Inflammatory and immune pathways in the pathogenesis of periodontal disease

Advances of functional nanomaterials as either therapeutic agents or delivery systems in the treatment of periodontitis

Periodontitis is a common chronic inflammatory disease primarily caused by pathogenic microorganisms in the oral cavity. Without appropriate treatments, it may lead to the gradual destruction of the supporting tissues of the teeth. While current treatments can alleviate symptoms, they still have limitations, particularly in eliminating pathogenic bacteria, promoting periodontal tissue regeneration, and avoiding antibiotic resistance. In recent years, functional nanomaterials have shown great potential in the treatment of periodontitis due to their unique physicochemical and biological properties. This review summarizes various functionalization strategies of nanomaterials and explores their potential applications in periodontitis treatment, including metal-based nanoparticles, carbon nanomaterials, polymeric nanoparticles, and exosomes. The mechanisms and advances in antibacterial effects, immune regulation, reactive oxygen species (ROS) scavenging, and bone tissue regeneration are discussed in detail. In addition, the challenges and future directions of applying nanomaterials in periodontitis therapy are also discussed.

Advancement in smart bone implants: the latest multifunctional strategies and synergistic mechanisms for tissue repair and regeneration

Artificial implants have consistently been recognized as the most effective clinical strategy for repairing bone fractures and defects, particularly in orthopedics and stomatology. Nowadays, the focus of bone repair has shifted from basic fixation and structural restoration to the reconstruction of multifunctional "live" tissue to mimic the natural bone microenvironment. However, developing the smart implants with ideal osteogenesis-related multi-functions remains challenging, as the effects of physicochemical properties of implant materials on intracellular signaling, stem cell niches, and tissue regeneration are not yet fully understood. Herein, we systematically explore recent advancements in innovative strategies for bone repair and regeneration, revealing the significance of the smart implants that closely mimic the natural structure and function of bone tissue. Adaptation to patient-oriented osteogenic microenvironments, dynamic osteoblastogenesis-osteoclastogenesis balance, antibacterial/bactericidal capacity, vascularization, and osteoimmunomodulatory capacity and their regulatory mechanisms achieved by biomaterials design and functional modifications are thoroughly summarized and analyzed. Notably, the popular research on multifunctional platforms with synergetic interactions between different functions and treatment of complex clinical issues, including the emerging neurogenic bone repair, is also significantly discussed for developing more intelligent implants. By summarizing recent research efforts, this review proposes the latest multifunctional strategies and synergistic mechanisms of smart bone implants, aiming to provide better bone defect repair applications that more closely mimic the natural bone tissue.

Patient-related factors that link chronic kidney disease and periodontitis: a scoping review

Several studies have proposed the existence of an association between periodontitis and chronic kidney disease (CKD) based on biological premises. There is growing evidence that chronic inflammation caused by periodontitis may contribute to the progression of CKD. The present study aimed to investigate studies that link CKD and periodontitis, including periodontitis proxies such as oral hygiene and tooth loss, and patient-related factors such as inflammatory response and genetic polymorphisms. An electronic search was conducted on the MEDLINE (Pubmed), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science databases using an advanced search option up until August 2024. Thirty-two studies were included: 4 interventional, 16 cohort, and 12 case-control. Overall, the prevalence of periodontitis was significantly higher in patients with CKD: the diagnosis of periodontal disease was associated with an increase in the risk of incident CKD, and parameters of periodontal disease were negatively correlated with kidney function. Inside the field of periodontal medicine, the current evidence indicates a possible association between CKD and periodontitis and supports future longitudinal studies to investigate the two-way relationship between the diseases and their pathophysiology, and possibly to establish cause and effect.

Triggering mouth-resident antiviral CD8+ T cells potentiates experimental periodontitis

Emerging evidence indicates that gingival-resident helper CD4+ T cells are major drivers of periodontal inflammation in response to commensal and pathogenic oral microorganisms. Whether tissue-resident memory CD8+ T cells (TRM), which principally safeguard against viruses and cancer but also drive certain autoimmune and inflammatory conditions, impact periodontitis progression and severity remain unknown. We asked whether local reactivation of oral CD8+ TRM of a defined antigen specificity could exacerbate ligature-induced periodontitis (LIP), a well-established model of periodontal disease in mice. Topical application of virus-mimicking peptides to the oral mucosa concurrent with LIP 1) intensified alveolar bone loss, 2) amplified gingival and cervical lymph node inflammation, and 3) stimulated gingival transcriptional changes in genes related to innate immune sensing and cell-mediated cytotoxicity. Therapeutic depletion of CD103-expressing oral CD8+ TRM in advance of LIP prevented exacerbation of disease. These observations provide evidence that oral CD103+ CD8+ TRM have the potential to participate in gingival inflammation, alveolar bone loss, and periodontitis.

Identification of Periodontal Disease Diagnostic Markers Via Data Cross-Validation

INTRODUCTION AND AIMS

Periodontitis is a globally prevalent disease that is clinically diagnosed when the periodontal tissues are pathologically affected. Therefore, it is vital to identify novel periodontitis-associated biomarkers that will aid in diagnosing or treating potential patients with periodontitis.

METHODS

The GSE16134 and GSE10334 datasets were downloaded from the Gene Expression Omnibus database to identify differentially expressed genes between periodontitis and healthy samples. Single-sample gene set enrichment analysis was performed to identify significantly involved signalling pathways. Weighted gene correlation network analysis was used to identify key molecular modules. Hub genes were screened using key genes to construct a diagnosis and prediction model of periodontitis. Microenvironment cell population-counter was used to analyse immune cell infiltration patterns in periodontal diseases.

RESULTS

Single-sample gene set enrichment analysis revealed that periodontitis involves the PI3K/AKT/mTOR signalling pathway and associated module genes (667 genes). Kyoto Encyclopedia of Genes and Genomes enrichment analysis of the module genes revealed that periodontitis involves the type I interferon, rhythmic process, and response to type I interferon signalling pathways. GSEA identified 21 core genes associated with periodontitis and classified them into two clusters, A and B. Genomics of Drug Sensitivity in Cancer analysis revealed that AKT.inhibitor.VIII had high drug sensitivity in the cluster A subtype. Monocytes and myeloid dendritic cell infiltration were enriched in the cluster A subtype, whereas natural killer T cell infiltration was enriched in the cluster B subtype.

CONCLUSION

The pathway and gene modules identified in this study may help comprehensively diagnose periodontitis and provide a novel method for evaluating new treatments.

CLINICAL RELEVANCE

Our results are beneficial for classifying periodontitis subtypes and treatment using targeted medicine.

Exosomes derived let-7f-5p is a potential biomarker of SLE with anti-inflammatory function

This study found that in patients with SLE (n = 5), lethal (let)-7f-5p expression was significantly downregulated in peripheral blood mononuclear cells. Further, high-throughput RNA sequencing was used to mine the differential transcriptome expression in renal tissue exosomes of systemic lupus erythematosus (SLE)-prone mice, and bioinformatics was utilized to analyze non-coding RNAs and coding RNAs in exosomes for their possible roles in SLE. In renal tissues of MRL/lpr SLE-prone mice with exosomes and Pristane-induced SLE mice, we also demonstrated aberrant expression levels of microRNA (miRNA) let-7f-5p. Meanwhile, in the macrophage inflammation model, the expression levels of let-7f-5p were downregulated, that of guanylate binding protein (Gbp2 and Gbp7) were upregulated, and the inflammatory state of macrophages was alleviated following transfection with the let-7f-5p mimic. Co-culturing mesenchymal stem cells with a macrophage model of inflammation resulted in increased let-7f-5p expression and downregulated inflammatory factors, Gbp2 and Gbp7 expression in macrophages. Dual luciferase reporter gene assays confirmed that let-7f-5p directly binds to the 3' UTR of Gbp7 to regulate its expression. Let-7f-5p regulation of the Gbp family is involved in SLE pathogenesis and is a biomarker associated with the inflammatory response with potential clinical applications.

A drop-like optical fiber salivary pH sensor: A rapid and real-time detection of periodontal disease

A real-time and rapid detection of salivary pH for periodontal diagnosis is an emerging point-of-care (POC) technology trend. The precise and non-invasive sensitive POC devices, which could be used as chair-side tools to improve clinical dental inspections, are essential for an excellent periodontal diagnosis. In this paper, we report on developing a POC technology based on optical fiber sensors as a promising marker, to the best of our knowledge, to detect the role of salivary pH in periodontitis diagnosis and support dentists' inspection. The optical fiber sensor based on a drop-like structure was fabricated by bending single-mode fiber (SMF) into a section of a thin capillary tube. In this work, firstly, the performance of the proposed sensor towards different pH levels ranging from 1 to 7 was experimentally investigated. Experimentations showed that the pH sensor responded to various pH levels with a calibration curve sensitivity of -2.075 nm/pH and a high linearity of 0.985. Then, 66 patients were enrolled in this study and divided into two groups according to clinical outcomes: Group A with clinically healthy periodontium and Group B with chronic periodontitis. The real saliva from each patient was collected, and the salivary pH was evaluated immediately using the aforementioned proposed sensor. The experimental results show that Group A and Group B salivary pH mapping ranged from 6.5 to 7.3 and 5.5 to 6.4, respectively. The proposed sensor offers substantial practical benefits, providing a rapid response time of less than 2 s, instantaneous, noninvasive, and easily monitored tool for the early detection and diagnosis of periodontal health status.

