural progression of periodontal diseases in Chinese villagers based on the 2018 classification

BACKGROUND

Based on the 2018 classification, we aimed to determine the prevalence, distribution, and progression of periodontitis in the rural Chinese population without access to dental care.

METHODS

In all, 404 subjects (28.7 ± 8.9 years, M:F = 182:222) were randomly enrolled in 1992 and re-called in 1996. With the new classification, the prevalence and distribution of stage, grade, and extent were characterized. Stage progression was compared with the progression of clinical attachment loss (CAL) and radiographic bone loss (RBL).

RESULTS

At baseline, 94.1% villagers suffered from periodontitis, of whom 53.7% were in stage III/IV. The prevalence of stage III/IV increased from 18.2% in the age group of 15 to 24 years to 60.9% in 25 to 34-year-old group and 88.7% in the 35 to 44-year-old group. Significantly more stage III/IV, generalized, and grade C periodontitis were found in male villagers than female villagers. In 1996, the prevalence rate of periodontitis increased to 98.5%, with 80.0% in stage III/IV. Further, 84.2% villagers presented with grade C periodontitis based on longitudinal ΔCAL. The rate of progression (≥1 site with ΔCAL ≥3 mm) was 63.7%. Stage progression correlated significantly with CAL and RBL progression in stage I/II, but this association was not found in stage III/IV. Among subjects with disease progression in stage III/IV, 90.4% shifted from localized to generalized cases. Furthermore, ceiling effects were observed in stage III/IV.

CONCLUSIONS

In villagers without access to dental care, 94.1% suffered from periodontitis, with more than half having stage III/IV disease based on the 2018 classification. The majority cases presented with rapid periodontal progression. Although stage progression correlated significantly with CAL and RBL progression in stage I/II, ceiling effects existed in stage III/IV.

The prevalence and severity of periodontal disease in Mainland China: Data from the Fourth National Oral Health Survey (2015-2016)

AIM

To evaluate periodontal conditions in adults in mainland China based on data from the 4th National Oral Health Survey.

MATERIALS AND METHODS

Data of adult subjects (35- to 44-year-old group [N = 4409], 55- to 64-year-old group [N = 4622], and 65- to 74-year-old group [N = 4428]) were analysed. Demographic, socio-economic, personal habit, dental history, and health attitude data were obtained using a questionnaire. Periodontal condition was assessed using the standardized case definitions of the 2018 classification scheme. A multivariate analysis was performed to investigate the relationship between periodontitis severity and age, smoking status, gender, and region using generalized additive models after adjusting for confounders.

RESULTS

The frequency of subjects with periodontitis was 52.8%, 69.3%, and 64.6% in the three age groups, respectively. The frequency of subjects with severe periodontitis (stage III or IV) was 10.6%, 37.3%, and 43.5% in the three age groups, respectively. The severity of periodontal disease was positively associated with age. Current and former smokers exhibited significantly greater disease severity than non-smokers after adjustment for confounders. No significant difference of severity was found between males and females.

CONCLUSION

Within the limitations of the study, the prevalence of periodontitis is very high among adults in mainland China. Periodontal status is associated with age and smoking status.

Curcumin promotes osteogenic differentiation of human periodontal ligament stem cells by inducting EGR1 expression

OBJECTIVE

Human periodontal ligament stem cells (hPDLSCs) attract attention for the periodontal regeneration therapy. Curcumin may promote osteogenic differentiation of hPDLSCs. This research aims to elucidate whether Curcumin displays promoting osteogenic differentiation and its mechanism.

METHODS

The hPDLSCs were isolated from human periodontal ligament by immunomagnetic beads, identified with immumofluorescence. hPDLSCs were treated with 0, 5, 10, 20, 50, 100 μmol/L Curcumin. The early growth response gene 1 (EGR1) siRNA or plasmind were tranfected into the hPDLSCs. The viability, Alkaline Phosphatase (ALP) activity and mineralizaiton level of hPDLSCs were measured with 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) assay, ALP Assay Kit or Alizarin Red staining. The expression of EGR1, RUNX family transcription factor 2 (Runx2), bone gamma-carboxyglutamate protein (OC), secreted phosphoprotein 1 (OPN) and collagen type I alpha 1 chain (Collagen I), in hPDLSC were determined by Western blotting and quantitative reverse transcription-polymerase chain reaction.

