Development of gestational diabetes mellitus in women with periodontitis in early pregnancy: A population-based clinical study

Gingipain from Porphyromonas gingivalis causes insulin resistance by degrading insulin receptors through direct proteolytic effects

Periodontitis is a critical risk factor for the occurrence and development of diabetes. Porphyromonas gingivalis may participate in insulin resistance (IR) caused by periodontal inflammation, but the functional role and specific mechanisms of P. gingivalis in IR remain unclear. In the present study, clinical samples were analysed to determine the statistical correlation between P. gingivalis and IR occurrence. Through culturing of hepatocytes, myocytes, and adipocytes, and feeding mice P. gingivalis orally, the functional correlation between P. gingivalis and IR occurrence was further studied both in vitro and in vivo. Clinical data suggested that the amount of P. gingivalis isolated was correlated with the Homeostatic Model Assessment for IR score. In vitro studies suggested that coculture with P. gingivalis decreased glucose uptake and insulin receptor (INSR) protein expression in hepatocytes, myocytes, and adipocytes. Mice fed P. gingivalis tended to undergo IR. P. gingivalis was detectable in the liver, skeletal muscle, and adipose tissue of experimental mice. The distribution sites of gingipain coincided with the downregulation of INSR. Gingipain proteolysed the functional insulin-binding region of INSR. Coculture with P. gingivalis significantly decreased the INSR-insulin binding ability. Knocking out gingipain from P. gingivalis alleviated the negative effects of P. gingivalis on IR in vivo. Taken together, these findings indicate that distantly migrated P. gingivalis may directly proteolytically degrade INSR through gingipain, thereby leading to IR. The results provide a new strategy for preventing diabetes by targeting periodontal pathogens and provide new ideas for exploring novel mechanisms by which periodontal inflammation affects the systemic metabolic state.

Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study

PURPOSE

Pregnancy is a period in a woman's life that has important consequences on oral health, particularly for gingival health. Present study aims to identify women at higher risk of developing periodontal disease (gingivitis and periodontitis) during late pregnancy and evaluate how this condition evolves during this period.

METHODS

Prospective cohort study was designed with pregnant women who were assessed during the first and third trimesters of gestation in a southern Spanish public hospital. Data regarding gingival and periodontal health, oral hygiene, and overall health status (obesity and diabetes mellitus) were collected. Reporting followed STROBE checklist.

RESULTS

Significantly higher number of women had the periodontal and gingival disease in the third trimester of gestation compared with in early pregnancy. In the third trimester of gestation, 42 (28.6%) and 63 (42.9%) of women presented symptoms of periodontal disease and gingival disease, respectively. Obesity (OR 2.834; 95%CI 0.919-8.741), worse oral hygiene during the first trimester of gestation (OR: 4.031; 95%CI 2.12-7.65), and periodontal disease during early pregnancy (OR: 15.104; 95%CI 3.60-63.36) most effectively predicted periodontal disease during late pregnancy.

CONCLUSIONS

Pregnancy is associated with exacerbated periodontal and gingival disease symptoms throughout the different trimesters of gestation. Obesity and oral hygiene during early pregnancy were the risk factors that most contributed to the aforementioned changes in periodontal disease.

Associations of periodontitis with risk of all-cause and cause-specific mortality among us adults with chronic kidney disease

OBJECTIVES

To investigate the associations of periodontitis with risk of all-cause and cause-specific mortality in a nationally representative sample of adults with chronic kidney disease (CKD) in the United States.

METHODS

This prospective cohort study included 4,271 individuals aged ≥30 years at baseline with CKD participants in the National Health and Nutrition Examination Survey (NHANES) during 1988-1994, 1999-2004, and 2009-2014. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 and/or urinary albumin/creatinine ratio (uACR) ≥30 mg/g. Multivariate cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of all-cause and cause-specific mortality in participants with CKD according to periodontitis. The associations of the quartiles of mean clinical attachment loss (CAL) and mean periodontal probing depth (PPD) levels with mortality were examined using the first quartile as the reference group.

RESULTS

During a median of 8.67 years of follow-up, 2,146 deaths were documented. After multivariate adjustments, moderate/severe periodontitis was significantly associated with all-cause (HR:1.28; 95 % CI:1.11-1.47; P = 0.001) and cardiovascular disease (CVD)-related mortality (HR:1.44; 95 % CI:1.14-1.81; P = 0.002) in participants with CKD. Compared with the reference group of mean CAL and mean PPD levels, all-cause (CAL: HR, 1.58; 95 % CI, 1.32-1.89, P <0.001; PPD: HR, 1.35, 95 % CI, 1.09-1.67, P = 0.011) and CVD-related mortality (CAL: HR, 1.70, 95 % CI, 1.21-2.40, P = 0.001) were increased for participants in the highest quartile.