Overexpression of interleukin-4 using adeno-associated virus is a potential strategy to enhance bone regeneration

This study aimed to investigate the bone regeneration potential of IL-4 gene delivery via adeno-associated virus (AAV) vectors, with a particular focus on modulating macrophage polarization and promoting osteogenic differentiation. Four different AAV serotypes (AAV1, AAV2, AAV5, and AAV6) encoding the IL-4 gene were evaluated in rat and human gingival fibroblasts and dental pulp stem cells (DPSCs). AAV2 exhibited the highest transduction efficiency and IL-4 expression in all tested cell types. IL-4 transduced DPSCs demonstrated enhanced osteogenic differentiation, as evidenced by the upregulation of osteogenic markers, increased alkaline phosphatase activity, and elevated calcium deposition. IL-4 transduction activated the extracellular signal-regulated kinase signaling pathway, contributing to osteogenesis. To assess the therapeutic efficacy of AAV2-IL-4 in vivo, a lipopolysaccharide-induced calvarial osteolysis model was established in C57BL/6 mice. AAV2-IL-4 administration significantly reduced bone resorption, as confirmed by micro-CT and histological analysis. Moreover, IL-4 gene delivery promoted M2 macrophage polarization. These findings highlight AAV2-IL-4 as a promising gene therapy strategy for bone regeneration, effectively integrating immunomodulation and osteogenesis to counteract inflammation-driven bone loss.

Bridging oral and systemic health: exploring pathogenesis, biomarkers, and diagnostic innovations in periodontal disease

PURPOSE

This narrative review explores the multifaceted links between periodontal diseases (gingivitis and periodontitis) and systemic health conditions, including cardiovascular disease, diabetes, adverse pregnancy outcomes, Alzheimer's disease, cancers, rheumatoid arthritis, and respiratory infections. It aims to synthesize evidence on how local oral infections exert systemic effects and evaluate the potential of diagnostic technologies to monitor these interactions.

METHODS

This narrative review synthesizes current scientific literature on periodontal disease pathogenesis, focusing on key pathogens (e.g., Porphyromonas gingivalis, Fusobacterium nucleatum) and their roles in driving local and systemic inflammation via virulence factors and microbial dysbiosis. It examines biomarker-based diagnostic approaches (e.g., IL-1β, TNF-α, microbial DNA) in saliva, blood, and gingival crevicular fluid (GCF) and evaluates current and emerging diagnostic tools (e.g., ELISA, PCR, lateral flow assays, biosensors, microfluidics).

RESULTS

The review highlights that periodontal pathogens contribute to systemic disease through complex mechanisms including persistent inflammation (driven by cytokines like IL-1β, TNF-α), endotoxemia (via LPS, noting pathogen-specific structural variations impacting immune response), molecular mimicry, and immune modulation. Current diagnostic methods provide valuable information but often face limitations in speed, portability, and multiplexing capability needed for comprehensive point-of-care assessment. Emerging technologies, particularly multiplex platforms integrating biosensors or microfluidics, demonstrate significant potential for rapid, user-friendly analysis of multiple biomarkers, facilitating earlier detection and personalized risk stratification, especially in high-risk populations.

CONCLUSION

Periodontal diseases significantly impact systemic health via intricate microbial and inflammatory pathways. The complexity of these interactions necessitates moving beyond conventional diagnostics towards integrated, advanced technologies. Implementing rapid, multiplex biomarker detection platforms within a multidisciplinary healthcare framework holds the potential to revolutionize early detection of linked conditions, improve personalized management strategies, and ultimately reduce the systemic burden of periodontal disease.

Investigating the role of necroptosis in the immunological microenvironment of periodontitis

BACKGROUND

Extensive research has delved into the nexus between necroptosis and immunity, yet its impact on the immunological microenvironment of periodontitis remains elusive. Therefore, the study aims to elucidate the role of necroptosis in shaping this particular microenvironment.

RESULTS

We examined the differential expression of necroptosis genes in healthy and periodontitis samples, analyzing their correlations with infiltrating immunocytes, immune responses, and the human leukocyte antigen (HLA) gene. Distinct necroptosis-mediated expression patterns were identified, along with genes associated with the necroptosis phenotype. Notably, 37 necroptosis genes were dysregulated, leading to the development of a seven-necroptosis classifier that accurately distinguished periodontitis from healthy samples. The findings reveal a profound association between necroptosis and the immunological microenvironment, evidenced by the positive correlation between ZBP1 and MLKL expression with plasma cells, the negative correlation between TNFRSF1B and ZBP1 with resting dendritic cells, and the modulation of BCR signaling and TGF family receptor activity by ZBP1 and MLKL. Furthermore, we uncovered a positive correlation between ZBP1 and HLA-C expression and a negative correlation between HSPA4 and HLA-A expression. The analysis identified two distinct necroptosis expression patterns, each characterized by unique immune features. Among the 5272 genes associated with the necroptosis phenotype, 339 genes were linked to immunity, their biological functions centering on immunocyte regulation.

CONCLUSION

This study underscores the significant role of necroptosis in shaping the immunological microenvironment of periodontitis, offering novel insights into the pathogenesis of this condition and paving the way for potential therapeutic strategies for periodontitis and its systemic comorbidities.

Glioma raises periodontitis risk via CD8 upregulation on NKT cells: a Mendelian randomization study

OBJECTIVES

Gliomas, primary tumors of the central nervous system, and periodontitis, a chronic inflammatory disease impacting oral health, have both been subjects of extensive research due to their significant impact on patients' well-being. This study delves into the question of whether there is a causal relationship between glioma and periodontitis, mediated by systemic immunological changes.

METHODS

This research draws from a wealth of publicly available genetic data, including genome-wide association studies for glioma, periodontitis, and immune cell traits. A comprehensive Mendelian randomization (MR) analysis is conducted, incorporating multiple MR methods and statistical tests to assess causality and account for possible biases.

RESULTS

The findings indicate that individuals genetically predisposed to glioma face an increased risk of developing periodontitis. Furthermore, CD8 upregulation on NKT cells was identified as a mediator in this causal pathway, providing a partial explanation for the observed connection. This discovery aligns with clinical observations of glioma patients exhibiting a higher prevalence of poor periodontal health.

CONCLUSIONS

This study advances our understanding of the complex interplay between glioma and systemic diseases like periodontitis. It underscores feasible implications for patient care and opens avenues for future research to explore the mechanistic underpinnings of this relationship.

Advanced Strategies in Enhancing the Hepatoprotective Efficacy of Natural Products: Integrating Nanotechnology, Genomics, and Mechanistic Insights

Liver disorders like hepatitis, cirrhosis, and hepatocellular carcinoma present a significant global health challenge, with high morbidity and mortality rates. Key factors contributing to liver disorders include inflammation, oxidative stress, and apoptosis. Due to their multifaceted action, natural compounds are promising candidates for mitigating liver-related disorders. Research studies revealed the antioxidant, anti-inflammatory, and detoxifying properties of natural compounds like curcumin, glycyrrhizin, and silymarin and their potential for liver detoxification and protection. With advancements in nanotechnology in drug delivery, natural compounds have improved stability and targetability, thereby enhancing their bioavailability and therapeutic efficiency. Further, recent advancements in genomics and an increased understanding of genetic factors influencing liver disorders and the hepatoprotective effects of natural agents made way for personalized medicine. Moreover, combinatorial therapy with natural products, synthetic drugs, or other natural agents has improved therapeutic outcomes. Even though clinical trials have confirmed the efficiency of natural compounds as hepatoprotective agents, several challenges remain unanswered in their translation to clinical practice. Therefore, it is logical to integrate natural compounds with nanotechnology and genomics to further advance hepatoprotection. This review gives an overview of the substantial progress made in the field of hepatoprotection, with specific emphasis on natural compounds and their integration with nanotechnology and genomics. This provides valuable insights for future research and innovations in developing therapeutic strategies for liver disorders.

The investigation of apoptosis-related genes in periodontitis

OBJECTIVES

This study aims at determination of the roles of five apoptosis-related genes, namely CASP2, CASP8, BCL2, HULC and PVT1 in the pathoetiology of periodontitis via measurement of their expressions in both peripheral blood and tissues of affected persons.

RESULTS

CASP2 was over-expressed in gingiva of patients compared with healthy subjects (RME = 24.56, P < 0.001), and in both affected females and males (RME = 30.53, P = 0.03 and RME = 20.59, P = 0.01, respectively). BCL2 was higher in affected tissues compared with controls (RME = 32.28, P < 0.001) and in affected tissues of males versus controls (RME = 69.03, P < 0.001). Finally, HULC had lower level in the blood of patients (RME = 0.21, P = 0.01) and in the blood of female patients compared with normal females (RME = 0.15, P = 0.01). Other comparisons yielded no significant results. BCL2 and CASP2 had the highest diagnostic values for separation of diseased gingival tissues from normal ones. HULC has the best values in the distinction of blood samples of affected persons from control persons. Combination of transcript levels of CASP2, CASP8, BCL2, HULC and PVT1 changed AUC to 0.84 and 0.72 in tissues and blood samples, respectively. To conclude, these genes might be regarded as putative contributors in the pathophysiology of periodontitis.