RESULTS

The isolated hPDLSCs were spindle or irregular, arranged in radial shape and shown positive expression of STRO-1, CD146 and Vimentin. Curcumin 10 μmol/L treatment maximal promoting the cells viability, ALP activities, mineralization, and levels of Runx2, OC, OPN, Collagen I and EGR-1 in hPDLSCs. EGR-1 siRNA transfection inversed Curcumin's promoting effect on ALP activities, mineralization, and levels of Runx2, OC, OPN, Collagen I and EGR-1 in hPDLSCs. While the EGR-1 plasmid transfection enhanced Curcumin's promoting effect on these parameters of hPDLSCs.

CONCLUSION

Curcumin promotes the osteogenic differentiation of hPDLSCs, which may work through the EGR1. Curcumin may be a promising medicine for periodontitis treatment and periodontal regeneration.

Antimicrobial resistance of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia in periodontitis patients

OBJECTIVES

Administration of systemic antimicrobials as an adjunct to mechanical treatment of periodontitis and sites with adverse clinical results leads to improved outcomes. This study aimed to assess the antimicrobial susceptibility of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia isolated from periodontitis patients to amoxicillin, metronidazole, azithromycin and moxifloxacin.

METHODS

A total of 76 patients diagnosed with generalised periodontitis were included in the study. Subgingival samples were processed by culture. Etest was used to determine susceptibility to amoxicillin, metronidazole, azithromycin and moxifloxacin.

RESULTS

A total of 141 isolates from 76 patients were evaluated, including 61 P. gingivalis, 43 T. forsythia and 37 A. actinomycetemcomitans. Etest results showed complete susceptibility of A. actinomycetemcomitans, P. gingivalis and T. forsythia to moxifloxacin. However, the isolates presented reduced susceptibility to the other antimicrobial agents investigated. Of the A. actinomycetemcomitans isolates, 70.3%, 40.5% and 89.2% were resistant to amoxicillin, azithromycin and metronidazole, respectively. The P. gingivalis samples showed relatively similar rates of resistance to amoxicillin (24.6%), azithromycin (21.3%) and metronidazole (24.6%). Similarly, 25.6%, 21.0% and 25.6% of the T. forsythia isolates were resistant to amoxicillin, azithromycin, and metronidazole, respectively.

CONCLUSION

These findings show that moxifloxacin may be a promising antimicrobial agent against P. gingivalis, T. forsythia and A. actinomycetemcomitans for the treatment of periodontitis. However, amoxicillin, azithromycin and metronidazole were less effective, especially against A. actinomycetemcomitans in vitro.

Th2 cell regulatory and effector molecules single nucleotide polymorphisms and periodontitis

To investigate the association between T helper 2 (Th2) cell regulatory and effector molecules' genetic polymorphisms and periodontitis. Single nucleotide polymorphisms (SNPs) of 11 Th2 cell regulatory or effector molecules genes (CD28, CTLA4, IL4, IL5, IL6, IL9, IL10, IL13, IL4R, GATA3, STAT6, and rs1537415; total 130 SNPs) were studied in Chinese nonsmokers (163 periodontitis-free controls, 141 periodontitis patients) using Sequenom iPlex assays. SNPs potentially associated with periodontitis (adjusted allelic P < 0.1) in this cross-sectional study were further investigated via meta-analysis. Allele G of rs4553808 in promoter of CTLA4 was more frequently detected in periodontitis than controls (P < 0.005), but did not remain significant after age and gender adjustment. Haplotype (GTT) in a block of three CTLA4 SNPs (rs4553808, rs16840252, rs5742909) was significantly associated with periodontitis. Meta-analysis of SNPs identified indicated allele T of CTLA4 rs5742909 (3 studies; 461 control, 369 periodontitis) and allele G of IL6 rs1800796 (18 studies; 2760 control, 2442 periodontitis) were significantly associated with periodontitis (OR = 1.44 and OR = 1.30, respectively). Within limitations of this study, a haplotype of CTLA4 concerning Th2 cell regulation, may be associated with periodontitis in Chinese nonsmokers followed. Meta-analysis indicated rs5742909 of CTLA4 and rs1800796 of IL6 appeared significantly associated with periodontitis.

Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis

To explore the vitamin D levels of periodontitis patients in comparison with periodontally healthy ones, and to assess the influence of vitamin D supplementation as an adjunctive during nonsurgical periodontal treatment (NSPT). Five databases (Pubmed, Embase, Scholar, Web of Sciences, and Cochrane Library) were searched until May 2020. Mean difference (MD) meta-analysis with corresponding 95% confidence interval (95% CI) and sensitivity tests via meta-regression were used. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Sixteen articles were included, fourteen case-control and two intervention studies, all reporting 25-hydroxyvitamin D (25(OH)D) levels. Compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in chronic periodontitis patients (pooled MD = -6.80, 95% CI: -10.59 to -3.02). Subgroup analysis revealed differences among 25(OH)D measurements, with liquid chromatography-mass spectrometry being the most homogeneous method (pooled MD = -2.05, 95% CI: -3.40 to -0.71). Salivary levels of 25(OH)D showed no differences between groups. Due to the low number of studies, conclusions on aggressive periodontitis and in the effect of vitamin D supplementation after NSPT were not possible to ascribe. Compared with healthy controls, 25(OH)D serum levels are significantly lower in chronic periodontitis patients, with an overall SORT A recommendation. Future studies are needed to clarify the effect of vitamin D supplementation and the biological mechanisms linking vitamin D to the periodontium.

Comparisons of Periodontal Status between Females Referenced for Fertility Treatment and Fertile Counterparts: A Pilot Case-Control Study

Studies investigating the periodontal status of women seeking fertility treatment have never been conducted. The purpose of this pilot study was to compare the periodontal status among females referenced to a Fertility Clinic (FC) when compared to matched females from a representative regional epidemiological sample. Our secondary aims were to investigate if periodontal clinical measures differ between these two groups of females and how they impact on oral health-related quality of life (OHRQoL). We enrolled 18 women from an FC and 18 age, race and body mass index matched controls from the epidemiological survey Study of Periodontal Health in Almada-Seixal (SoPHiAS). In each subject, we performed a circumferential periodontal inspection to infer the periodontal status and applied a questionnaire measuring OHRQoL. FC females presented higher levels of periodontal disease, with higher periodontal epithelial surface area, periodontal probing depth and clinical attachment loss. However, periodontal diseases did not impact OHRQoL in this particular group of women seeking fertility care, suggesting unawareness about periodontal diseases. Within the limitations of this study, females referenced for fertility treatment presented worse periodontal measures than females from a representative control sample. These preliminary results may support future prospective studies to further explore the periodontal status and possible consequences in women seeking fertility care.

Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination

In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.

Long-term periodontitis treatment costs according to the 2018 classification of periodontal diseases

OBJECTIVES

To assess if long-term treatment costs in periodontitis patients differ between stage III vs. IV and grade B vs. C according to the 2018 classification of periodontal diseases.

METHODS

A cohort of 231 periodontitis patients (followed over a mean of 18.4 years) was evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections) and supportive periodontal therapy (SPT, including also restorative, endodontic, prosthetic and surgical treatment) were estimated from a mixed payer-perspective in Germany (in Euro 2020). Multi-dimensional staging and grading was applied. The impact of stage, grade, sex and age on total and annual costs was assessed.

RESULTS

Mean (SD) total and annual treatment costs were 7154 (2554) Euro and 437 (222) Euro. Costs were generated during SPT (92 %) and by periodontal treatment (88 %) and decreased significantly with longer follow-up (p < 0.001). Total costs were 7120 (2692) Euro in stage III (n = 154) vs. 7221 (2271) Euro in stage IV (n = 77; p > 0.05), and 6256 (1605) Euro in grade B (n = 35) vs. 7314 (2660) Euro in grade C (n = 196; p < 0.001). Annual costs were 426 (219) Euro vs. 459 (228) Euro for stage III vs. stage IV (p > 0.05) and 308 (163) Euro vs. 460 (224) Euro for grade B vs. grade C (p < 0.001). Multivariable modelling found grade, but not stage, sex and age significantly associated with costs.

CONCLUSIONS

Within the limitations of this study, and in patients with severe periodontitis who were systematically treated long-term, grading, but not staging was associated with costs.

CLINICAL SIGNIFICANCE

Treatment costs were higher in patients with more progressive periodontitis and were found to decrease during follow-up. Dentists need to consider costs during treatment planning and communication with patients.

Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis

Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.