CONCLUSIONS

This study suggests that moderate/severe periodontitis and high levels of mean CAL and mean PPD are associated with an increased risk of all-cause mortality, and moderate/severe periodontitis and mean CAL associated with CVD-related mortality among adults with CKD in the US.

CLINICAL SIGNIFICANCE

This study details the association between periodontitis and the increased risk of all-cause mortality and CVD-related mortality in a large, representative sample of adults with CKD.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

Effect of polycaprolactone nanofibers loaded with oxytetracycline hydrochloride and zinc oxide as an adjunct to SRP on GCF lipocalin-2 levels in periodontitis patients: A clinical and laboratory study

Background. The aim of this study was the clinical and laboratory evaluation of using polycaprolactone (PCL) nanofibers loaded with oxytetracycline hydrochloride (OTC) and zinc oxide (ZnO) as an adjunct to mechanical therapy in managing stage II grade A periodontitis patients concerning GCF lipocalin2- levels. Methods. Fifty stage II grade A periodontitis patients (27 women and 23 men, with an age range of 30‒60) were enrolled in the study. The patients were randomly assigned to five equal groups and treated with scaling and root planing (SRP), followed by local application of PCL nanofibers: group I: SRP + PCL loaded with OTC and ZnO, group II: SRP + PCL loaded with OTC, group III: SRP + PCL loaded with ZnO, group IV: SRP + unloaded PCL, and group V: SRP alone. Additionally, 10 healthy subjects with healthy periodontium (group VI) (age- and gender-matched) served as the negative control. Nanofibers were applied in the selected pockets of periodontitis patients in groups I to IV once weekly for two months. All the participants were examined clinically by assessing periodontal indices (gingival index, plaque index, pocket depth, and clinical attachment level), and biochemically by assessing GCF lipocalin-2 levels. Results. Compared to controls, periodontitis groups (I, II, III, IV, and V) showed significant elevation of both clinical parameters and GCF lipocalin2- levels at baseline. In addition, these parameters improved significantly after treatment, which was more pronounced in groups I, II-, and III) compared to groups IV and V. However, it did not reach normal values. Conclusion. In association with SRP, PCL nanofibers loaded with OTC and ZnO had beneficial therapeutic effects at both clinical and laboratory levels.

Application of Gestational Blood Glucose Control During Perinatal Period in Parturients with Diabetes Mellitus: Meta-Analysis of Controlled Clinical Studies

Background

Gestational diabetes mellitus (GDM) is a common metabolic disorder. Hyperglycemia may cause gestational hypertension, increase the probability of infection, abnormal embryonic development, and increase the abortion rate. Oral hypoglycemic drugs may be another effective means of blood glucose control in addition to insulin injection. We included controlled clinical studies for meta-analysis to understand the effect of oral hypoglycemic drugs in gestational diabetes.

Methods

The databases were searched with the keywords “Glycemic control” & “gestational diabetes”: Embase (January, 2000–August, 2021), Pubmed (January, 2000–August, 2021), Web of Science (January, 2000–August, 2021), Ovid (January, 2000–August, 2021), and ClinicalTrials.org to obtain the randomized controlled trial (RCT) literatures related to the treatment of gestational diabetes with oral hypoglycemic drugs, after screening, the R language toolkit was used for the analysis.

Results

A total of 10 articles with a total of 1,938 patients were included, 7 studies used metformin as an hypoglycemic agent. Meta-analysis showed that oral metformin had no significant difference in fasting blood glucose levels after the intervention compared with insulin injection [MD = −0.35, 95%CI(−0.70,1.40), Z = 0.66, P = 0.51], with no significant difference in postprandial blood glucose levels after intervention [MD = −2.20, 95%CI(−5.94,1.55), Z = −1.15, P = 0.25], and no statistical difference in glycosylated hemoglobin [MD = 0.10, 95%CI(−0.17,−0.04), Z = −0.94, P = 0.31]. Metformin was more conducive to reducing maternal weight during pregnancy than insulin [MD = −1.55, 95%CI(−2.77,−0.34), Z = −2.5, P = 0.0123], metformin reduced the abortion rate compared with insulin [RR = 0.81, 95%CI(0.63,1.05), Z = −2.61, P = 0.015], and reduced cesarean section rate [RR = 0.66, 95%CI(0.49,0.90), Z = −3.95, P = 0.0001].

Discussion

The application of oral hypoglycemic drug metformin in blood glucose control of gestational diabetes can play a hypoglycemic effect equivalent to insulin and can control the weight of pregnant women, reduce the rate of abortion and cesarean section, and improve pregnancy outcomes.