Periodontal Inflammation and Serum Inflammatory Markers in Community-Dwelling Older Adults in Japan: The Otassha Study

AIM

To investigate the associations between periodontal inflammation-as determined by the periodontal inflamed surface area (PISA)-and serum inflammatory markers in community-dwelling older adults in Japan.

MATERIALS AND METHODS

This cross-sectional study included 470 adults (mean age: 73.1 years). The composite inflammatory marker z-score (CIMZ) was calculated as the sum of the participants' individual z-scores for C-reactive protein (CRP), interleukin-1beta (IL-1β), IL-6 and tumour necrosis factor-α (TNF-α). The associations of PISA (quartiles) with individual biomarkers (continuous, log-transformed) and CIMZ (dichotomized, highest quartile or not) were assessed using linear or Poisson regression models.

RESULTS

Compared with participants in the lowest PISA quartile (Q1), those in Q3 and Q4 had significantly (p < 0.05) higher CRP and IL-6 levels. Statistically significant linear trends (ptrend < 0.05) across the PISA quartiles were observed for CRP and IL-6. The multivariable adjusted prevalence ratios (95% confidence intervals) of high CIMZ (reference: Q1) were 1.20 (0.68-2.14), 1.66 (0.96-2.88) and 1.90 (1.08-3.34) (ptrend = 0.01) in individuals in PISA Q2-Q4.

CONCLUSIONS

Older adults with high periodontal inflammation had high serum CRP and IL-6 concentrations and composite summary inflammatory indicator values. Periodontal inflammation is a potential modifiable factor of elevated inflammatory status among older adults in Japan.

Asarum sieboldii, a Potential Ethnomedicinal Herb in Dentistry and Oral Health

Asarum sieboldii, a species of wild ginger native to East Asia, has long been recognised as an important herb in Asian traditional medicine. It has been applied in the treatment of toothache, cough, asthma, and sinusitis. A. sieboldii has gained global interest because it offers solutions to multiple health concerns. The plant is renowned for its anti-inflammatory, analgesic, antimicrobial, antifungal, and antioxidant properties. Its roots exhibit a wide range of biological and pharmacological effects. The plant contains several chemical constituents, including methyleugenol, 3,4,5-trimethoxytoluene, and safrole, which contribute to its medicinal benefits. Whereas literature search highlights the potential application of A. sieboldii in herbal medicine, to date its application in dentistry remains largely unexplored, with the existing literature vastly fragmented in various sources. This review therefore, provides a comprehensive overview of the potential application of A. sieboldii in dentistry and oral health. The plant shows considerable promise and appears to be effective for managing common oral diseases such as tooth decay, periodontal diseases, toothache, oral cancer, oral ulcers, and gingivitis. Its ability to inhibit nitric oxide release, along with its neuroprotective effects, further enhances its potential for relieving pain and inflammation. With these therapeutic benefits, A. sieboldii presents a promising natural alternative or a complementary option to conventional dental treatments, capable of addressing a wide range of oral health conditions. The findings from this review could serve as a solid foundation for future research, supporting the development of high-quality, safe, and effective A. sieboldii-based products in dentistry and oral health.

Association of Chronic Periodontitis with Hemorrhagic Stroke: A Systematic Review and Meta-Analysis

Periodontitis is a chronic, multifactorial inflammatory condition linked to dysbiotic plaque biofilms and characterized by the gradual destruction of the structures supporting the teeth owing to compromised immune system function. Hemorrhagic stroke, which primarily occurs within the brain tissue or in the subarachnoid space as a blood leak of ruptured vessels, is a sudden neurological impairment caused by vascular damage in the central nervous system, resulting in focal neurological deficits. Chronic periodontitis (CP) and hemorrhagic stroke may share common pathogenic features involving inflammation and immune system activation, prompting researchers to investigate their potential connection. The aim of the study is to systematically review the literature on the epidemiological association between CP and hemorrhagic stroke in adults. The study protocol adhered to the PRISMA 2020 guidelines, and the design followed the Cochrane methodology. A thorough literature search encompassing PubMed, Scopus, and Web of Science databases and a manual search and evaluation of gray literature was conducted. Meta-analysis was performed using Review Manager (RevMan) 5.4, with the effect size represented by the odds ratio (OR) and a 95% confidence interval (CI). Heterogeneity was assessed using the chi-squared and I 2 statistics. The selected articles, written in English without time constraints, focused on observational studies involving patients and controls and included disease diagnostic criteria. Duplicate entries were eliminated. The reliability of each study's results was evaluated using the Newcastle-Ottawa Scale and GRADE tools. Two reviewers conducted the assessments, and a third reviewer resolved any disagreements. The meta-analysis comprised four observational studies involving 1,882 individuals. It revealed that individuals diagnosed with hemorrhagic stroke were notably more likely to have concurrent CP (OR: 6.32; 95% CI: 1.35-29.49; p = 0.02) or severe CP (OR: 3.08; 95% CI: 1.56-6.06; p = 0.001) compared with healthy controls. A notable occurrence of CP was detected in patients with hemorrhagic stroke compared with controls. Health care professionals need to acknowledge the connection between the two conditions, as it allows them to provide optimal holistic care through a thorough approach to diagnosis and treatment.

Anxiety in periodontally healthy, stage III/IV periodontitis with and without smoking: a cross-sectional study

BACKGROUND

Psychological stress and smoking have been known as pertinent risk factors associated with various inflammatory diseases like periodontal disease. So, the aim of this study was to evaluate and correlate anxiety in Periodontally healthy, Stage III/IV Periodontitis patients with and without smoking.

METHODS

120 participants included in the study were divided equally into four groups of healthy non-smokers (Group I), healthy smokers (Group II), non-smokers with untreated Stage III or IV periodontitis (Group III) and smokers with untreated Stage III or IV periodontitis (Group IV). The anxiety levels of the patients were assessed using the Zung's self-rating anxiety scale. Socioeconomic status, smoking exposure through a questionnaire and the clinical parameters Probing pocket depth (PPD), Clinical attachment levels (CAL), Gingival index (GI) and Plaque index (PI) were recorded.

RESULTS

The clinical periodontal parameters were compared within and across the groups at the four different anxiety levels and depicted a significant increase with the increase in the anxiety levels of the patients. The correlation of CAL with the anxiety score in Group III and Group IV was high positive (r = 0.926 and 0.823) and highly significant. (p-value < 0.0001 respectively). Also, a strong positive association was seen between duration, frequency of smoking and anxiety scores. (r = 0.824 and 0.853 respectively).

CONCLUSION

The anxiety scores showed a positive correlation with PPD and CAL in Group III and IV and it was high positive in smokers.

CLINICAL TRIAL REGISTRY OF INDIA REGISTRATION NUMBER

CTRI/2023/06/053408.

Chronic inflammation in obesity and neurodegenerative diseases: exploring the link in disease onset and progression

Obesity, a worldwide health emergency, is defined by excessive fat accumulation and significantly impacts metabolic health. In addition to its recognized association with cardiovascular disease, diabetes, and other metabolic illnesses, recent studies have revealed the connection between obesity and neurodegeneration. The main reason for this link is inflammation caused by the growth of fat tissue, which activates harmful processes that affect how the brain works. Fat tissue, particularly the fat around the organs, produces various substances that cause inflammation, such as cytokines (TNF-α, IL-6), adipokines (leptin, resistin), and free fatty acids. These chemicals cause low-grade, persistent systemic inflammation, which is becoming more widely acknowledged as a major factor in peripheral metabolic dysfunction and pathology of the central nervous system (CNS). Inflammatory signals in the brain cause neuroinflammatory reactions that harm neuronal structures, change neuroplasticity, and disrupt synaptic function. When obesity-related inflammation is present, the brain's resident immune cells, known as microglia, become hyperactivated, which can lead to the production of neurotoxic chemicals, which can cause neuronal death. This neuroinflammation exacerbates the negative effects of obesity on brain health and is linked to cognitive decline, Alzheimer's disease, and other neurodegenerative disorders. Moreover, the blood-brain barrier (BBB) exhibits increased permeability during inflammatory states, facilitating the infiltration of peripheral immune cells and cytokines into the brain, hence exacerbating neurodegeneration. Adipose tissue is a source of chronic inflammatory mediators, which are examined in this review along with the molecular pathways that connect inflammation brought on by obesity to neurodegeneration. Additionally, it addresses various anti-inflammatory treatment approaches, including lifestyle modifications, anti-inflammatory medications, and gut microbiota modulation, to lessen the metabolic and neurological effects of obesity. Recognizing the link between obesity and inflammation opens up new opportunities for early intervention and the development of targeted treatments to prevent or alleviate neurodegenerative disorders.

