Bacteraemia of oral origin in children-A Systematic review and network meta-analysis

Mapping Review of the Correlations Between Periodontitis, Dental Caries, and Endocarditis

Background/Objectives: The correlation between cardiovascular diseases, particularly infective endocarditis, and oral disorders such as periodontitis and dental caries has been widely discussed in the scientific literature. In this mapping review, we aim to examine the available evidence on the link between these conditions, focusing on the pathogenetic mechanisms that underlie the development of endocarditis in patients with oral diseases. Methods: A systematic search was conducted across three major databases-PubMed, Scopus, and ScienceDirect-as well as grey literature in Google Scholar. Relevant articles were selected based on inclusion and exclusion criteria, focusing primarily on systematic reviews. The data extracted included study characteristics, main outcomes, and risk-of-bias evaluations. Results: A total of 13 systematic reviews were included in this mapping review. The findings suggest there is a significant connection between periodontal disease, dental caries, and the incidence of infective endocarditis. The evidence highlights that oral bacteria, particularly Streptococcus species, can enter the bloodstream during daily activities and invasive dental procedures, contributing to the development of endocarditis in susceptible individuals. However, the role of antibiotic prophylaxis in preventing endocarditis following dental procedures remains controversial. Conclusions: This review reinforces the importance of oral health in preventing cardiovascular complications, especially infective endocarditis. Although antibiotic prophylaxis may reduce the risk in high-risk individuals, further research is needed to clarify its effectiveness. Enhanced awareness of and education on the shared risks between oral and cardiovascular health could improve prevention strategies and patient outcomes.

Gingivitis Control in Children, Adolescents and Young Adults With Chronic Kidney Disease by a Need-Related Programme: A Randomised Clinical Trial

OBJECTIVES

Children and young patients with chronic kidney disease (CKD) are at persistent risk of gingivitis despite usual preventive measures. This clinical study aimed to determine the efficacy of an intensive oral preventive programme (OPP) for young patients with CKD in treating plaque-induced gingivitis modified by systemic factors.

METHODS

Young patients with CKD (N = 30) were recruited/randomised to a need-related OPP (n = 15) or treatment as usual (TAU) including mainly motivation and instructions (controls, n = 15) followed by a single intensive prophylactic appointment after 3 months. For the OPP group, depending on the baseline degree of inflammation (PBI) professional mechanical plaque removal, local chlorhexidine gel application and mouth rinse were applied at need-related appointments focussing on local plaque control and reduction in inflammation.

RESULTS

After 3 months OPP, lower plaque indices were found (2.62-0.66, p < 0.05) in contrast to TAU (2.32-2.05, p > 0.05) with differences between study groups (p < 0.05). Regarding gingivitis, lower PBI values than baseline were observed in OPP (1.03-0.05, p < 0.05) than TAU (1.15-1.00; p > 0.05); OPP reductions (effect size) were higher than after a single intensive appointment (1.00-0.36; p < 0.05). Degree of immunosuppressive therapy did not differ between groups throughout the study.

CONCLUSIONS

Young patients with CKD suffer from generalised gingivitis with increased bleeding sites. This moderate degree of inflammation shows a normal distribution of high and low plaque responders, with no pattern of impact for the degree of immunosuppression. Effectiveness and duration of preventive measures follow a dose-response principle. Therefore, need-related preventive measures should be implemented and maintained in future regular care for CKD patients.

TRIAL REGISTRATION

German Clinical Trials Register, registration number: DRKS00010580.

Critical Analysis of Reporting Quality of Network Meta-Analyses in Periodontology and Implantology

The increasing recognition of network meta-analyses (NMAs) in dentistry, particularly in periodontology and implantology, lacks assessed reporting quality. To address this, our study will undertake a systematic review of previously reported NMAs. Researchers conducted an electronic search in Web of Science and Scopus to identify NMAs across all dentistry journals. Two independent investigators selected studies, extracted data, and assessed reporting quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for NMA (PRISMA-NMA) checklist with 32 items. Each "yes" response earned 1 point, and "no" responses received 0 points, yielding an overall reporting quality score. In total, 39 NMAs were included in this study. The NMAs were published between 2010 and October 2024, with most of them published in 2022 (25%). Most of the NMAs employed the PRISMA-NMA guidelines (47%) and have been published in the Journal of Clinical Periodontology (53%). The overall reporting quality of the included NMAs ranged between 87.5 and 100% (i.e., high quality of reporting [≥ 75th %]), with 5 NMAs reporting all 27 items of the PRISMA-NMA statement. The limitations, presentation of network structure (results), funding, and objectives (methods) were reported in 97, 94, 81, and 78% of the NMAs, respectively. The least reported items were the protocol registration and the summary of network geometry, which were reported in 53% of the NMAs. All the remaining items were reported in all 39 NMAs. The reporting quality of the NMAs published related to periodontology and implantology was high. However, some deficiencies were revealed associated with the reporting quality of the PRISMA-NMA items, including protocol registration, formulation of the research question based on the PICO (Population, Intervention, Comparison, Outcome) format, and summarization of the network geometry.