TSPO participates in the pathogenesis of diabetic periodontitis related to mitophagy

OBJECTIVES

Diabetic periodontitis (DP) appears to be the sixth most common complication of diabetes; however, its underlying pathological mechanisms require further explored. Our study investigated the potential function of the translocator protein (TSPO) in the progression of DP, aiming to provide a theoretical foundation for novel treatment strategies.

METHODS

The ultrastructure and TSPO expression of gingival tissue, collected from healthy individuals, people with periodontitis, and those with DP, were examined. In vivo, a DP model in rats was established using streptozotocin (STZ) and silk ligation. TSPO ligand antagonist PK 11195 was administered as a treatment. Microcomputed tomography (Micro-CT), quantitative real-time polymerase chain reaction (qPCR), histology and immunohistochemistry were employed to assess the destruction, inflammatory and mitophagy in rat periodontal tissues. In in vitro experiments, the inflammatory responses, mitochondrial function, mitophagy and the potential role of TSPO in macrophages were also examined under high-glucose inflammatory conditions, using flow cytometry, fluorescence probes, qPCR, Western blotting and transcription inhibition.

RESULTS

Mitochondrial damage, mitophagy inhibition and increased TSPO expression were observed in gingivae from patients with DP. PK 11195 facilitated the restoration of mitophagy and alleviated the inflammatory destruction of DP rats. Additionally, the high-glucose inflammatory environment intensified the macrophage inflammatory response, ROS production, and mitochondrial damage. These pathological changes were reduced by TSPO inhibition, which could also upregulate the mitophagy.

CONCLUSIONS

The inflammation and destruction of periodontal tissue in DP are closely linked to mitophagy associated with TSPO. Immunotherapy targeting TSPO in macrophages could significantly influence the treatment of DP by modulating mitophagy.

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

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

Dimethyl fumarate modulates M1/M2 macrophage polarization to ameliorate periodontal destruction by increasing TUFM-mediated mitophagy

Periodontitis is a common oral disease characterized by progressive alveolar bone resorption and inflammation of the periodontal tissues. Dimethyl fumarate (DMF) has been used in the treatment of various immune-inflammatory diseases due to its excellent anti-inflammatory and antioxidant functions. Here, we investigated for the first time the therapeutic effect of DMF on periodontitis. In vivo studies showed that DMF significantly inhibited periodontal destruction, enhanced mitophagy, and decreased the M1/M2 macrophage ratio. In vitro studies showed that DMF inhibited macrophage polarization toward M1 macrophages and promoted polarization toward M2 macrophages, with improved mitochondrial function, inhibited oxidative stress, and increased mitophagy in RAW 264.7 cells. Furthermore, DMF increased intracellular mitochondrial Tu translation elongation factor (TUFM) levels to maintain mitochondrial homeostasis, promoted mitophagy, and modulated macrophage polarization, whereas TUFM knockdown decreased the protective effect of DMF. Finally, mechanistic studies showed that DMF increased intracellular TUFM levels by protecting TUFM from degradation via the ubiquitin-proteasomal degradation pathway. Our results demonstrate for the first time that DMF protects mitochondrial function and inhibits oxidative stress through TUFM-mediated mitophagy in macrophages, resulting in a shift in the balance of macrophage polarization, thereby attenuating periodontitis. Importantly, this study provides new insights into the prevention of periodontitis.

The Global Burden of Periodontal Disease: A Narrative Review on Unveiling Socioeconomic and Health Challenges

Periodontal disease is a prevalent chronic inflammatory condition that impacts over a billion people worldwide, leading to substantial tooth loss, reduced quality of life, and heightened systemic health risks. This narrative review synthesizes current evidence regarding the global burden of periodontal disease, its established associations with systemic conditions including cardiovascular disease, diabetes, adverse pregnancy outcomes, respiratory infections, and neurodegenerative disorders, and its significant socioeconomic implications. The review focused on the following research question: What is the global burden of periodontal disease, and how do its systemic and socioeconomic implications necessitate integrated public health strategies? A structured search of the PubMed, Scopus, and WHO databases from 2000 to 2024 was conducted to identify relevant literature using key terms, including "periodontal disease", "global burden", "systemic inflammation", and "public health strategies". Out of 312 initially identified articles, 175 satisfied the inclusion criteria for the final synthesis. The findings underscore the significance of periodontal disease as a modifiable risk factor for various noncommunicable diseases, the influence of healthcare disparities on disease progression, and the critical necessity for integrated public health strategies to mitigate the global burden of periodontal disease and its consequences. The review concludes that coordinated policy reform, health system integration, and enhanced research efforts are crucial for mitigating the global burden of periodontal disease and advancing health equity.

Influence of antidepressant use on periodontal status: a systematic review and meta-analysis

OBJECTIVE

The aim of this review was to evaluate the influence of antidepressant use on inflammatory and clinical data related to periodontal status in animal and human studies.

MATERIALS AND METHODS

A systematic review was conducted according to the PRISMA guidelines. The potential risk of bias was assessed using the SYRCLE RoB or the Joanna Briggs Institute tools. For human studies, a meta-analysis was performed to compare periodontal parameters between users and non-users of antidepressants, and to estimate the mean difference using random effects models.

RESULTS

Twelve studies met the inclusion criteria: eight were conducted on animal models, and four were human studies. Tianeptine, desipramine, imipramine, and fluoxetine effectively reduced alveolar bone loss in experimental periodontitis. Furthermore, desipramine, imipramine, and fluoxetine were observed to reduce the expressions of inflammatory markers in gingival tissue. The meta-analysis found no differences in the influence of antidepressant use on periodontal pocket depth, clinical attachment level, and gingival index between users and non-users. There was no standardization of the duration of use, type, and dosage of medication between studies.

CONCLUSIONS

Animal studies suggest antidepressants modulate the immunoinflammatory response and prevent alveolar bone loss in experimental periodontitis, but their impact on human periodontal status remains controversial. Standardized methods are needed to clarify antidepressant effects on the periodontium.

CLINICAL RELEVANCE

This study informs health professionals that certain antidepressants may positively impact the periodontium, while also highlighting the need for further research evaluating their possible influence on the human periodontal condition and their potentially associated local/systemic adverse effects.

Dental Calculus Formation Rate: The Role of Salivary Proteome and Metaproteome

BACKGROUND

Dental calculus accumulation varies across individuals. While various factors contribute to its accumulation, the role of salivary composition remains underexplored. This study aims to compare individuals suffering from rapid rates of dental calculus formation rates with those having slow formation rates in terms of salivary electrochemical properties as well as its proteomic, metaproteomic and elemental composition.

METHODS

A total of 26 patients with a history of dental calculus were recruited. Saliva samples were collected and evaluated for electrochemical properties as well as elemental, proteomic and metaproteomic composition. Patients were provided scaling treatment to remove all calculus. Six months after the dental cleaning patients were re-assessed for the presence of dental calculus. Based on the dental calculus formation rate participants were categorised into slow (57.7%) and rapid calculus formers (42.3%) that were then assessed for differences in salivary composition.

RESULTS

Rapid calculus formers exhibited a more neutral zeta-potential and lower concentration of salivary calcium ions than their slow-forming counterparts. Proteomic analysis identified 895 proteins across all samples. Of these, 38 proteins were exclusive to the rapid formation group, while 24 proteins were specific to the slow group. The rapid group demonstrated augmented pathways related to cell binding (e.g., cytoskeletal regulation by Rho GTPase and integrin signalling), inflammatory mediation (e.g., chemokine and cytokine signalling) and neurodegenerative disorders (e.g., 5-Hydroxytryptamine degradation, Huntington's disease and Parkinson's disease) and significant enrichment in peptidase inhibitor activity. In contrast, the slow group demonstrated enrichment mainly in immune response. Metaproteomic analysis for salivary bacteria showed significant predominance of Streptococci in the rapid group and elevated levels of Rothia in the slow group.

CONCLUSION

The saliva of patients with rapid calculus formation rates differs from that of patients with slow rates of calculus formation in terms of electrochemical properties as well as proteomic, metaproteomic and elemental composition.

Gelatin methacryloyl @MP196/exos hydrogel induced neutrophil apoptosis and macrophage M2 polarization to inhibit periodontal bone loss

OBJECTIVES

Periodontitis is an inflammatory and destructive disease caused by dental plaque, which can result in the immune microenvironment disorders and loss of periodontal support tissue. In order to promote the restoration of local microenvironment stability, a functional biomaterial Gelatin methacryloyl @MP196/exos based on characteristics of disease occurrence is designed.

METHODS

Transmission electron microscopy, nanosight particle tracking analysis and western blot analysis were applied to prove the presence of exos in GelMA@MP196/exos. The swelling and degradation rates of GelMA@MP196/exos were evaluated. Cell proliferation, antibacterial ability and cellular uptake and intracellular internalization of exos were assessed in the study. Efferocytosis and M2 polarization of macrophages was estimated and the effects of GelMA@MP196/exos were proved in vivo.

RESULTS

GelMA@MP196/exos upregulated the expression of genes and proteins related to neutrophil apoptosis and promoted neutrophil apoptosis, macrophage M2 polarization, and efferocytosis. Furthermore, GelMA@MP196/exos exhibited significant antibacterial activity against Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. GelMA@MP196/exos alleviated periodontitis and reduced alveolar bone loss in vivo in rat models.

CONCLUSIONS

GelMA@MP196/exos can serve as a potential strategy for the treatment of periodontitis.

CLINICAL SIGNIFICANCE

The main aim of periodontal therapy is to remove dental plaque and eliminate inflammation. However, some patients with low plaque scores and insufficient neutrophil clearance, resulting in poor responsiveness to periodontal therapy. Under the circumstances, local Application of drug that regulate the immune microenvironment had significance in controlling the progression of inflammation.

Inflammation-triggered Gli1+ stem cells engage with extracellular vesicles to prime aberrant neutrophils to exacerbate periodontal immunopathology

Periodontitis is a prevalent and progressive detrimental disease characterized by chronic inflammation, and the immunopathological mechanisms are not yet fully understood. Mesenchymal stem cells (MSCs) play crucial roles as immunoregulators and maintain tissue homeostasis and regeneration, but their in vivo function in immunopathology and periodontal tissue deterioration is still unclear. Here, we utilized multiple transgenic mouse models to specifically mark, ablate and modulate Gli1+ cells, a critical and representative subset of MSCs in the periodontium, to explore their specific role in periodontal immunopathology. We revealed that Gli1+ cells, upon challenge with an inflammatory microenvironment, significantly induce rapid trafficking and aberrant activation of neutrophils, thus exacerbating alveolar bone destruction. Mechanistically, extracellular vesicles (EVs) released by Gli1+ cells act as crucial immune regulators in periodontal tissue, mediating the recruitment and activation of neutrophils through increased neutrophil generation of reactive oxygen species and stimulation of nuclear factor kappa-B signaling. Furthermore, we discovered that CXC motif chemokine ligand 1 (CXCL1) is exposed on the surface of EVs derived from inflammation-challenged Gli1+ cells to prime aberrant neutrophils via the CXCL1-CXC motif chemokine receptor 2 (CXCR2) axis. Importantly, specific inhibition of EV release from Gli1+ cells or pharmacological therapy with GANT61 ameliorates periodontal inflammation and alveolar bone loss. Collectively, our findings identify previously unrecognized roles of Gli1+ cells in orchestrating infiltration and promoting aberrant activation of neutrophils under inflammation, which provides pathological insights and potential therapeutic targets for periodontitis.

Women with breast cancer exhibit a higher risk for periodontitis: A nationwide cohort study

Background/purpose

Epidemiologic research has linked periodontitis to several types of cancer, particularly breast cancer. Although clinical evidence indicates a higher risk of breast cancer in women with periodontitis than in those without, few studies have explored whether the risk of periodontitis is higher in women with breast cancer than in those without. In this study, we examined the incidence of periodontitis in patients with breast cancer and identified potential interventions for its prevention.

Materials and methods

This retrospective cohort study included data from the National Health Insurance Research Database of Taiwan. We identified women who received a diagnosis of breast cancer between 2010 and 2019 and included a 1:1 matched control cohort with no breast cancer. Subsequently, we analyzed the risk of periodontitis by using Cox proportional-hazards models while adjusting for sociodemographic factors, comorbidities, and treatment regimens.

Results

In 82,146 matched pairs, the breast cancer cohort was at a 51 % higher risk of periodontitis compared with the control cohort (adjusted hazard ratio = 1.51, 95 % confidence interval = 1.43-1.60). The stratified analysis revealed the same results. The risk of breast cancer was higher in younger patients than in older patients, whereas the risk of periodontitis was significantly lower in patients who underwent surgery, radiotherapy, chemotherapy, or hormone therapy compared with those who did not.

Conclusion

Breast cancer increases the risk of periodontitis, particularly in younger patients. These patients should receive regular dental care to prevent and manage periodontitis. Anticancer treatments may mitigate the risk of periodontitis in patients with breast cancer.

Nanoemulsion and nanoemulgel-based carriers as advanced delivery tools for the treatment of oral diseases

Oral diseases rank among the most widespread ailments worldwide posing significant global health and economic challenges affecting around 3.5 billion people, impacting the quality of life for affected individuals. Dental caries, periodontal disease, bacterial and fungal infections, tooth loss and oral malignancies are among the most prevalent global clinical disorders contributing to oral health burden. Traditional treatments for oral diseases often face challenges such as poor drug bioavailability, breakdown of medication in saliva, inconsistent antibiotic levels at the site of periodontal infection as well as higher side effects. However, the emergence of nanoemulgel (NEG) as an innovative drug delivery system offers promising solutions where NEG combines the advantages of both nanoemulsions (NEs) and hydrogels providing improved drug solubility, stability, and targeted delivery. Due to their minuscule size and ability to control drug release, NEGs hold promise for improving treatment of oral diseases, where versatility of these delivery systems makes them suitable for various applications, including topical delivery in dentistry. This review concisely outlines the anatomy of the oral environment and investigates the therapeutic potential of NE-based gels in oral disorder treatment. It thoroughly examines the challenges of drug delivery in the oral cavity and proposes strategies to improve therapeutic efficacy, drawing attention to previous research reports for comparison. Through comprehensive analysis, the review highlights the promising role of NEGs as a novel therapeutic approach for oral health management via research advancements and their clinical translation. Additionally, it provides valuable insights into future research directions and development opportunities in this area.

Profile of Inflammatory Cytokines in Gingival Crevicular Fluid and Plasma in Patients With Grade C Periodontitis During Orthodontic Treatment: A Longitudinal Case Series Report

AIM

To examine the immune responses in patients diagnosed as grade C periodontitis during orthodontic treatment.

MATERIALS AND METHODS

Our study included seven orthodontic patients with grade C periodontitis and measured their levels of inflammatory cytokines in gingival crevicular fluid and plasma before orthodontic treatment, during the alignment and levelling phase, and during the detailing and finishing phase. The key signal pathways in the orthodontic process of patients with periodontitis were detected by KEGG analysis.

RESULTS

Studies have shown that orthodontic treatment brings great improvement to patients with grade C periodontitis, and most of the local/systemic inflammatory cytokines can be reduced after orthodontic treatment. Simultaneously, orthodontic treatment can reduce the percentage of IFN-γ+ Th1 cells in patients with grade C periodontitis. Through KEGG analysis, the IL-17 signalling pathway and TNF signalling pathway are closely interrelated in the orthodontic treatment of patients diagnosed with grade C periodontitis (p-value < 0.001).

CONCLUSION

Orthodontic treatment can effectively control the local and system levels of inflammation in patients with grade C periodontitis, with IL-17A and TNF-α as potential distinctive inflammatory markers for orthodontic-periodontal combined treatment in individuals with periodontitis.

In vitro evaluation of anti-inflammatory, anti-plaque efficacy, and biocompatibility of Norway spruce (Picea abies) resin extract for oral care applications

The periodontal disease is globally highly prevalent, and calls for novel, effective, and preferably bio-based raw materials. Accumulation of dental plaque causes gingivitis, which is reversible by treatments that control the bacterial biofilm. If left untreated, the gingivitis can lead to gingival inflammation and potentially progress to periodontitis. In this study, a natural antimicrobial and anti-inflammatory Norway spruce (Picea abies) resin extract was evaluated as a potential option in supportive periodontal care. Lipopolysaccharide-induced macrophage-like cells were used to study the anti-inflammatory properties in vitro. The spruce resin extract at 20 % concentration had the highest anti-inflammatory effect, comparable to a corticosteroid's effect on pro-inflammatory cytokines interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinase-3 (MMP-3). Consequently, the 20 % spruce resin extract was selected for toothpaste formulation. Its anti-plaque efficacy was evaluated by total aerobic colony counts and the proportions of streptococci grown on the surfaces of the treated glass rods using pooled human saliva. It was found that the toothpaste effectively reduced dental plaque biofilm, matching the anti-plaque efficacy of Corsodyl mouthwash, containing chlorhexidine digluconate. The toothpaste was also found to be non-damaging in biocompatibility studies on three-dimensional (3D) tissue models of human oral and gingival epithelium. These findings provide scientific validation of spruce resin's effectiveness in oral care, elucidating probable reasons why people have historically chewed resins for oral care purposes.

Use of a periodontal resective procedure (proximal wedge technique) for treating gingival and periodontal pockets of mandibular canine teeth in dogs

OBJECTIVES

This study aims to evaluate the ability of a periodontal resective procedure (the Proximal Wedge Technique) to improve the long-term health of the mandibular canines by reducing probing depths immediately post-surgery via targeted tissue recontouring and precise debridement. The technique aims to enhance periodontal health and stabilize the supporting structures of strategically important adjacent canine teeth, including alveolar bone, rather than relying solely on mandibular incisor extractions with simple closure.

MATERIALS AND METHODS

A retrospective records review compiled data from patients with suprabony pockets of 6 mm or greater at the mesial aspect of the mandibular canines treated with the proximal wedge technique (PWT). The PWT utilizes non-displaced gingival flaps combining concepts from the modified Widman flap and distal wedge procedures with selective osteoplasty.