Chronic Kidney Disease With Related Oral Health Problems and Alterations in the Tongue Microbiome Illustrated by a 15-Year-Old Girl: A Case Report

Chronic kidney disease (CKD) is characterised by a gradual loss of kidney function over time and is often linked to oral health issues. This case illustrates typical conditions in young CKD patients based on a 15-year-old girl with CKD stage 4 and methylmalonic aciduria, severe gingivitis and hyperplasia of the gingiva, and a need for orthodontic treatment. Oral hygiene interventions, homecare instructions and deep cleaning under antibiotic shielding were necessary to improve the patient's oral health. The immediate worsening of oral health status after extending the interval between regular prophylaxis appointments highlights the need for intensive prevention in young CKD patients to control oral health disorders. This report aims to demonstrate burden-of-care-reducing oral prophylaxis options for patients suffering from severe CKD with oral manifestations. Trial Registration: German Registry of Clinical Trials: DRKS00010580.

The tongue microbiome of young patients with chronic kidney disease and their healthy mothers

OBJECTIVES

Oral microbiome plays a crucial role in the incidence and development of oral diseases. An altered intestinal microbiome has been reported in adults with chronic kidney disease (CKD). This study aimed to characterize the tongue microbiome of young patients with CKD compared to their healthy mothers to identify the influence of CKD-associated factors on resilient tongue ecosystem.

MATERIAL AND METHODS

Thirty patients with CKD (mean age, 14.2 years; 16 males and 14 females) and generalized gingivitis were included in the study. Swabs of the posterior tongue were collected from the patients and 21 mothers (mean age 40.8 years). Next-generation sequencing of 16S rDNA genes was employed to quantitatively characterize microbial communities.

RESULTS

The bacterial communities were similar in terms of richness and diversity between patients and mothers (p > 0.05). In patients with CKD, 5 core phyla, 20 core genera, and 12 core species were identified.

CONCLUSIONS

The tongue microbiome of the study participants showed no relevant CKD-associated differences compared to their mothers and appears to be a highly preserved niche in the oral cavity. Differences observed in the abundance of individual species in this study could be attributed to the age rather than CKD, even after a mean disease duration of 11 years.

CLINICAL RELEVANCE

CKD and its associated metabolic changes appear to have no detectable impact on the resilient tongue microbiome observed in young patients.

Dentist's visits and risk of brain abscess: a nationwide, population-based case control study

BACKGROUND

Brain abscesses are frequently caused by oral cavity bacteria, but whether dental status and invasive dental procedures are important risk factors is unknown.

METHODS

A nationwide, population-based, case-control study examined the association between dentist's visits and invasive dental procedures and risk of brain abscess caused by oral cavity bacteria from 1989-2016. Date of brain abscess diagnosis was considered the index date. Using risk-set sampling, 10 population controls per case were individually matched by age, sex, and residential area. Conditional logistic regression was used to compute odds ratios (OR) with 95% confidence intervals (CIs), adjusted for comorbidity (aOR).

RESULTS

We identified 362 patients with culture-proven brain abscess caused by oral cavity bacteria. The median age was 53 years (IQR 39 - 65) and 220/362 (61%) were male. Invasive dental procedures within six months before the index date was observed in 21/362 (6%) brain abscess patients and 179/3257 (5%) population controls yielding an aOR of 1.07 (95% CI 0.67-1.70). A total of 213/362 (59%) brain abscess patients had visited their dentist within one year before the index date compared with 1944/3257 (60%) of population controls corresponding to an aOR of 0.99 (95% CI 0.77-1.26). Using no dentist's visits as reference, we observed aOR's of 0.95 (95% CI 0.64-1.40) for 1-2 visits within three years of the index date and 1.01 (95% CI 0.76-1.35) for 3 or more visits.

CONCLUSIONS

Recent invasive dental procedures and number of dentist's visits were not associated with culture verified brain abscess caused by oral cavity bacteria.