RESULTS

Twenty-one mandibular canine sites from 12 patients of various breeds with pocket depths ranging from 6 to 10 mm were treated with the PWT resulting in post-operative mean pocket depths of 1.7 ± 0.1 mm. Approximately 1 year later, the improved depths were unchanged in six of the patients comprising 12 of the 21 sites.

CLINICAL SIGNIFICANCE

By employing this method, veterinarians can enhance periodontal health and stabilize the supporting structures of strategically important adjacent canine teeth, including alveolar bone, rather than relying solely on mandibular incisor extractions with simple closure. The Proximal Wedge Technique resulted in reliable periodontal success and improved patient outcomes for one year and potentially longer, allowing retention of the mandibular canines and maintaining the integrity of the rostral mandible.

Molar Incisor Hypomineralization and Periodontitis in Adolescents: A Population-Based Study

AIM

To investigate the association between molar incisor hypomineralization (MIH) and periodontitis in adolescents.

METHODS

A population-based study was undertaken of Brazilian adolescents aged 18 and 19 years (n = 2515). MIH was assessed according to Ghanim's criteria. The outcomes were Periodontitis Indicators, a continuous latent variable estimated on the basis of the common variance shared by the indicators bleeding on probing (BoP), probing pocket depth (PPD ≥ 4 mm) and clinical attachment level (CAL ≥ 3 mm), as well as periodontitis cases defined according to CDC-AAP. Structural equation modelling was used, and the models were adjusted for lower socioeconomic status, sex, smoking, triglycerides/high-density lipoprotein (TG/HDL) (mg/dL) and visible plaque index. Two other approaches were used for sensitivity analysis: (i) logistic regression, considering the effect of MIH on periodontitis (CDC/AAP) at the individual level, and (ii) multilevel regression to evaluate the association of MIH with CAL and PPD, considering the tooth as the unit of analysis, adjusted for other tooth-level and individual-level variables.

RESULTS

The prevalence of MIH was 16.86% (n = 423). Individuals with MIH had higher values of the Periodontitis Indicators through a direct pathway (standardized coefficient [SC] = 0.193, p < 0.001) and indirectly mediated by biofilm (SC = 0.263, p < 0.001). MIH was also associated with periodontitis according to CDC-AAP (SC = 0.071, p < 0.001) and indirectly mediated by biofilm (SC = 0.344, p < 0.001). Consistently, lower socioeconomic status, sex, TG/HDL and biofilm were associated with both periodontal outcomes. Tooth-level sensitivity regression analysis confirmed the association observed in individual-level analyses.

CONCLUSION

Our findings suggest that adolescents with MIH are susceptible to periodontitis, and it is therefore important to monitor their periodontal health.

Behçet's disease modifies the gingival inflammatory response

BACKGROUND

Behçet's disease (BD) pathogenesis involves severe outcomes such as blindness, central nervous system manifestations, and deep venous thrombosis that impacts systemic and local inflammatory changes. We tested the hypothesis that BD negatively affects gingival health and increases the severity of gingivitis.

METHODS

The study included 37 BD patients with gingivitis without any sign of periodontitis. Systemically healthy 19 patients with gingivitis (G) and 20 periodontally and systemically healthy individuals (C) were recruited as controls. BD patients were further grouped as stable and unstable based on their responses to BD treatment. Clinical periodontal parameters were measured to determine the impact of BD on gingival health. Serum and saliva levels of ELA-2 (neutrophil elastase-2), SLPI (secretory leukocyte protease inhibitor), α1-AT (alpha1-anti-trypsin), VEGF (vascular endothelial growth factor), IL-6 (interleukin-6), IL-8 (interleukin-8), and TNF-α (tumor necrosis factor alpha) were analyzed using multiplex immunoassay to measure the systemic and local inflammatory impact of BD.

RESULTS

Plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) were significantly higher in the BD group than in the controls (p < 0.05). IL-6 was higher in both serum and saliva in the BD group than in the G group (p < 0.05). ELA-2 levels in saliva were higher in the stable BD group than in the controls, while TNF-α and SLPI were statistically significantly higher in BD than in the control (p < 0.05). Salivary α1-AT level was statistically lower in the BD group compared to the control group.

CONCLUSION

Our study suggested that the gingival inflammatory profile was impaired in patients with BD.

The active ingredients and targets of Kouqiangjie formula on periodontitis: a multi-approach study

Periodontitis (PD) is a complex oral inflammatory disease with diverse pathogenic factors, demanding effective multi-target therapeutic approaches. Traditional Chinese Medicine (TCM) formulations, like the Kouqiangjie Formula (KQJF), hold potential as alternative therapies due to their multiple pharmacological effects. This study comprehensively investigated the key active ingredients and molecular targets of KQJF in treating PD through a combination of network pharmacology, machine learning, Mendelian randomization (MR), and experimental validation. The active components and targets of KQJF were identified via the TCMSP and HERB databases, while PD-related genes were sourced from GeneCards, CTD, and DisGeNET. Gene expression data from GEO datasets enabled differential expression analysis. Machine learning models, including Random Forest (RF) and Support Vector Machine (SVM), were employed to evaluate the diagnostic potential of gene sets. Molecular docking was utilized to assess the interactions between active ingredients and targets, and MR analysis was conducted to explore the causal relationships with PD. Experimental validation was carried out using a rat model. The results indicated that KQJF consists of 193 active compounds that target 561 proteins, with a significant overlap of 272 targets related to PD. Key compounds such as luteolin, linolenic acid, and naringenin were identified. The SVM model demonstrated excellent predictive performance, with an AUC of 0.954. MR analysis revealed a significant causal effect of the CASP3 gene on the risk of PD (OR = 1.595, p = 0.015). Experimental findings showed that these compounds could reduce the expression of CASP3 and improve the integrity of periodontal tissues. In conclusion, luteolin, linolenic acid, and naringenin are the core compounds in KQJF, and CASP3 is an important target. This study emphasizes the great potential of KQJF for PD treatment and provides a solid data base for the development of new therapeutic strategies.

Effect of Oral Microbiota Composition on Metabolic Dysfunction-Associated Steatotic Liver Disease in the General Population

Background/Objective: This study investigated the relationship between the composition of oral microbiota and metabolic dysfunction-associated steatotic liver disease (MASLD) in the general population. Methods: In total, 712 participants in a health check-up project were divided into four oral microbiota patterns by principal component analysis and cluster analysis; they were included in Neisseria, Streptococcus, Fusobacterium, and Veillonella groups. The Neisseria group had the largest number of patients and was used as a reference group to compare the incidence of MASLD and cardiometabolic criteria with the other groups. Results: In a multivariate analysis, the Veillonella group was a risk factor for MASLD independent of cardiometabolic criteria compared with the Neisseria group. The correlation between oral bacterial species and MASLD-related items showed that Neisseria was negatively correlated with controlled attenuation parameters, body mass index, waist circumference, hemoglobin A1c, alanine aminotransferase, and fatty liver index. Veillonella showed a positive correlation with controlled attenuation parameters, waist circumference, body mass index, blood pressure, triglycerides, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, and fatty liver index, and a negative correlation with high-density lipoprotein cholesterol. In contrast, the Streptococcus and Fusobacterium groups were not clearly associated with MASLD. Conclusions: Maintaining oral hygiene and preventing periodontitis may contribute to preventing MASLD and extending a healthy lifespan.

Inflammatory Modulation of Toll-like Receptors in Periodontal Ligament Stem Cells: Implications for Periodontal Therapy

Toll-like receptors (TLRs) play a crucial role in the innate immune response, mediating cellular interactions with the microenvironment and influencing periodontal disease progression. This in vitro study aimed to comprehensively characterize the TLR expression profile of periodontal ligament mesenchymal stem/progenitor cells (PDLSCs) and investigate its modulation by inflammatory stimuli associated with periodontal disease. PDLSCs (n = 6) were isolated, selected using anti-STRO-1 antibodies, and cultured to evaluate their colony-forming abilities and stem/progenitor characteristics. Baseline and inflammation-induced TLR expressions were evaluated using RT-PCR and protein analyses following cytokine-mediated stimulation. PDLSCs exhibited the expected stem cell characteristics and expressed multiple TLRs under both conditions. Notably, inflammatory stimulation significantly upregulated TLR1 and TLR2 while downregulating TLR10 (p < 0.05). These findings provide a comprehensive characterization of TLR expression in PDLSCs and demonstrate how inflammation modulates their innate immune profile. The observed shifts in TLR expression may influence PDLSC responses to microbial pathogens and impact their immunomodulatory and regenerative properties in periodontal tissues. Understanding these interactions could contribute to developing targeted strategies for improving PDLSC-based therapies in periodontal disease.

Correlation between periodontal status, whole salivary interleukin-1beta levels and oral yeasts carriage among individuals with varying ranges of body mass index

OBJECTIVE

The aim was to assess the correlation between periodontal status, whole salivary interleukin-1 beta (IL-1β) levels and oral yeasts carriage (OYC) among individuals with varying ranges of body mass index (BMI).  Material and method: The weight, waist circumference (WC), and height of individuals were assessed. Participants were categorized into three groups: Group-1 - normal weight (18.5-24.9 Kg/m2); Group-2 - overweight (25-29.9 Kg/m2); and Group-3 - obese (≥ 30 Kg/m2). Plaque and gingival indices (PI and GI, respectively), probing depth (PD), clinical-attachment-loss (CAL), missing teeth (MT) and marginal-bone-loss (MBL) were assessed. Whole salivary IL-1β levels and OYC were assessed. Group-comparisons were done. P < 0.05 was considered statistically significant.  Findings: Twenty-two, 22 and 22 individuals with comparable mean ages were included in groups 1, 2 and 3, respectively. The mean WC and BMI were higher in Group 3 than Groups 1 (P < 0.05) and 2 (P < 0.05). The mean PI, CAL, PD, GI, MT and MBL were higher in Group-3 than groups 1 (P < 0.05) and 2 (P < 0.05). There was no difference in mean PI, CAL, PD, GI, MT and MBL in groups 1 and 2. The salivary flow rate was higher in groups 1 (P < 0.05) and 2 (P < 0.05) than Group-3. The OYC and IL-1β were higher in Group-3 than groups 1 (P < 0.05) and 2 (P < 0.05). There was a correlation between PD and OYC in Group-3 (P < 0.05).  Conclusion: Periodontal inflammation is worse, and whole salivary IL-1β levels are elevated in obese than overweight individuals and subjects with normal BMI. There seems to be no association between BMI and OYC.

Ligature-induced periodontitis in a transgenic mouse model of Alzheimer's disease dysregulates neuroinflammation, exacerbates cognitive impairment, and accelerates amyloid pathology

A growing body of literature has identified periodontal disease among the modifiable risk factors for Alzheimer's disease (AD), but the mechanisms underlying this relationship is unknown. This study investigated this relationship using a ligature-induced preclinical periodontitis (Pd) model in non-transgenic (non-Tg) and 3xTg-AD mice. We found that ligature placement caused significant alveolar bone loss, with 3xTg-AD mice exhibiting exacerbated bone loss, suggesting AD-related genetic risk may amplify disease progression. Pd induced robust local inflammatory gene expression in both genotypes, but 3xTg-AD mice indicated a dysregulated immune response. Cognitive deficits were observed only in Pd-afflicted 3xTg-AD mice, specifically in hippocampus-mediated spatial memory and perirhinal cortex-mediated object recognition memory, while non-Tg mice remained unaffected. Neuroinflammatory responses varied by brain region, with the hippocampus and prefrontal cortex (PFC) showing the most pronounced changes. In these regions, 3xTg-AD mice exhibited significantly altered cytokine gene expression compared to non-Tg mice, particularly at later time points. Synaptic markers revealed vulnerabilities in 3xTg-AD mice, including reduced baseline Syp expression and dysregulated Synpo post-ligature. Pd transiently reduced glutamate receptor gene expression in both genotypes, with non-Tg mice showing persistent changes, potentially linked to preserved memory. Pd also accelerated amyloid-β (Aβ) deposition and sustained neurodegeneration in 3xTg-AD mice. Overall, this study shows that combining Pd and AD-related genetic risk exacerbates inflammation, cognitive impairment, synaptic dysfunction, Aβ pathology, and neurodegeneration. Neither insult alone was sufficient to produce these effects, highlighting the synergistic impact. These findings emphasize the need to explore anti-inflammatory interventions and downstream mechanisms to mitigate the confluence of these diseases.

Association between Sleep Quality and Periodontal Status: A Case-Control Study

Statement of the Problem

In the literature, the relationship between sleep quality and periodontal diseases has been mentioned, but still there is a lack of consensus and a valid conclusion in the results obtained.

Purpose

This study aimed to compare the sleep quality of patients with periodontitis and their healthy counterparts. The correlation between sleep quality score and age, gender, occupation, brushing pattern, and the severity of periodontal disease was also investigated.

Materials and Method

This case-control study was conducted on 106 patients with periodontitis and 106 controls with healthy periodontium referring to the Periodontology Department of Yazd Dental School from December 2021 to April 2022. The sleep quality of the two groups was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by ANOVA, t-test, and linear regression to assess possible correlations between the sleep quality score and demographic variables, tooth brushing pattern, and presence of periodontitis and its severity (alpha=0.05).

Results

Totally, 149 females (70.3%) and 63 males (29.7%) with the mean age of 34.17±8.29 years, participated in this study. The sleep quality score had no significant correlation with age, gender, occupation, or tooth brushing pattern (p> 0.05). However, the sleep quality had a significant correlation with periodontitis (OR= 1.15, CI 95%: 1.02-1.29, p= 0.01). The sleep quality score had no significant correlation with the severity of periodontal disease (p= 0.225).

Conclusion

Sleep quality of patients with periodontitis was significantly lower than that of healthy controls.

Guidance on the assessment of the functionality of biomaterials for periodontal tissue regeneration: Methodologies and testing procedures

Innovative biomaterials and tissue engineering strategies show great promise in regenerating periodontal tissues. This guidance provides an overview and detailed recommendations for evaluating the biological functionality of these new biomaterials in vitro, focusing on mineralization, immunomodulatory effects, cellular differentiation, and angiogenesis. Additionally, it discusses the use of in vivo experimental models that mimic periodontitis and scrutinizes methods such as osteogenic differentiation, immunomodulation, and anti-inflammatory responses to assess the effectiveness of these biomaterials in promoting periodontal tissue reconstruction. The guidance also addresses translating these findings to clinical applications, including using large animal models. This article aims to provide general recommendations for assessing the biological performance of novel materials and scaffold-based strategies using in vitro and in vivo (animal models), examining their advantages, disadvantages, and methodologies to guide effective research and clinical translation of regenerative treatments in periodontology.

Gingival crevicular fluid levels of TLR-9, AIM-2, and ZBP-1 in periodontal diseases

OBJECTIVES

Toll-like receptor (TLR)-9, may play a role in periodontal disease inflammation. This study measured TLR-9 and its related molecules, absence in melanoma-2 (AIM-2) and Z-DNA-binding protein-1 (ZBP-1), in gingival crevicular fluid (GCF) from patients with varying stages of periodontal disease to assess the role of pathogen-derived nucleic acids in inflammation.

MATERIALS AND METHODS

The study comprised 80 participants: 20 with Stage III Grade C periodontitis, 20 with Stage III Grade B periodontitis (P-Stage III-B), 19 with gingivitis, and 21 with periodontal health. Parameters including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP) were recorded. ELISA was used to analyze TLR-9, AIM-2, and ZBP-1 levels in GCF. Nonparametric tests were used for statistical comparisons.

RESULTS

The total amount of TLR-9 was higher in P-Stage III-B than in the healthy group (p < 0.05). Similarly, the gingivitis group exhibited elevated GCF TLR-9 levels compared to the healthy group (p < 0.05). GCF AIM-2 and ZBP-1 levels remained consistent across groups (p > 0.05). Significant correlations were found between GCF TLR-9 and CAL (p < 0.05), BOP (p < 0.05), PI (p < 0.01), and GCF volume (p < 0.001).

CONCLUSION

These findings suggested that the TLR-9-mediated inflammatory process plays a role in periodontal disease, as evidenced by the increased levels of TLR-9 in GCF.

Temporal Transcriptomic Analysis of Periodontal Disease Progression and Its Molecular Links to Systemic Diseases

Periodontal disease, a prevalent oral inflammatory condition, is implicated in exacerbating systemic diseases. However, the molecular mechanisms underlying this association remain unclear. In this study, we performed RNA sequencing of gingival tissue samples collected from a mouse model of periodontal disease at multiple time points to investigate dynamic transcriptomic changes during disease progression. Our analysis revealed distinct temporal gene expression patterns associated with the key inflammatory and immune response pathways. These findings suggest stepwise molecular progression in the periodontal inflammatory process, potentially contributing to systemic inflammation through shared signaling networks. We further identified specific genes and pathways that may mediate the bidirectional relationship between periodontal disease and systemic conditions such as cardiovascular disease and diabetes. By elucidating the temporal dynamics of molecular changes in periodontal disease, this study provides insights into the pathogenesis and its systemic implications. It identifies potential biomarkers and therapeutic targets for local and systemic disease management.

Advances in modeling periodontal host-microbe interactions: insights from organotypic and organ-on-chip systems

Periodontal disease, a chronic inflammatory condition affecting the supporting structures of teeth, is driven by an imbalanced interaction between the periodontal microbiota and the host inflammatory response. Beyond its local impact, periodontal disease is associated with systemic conditions such as diabetes mellitus, cardiovascular disease, and inflammatory bowel disease, emphasizing the importance of understanding its mechanisms. Traditional pre-clinical models, such as monolayer cultures and animal studies, have provided foundational insights but are limited by their physiological relevance and ethical concerns. Recent advancements in tissue engineering and microfluidic technologies have led to the development of three-dimensional (3D) organotypic culture models and organ-on-chip systems that more closely mimic native tissue microenvironments. This review provides an overview of the evolution of methods to study periodontal host-microbe interactions, from simple 2D monolayer cultures to complex 3D organotypic and microfluidic organ-on-chip (OoC) models. We discuss various fabrication strategies, host-microbe co-culture techniques, and methods for evaluating outcomes in these advanced models. Additionally, we highlight insights gained from gut-on-chip platforms and their potential applications in periodontal research and understanding oral-systemic links of periodontal disease. Through a comprehensive overview of current advancements and future directions, this review provides insights on the transformative potential of OoC technology in periodontal research, offering new avenues for studying disease mechanisms and developing therapeutic strategies.

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.

Potential effects of induced focal ischemia in the motor cortex of rats undergoing experimental periodontitis

Stroke is a severe medical condition resulting from an interruption in the blood supply to the brain, ultimately compromising tissue homeostasis. Currently, stroke stands as the second leading cause of death worldwide and the third leading cause when considering both mortality and disability together. Periodontitis is characterized by persistent inflammation in hard and soft tissues which support the teeth, primarily caused by bacterial biofilms, and is one of the most common causes of tooth loss in adults and can contribute to a systemic inflammatory burden. In the light of this, the present study investigated the effects of inducing focal ischemia in the motor cortex in rats undergoing experimental periodontitis. Adult Wistar rats were divided into four groups (control, ischemia, periodontitis, and periodontitis + ischemia) and were evaluated for motor performance, basic histology, and the volume and microarchitecture of alveolar bone. The results showed that the comorbidity between ischemia and periodontitis aggravates the spontaneous locomotion of rats, although the motor performance of adult rats had not been altered. Nonetheless, they revealed significant tissue impairment in the motor cortex. Additionally, there was a meaningful alteration in both the volume and microarchitecture of alveolar bone in this group. Our results indicate that the model of comorbidity between ligature-induced experimental periodontitis and focal ischemia was capable of inducing greater neurological impairment and alveolar bone loss in rats, attributable to diminished bone quality, when compared to each condition individually.

Peripheral blood immune cell levels differ with the stage and grade of periodontitis in systemically healthy individuals

OBJECTIVES

To explore the level of peripheral blood immune cells in patients with different stages and grades of periodontitis.

MATERIALS AND METHODS

A total of 229 periodontitis patients and 36 periodontally healthy patients were included in this cross-sectional study. Individuals with systemic diseases were excluded. A periodontal examination and a complete blood cell examination were performed. The percentages of T and B cells and their subsets were analyzed via flow cytometry. Covariance and logistic regression analyses were conducted, and receiver operating characteristic curve analysis was used to assess the predictive ability of the indicators.

RESULTS

The white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil percentage (NEU%) and neutrophil-to-lymphocyte ratio (NLR) were greater, but the lymphocyte percentage (LYM%) was lower in the periodontitis group than in the healthy control group. Patients with severe periodontitis (Stage III and IV) presented higher WBC, ANC, NEU% and NLR than those with mild and moderate periodontitis (Stage I and II) did. Area under curve (AUC) of the ANC, NEU% and NLR for the prediction of Stage III/IV periodontitis were 0.750, 0.771, and 0.774, respectively. Compared with Grade A or B periodontitis patients, Grade C periodontitis patients had a significantly lower absolute lymphocyte count (ALC) and LYM% but higher NEU% and NLR in Grade C periodontitis. The AUC of the NLR, LYM% and NEU% for predicting Grade C periodontitis were 0.797, 0.799, and 0.793, respectively. In lymphocytes, the proportions of T and B cells were lower in Grade C periodontitis patients than in Grade A or B group. Similarly, immune regulatory cells, including B10 and Treg cells, also decreased. Conversely, the Th17/Treg ratio was greater. Moreover, the Th17/Treg ratio was most strongly correlated with Grade C periodontitis (r = 0.87), followed by Treg cells(r = -0.70) and B10 cells(r = -0.38).

CONCLUSIONS

ANC, NEU%, NLR and LYM% are closely correlated with periodontitis. ANC, NEU%, and NLR may serve as potential markers for Stage III/IV periodontitis. LYM%, NEU%, and NLR may serve as potential markers for Grade C periodontitis. An increase in the Th17/Treg ratio is a high-risk factor for Grade C periodontitis.

CLINICAL RELEVANCE

Peripheral immune cell levels vary with the stage and grade of periodontitis and can be used to distinguish the grade and stage of periodontitis.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

A personalized periodontitis risk based on nonimage electronic dental records by machine learning

OBJECTIVE

This study aimed to develop a machine-learning (ML) model to predict the risk for Periodontal Disease (PD) based on nonimage electronic dental records (EDRs).

METHODS

By using EDRs collected in the BigMouth repository, dental patients from the US were included. Patients were labeled as cases or controls, based on PD diagnosis, treatment and pocketing. By learning from their data, a model was trained. The ability of the developed model to predict PD was evaluated by the accuracy, sensitivity, specificity and area under the curve (AUROC) and the most important features were determined. The best-performing model was applied to the validation set.

RESULTS

The final study population included 43,331 participants. Based on the development set, the Random Forest model performed with high sensitivity (81 %) and had an excellent AUROC (94 %), compared to four other ML and deep learning techniques. The most important predictors were bleeding proportion, age, the number of visits, prior preventive treatment, smoking and drugs usage. When the model was applied to the validation set, the model could detect almost all cases (91 %), but overestimated controls (specificity=0.54). When EDRs were retrieved 3 years before the PD diagnosis, the predictions for PD were still sensitive (89 %).

CONCLUSION

Based on consistent and complete EDR, ML has an excellent ability to assist with the early detection and prevention of PD cases. Further research is required to follow-up high-risk controls and improve the model's internal and external validation. Improved EDR documentation is an important first step.

CLINICAL SIGNIFICANCE

If such ML models become clinically applied, clinicians can be assisted with personalized risk predictions based on the individual. If the key riskcontributing factors for the individual are revealed/provided, ML can suggest targeted prevention interventions. These advancements can contribute to a reduced workload, sustainable EDRs, data-based dental care, and, ultimately, improved patient outcomes.

IgG In Saliva, GCF, and Serum in Young Patients With Grade C Molar Incisor Pattern Periodontitis

OBJECTIVE

This cross-sectional study aimed to investigate immunoglobulin G levels in saliva, gingival crevicular fluid, and serum samples from young patients with grade C molar incisor pattern periodontitis (C/MIP) and age-matched periodontitis-free controls.

METHODS

Saliva, gingival crevicular fluid, and blood samples were collected from 62 patients, divided into 31 cases and 31 periodontitis-free age-matched controls. Saliva and blood samples were centrifuged to extract supernatant and serum. Gingival crevicular fluid periopapers were eluted. Human total immunoglobulin G levels were assessed using an Enzyme-Linked Immunosorbent Assay.

RESULTS

After adjusting for covariates, cases had higher Immunoglobulin G levels in saliva (p = 0.005), gingival crevicular fluid (p < 0.001) than controls; however, serum did not reach the significant threshold (p = 0.137). Among other factors contributing to immunoglobulin G levels, males had higher serum immunoglobulin G than females (p = 0.018), and serum immunoglobulin G levels increased with age (p = 0.033). Gender and ethnicity subgroup analyses revealed that C/MIP males had higher saliva IgG (p = 0.018) than control males, and both genders had higher GCF IgG than controls (p ≤ 0.001). C/MIP Caucasians had elevated saliva (p = 0.011) and GCF IgG p = (0.003) compared to the controls, and Asians had higher GCF IgG than the controls (p = 0.011).

CONCLUSION

This study shows for the first time that C/MIP cases have higher Immunoglobulin G levels than controls in saliva and gingival crevicular fluid, confirming its association with C/MIP pathogenesis and suggesting that it could be a potential biomarker in grade C molar incisor pattern periodontitis. Further research on a larger sample size is needed.

Chairside live biotherapeutic hydrogel for comprehensive periodontitis therapy

Periodontitis, characterized by microbial dysbiosis and immune dysregulation, destroys tooth-supporting tissues and negatively affects overall health. Current strategies face significant challenges in restoring damaged tissues while halting periodontitis progression. In this study, we introduce a live biotherapeutic product (LBP) in an engineered living hydrogel for comprehensive periodontitis therapy. A dental blue light-responsive hydrogel (LRG) was fabricated to deliver and confine live Lactobacillus rhamnosus GG (LGG) in periodontal pockets, endowing the LRG with sustained antibacterial and immunomodulatory effects. The LRG was engineered through peptide modification to also promote tissue regeneration. Both in vitro and in vivo evaluations confirmed the effectiveness of this integrated therapeutic strategy, which combines antibacterial, anti-inflammatory, and regenerative properties with an underlying immunomodulatory mechanism that involves suppressor of cytokine signaling (SOCS)3 upregulation and the Janus kinase/signal transducer and activator of transcription (JAK-STAT) pathway suppression in macrophages. Demonstrating a new paradigm, this proof of concept highlights the synergistic integration of live organisms and synthetic material engineering in a chairside treatment to address the multifaceted etiology of periodontitis.