A public health perspective on personalized periodontics

A structural color hydrogel for diagnosis of halitosis and screening of periodontitis

Oral pathogens can produce volatile sulfur compounds (VSCs), which is the main reason for halitosis and indicates the risk of periodontitis. High-sensitivity detection of exhaled VSCs is urgently desired for promoting the point-of-care testing (POCT) of halitosis and screening of periodontitis. However, current detection methods often require bulky and costly instruments, as well as professional training, making them impractical for widespread detection. Here, a structural color hydrogel for naked-eye detection of exhaled VSCs is presented. VSCs can reduce disulfide bonds within the network, leading to expansion of the hydrogel and thus change of the structural color. A linear detection range of 0-1 ppm with a detection limit of 61 ppb can be achieved, covering the typical VSC concentration in the breath of patients with periodontitis. Furthermore, visual and in situ monitoring of Porphyromonas gingivalis responsible for periodontitis can be realized. By integrating the hydrogels into a sensor array, the oral health conditions of patients with halitosis can be evaluated and distinguished, offering risk assessment of periodontitis. Combined with a smartphone capable of color analysis, POCT of VSCs can be achieved, providing an approach for the monitoring of halitosis and screening of periodontitis.

Coffee consumption and periodontitis: a Mendelian Randomization study

BACKGROUND

Coffee is one of the most consumed beverages in the world, coffee consumption has been growing in the United States over the past 20 years. Periodontitis is defined by the pathologic loss of the periodontal ligament and destruction of the connective tissue attachment and alveolar bone loss and is related to different systemic diseases and conditions. However, the causality has remained unclarified, thus we regarded discovering the causal relationship between coffee consumption and the liability to periodontitis as the objective of the study.

METHODS

Coffee consumption was subdivided into binary coffee consumption and continuous coffee consumption to refine the study design. Genetic instruments were stretched from the MRC-IEU's (MRC Integrative Epidemiology Unit) output from the GWAS pipeline using phesant-derived variables based on the UK Biobank, the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) project, and the joint meta-analysis of a recent GWAS. The IVW (Inverse Variance Weighted) was regarded as the primary method to estimate the causality, a scatter plot revealed the intuitive result, and tests for stability were also carried out.

RESULTS

An effect of continuous coffee consumption on the risk of periodontitis was found, with per SD of coffee consumed increases, the risk of periodontitis rises by 1.04% (Odds Ratio of IVW is 1.0104), while the effect of binary coffee consumption on periodontitis did not meet the requirement of indicating a strong causal association, neither were the reverse causality analyses.

CONCLUSIONS

The study indicated the causality of continuous coffee consumption to the risk of periodontitis with a relatively small scale of effect estimate and no strong evidence for an effect of binary coffee-consuming behavior on periodontitis. There was also no intensive evidence suggesting reverse causality.

Use of bioinformatic strategies as a predictive tool in implant-supported oral rehabilitation: A scoping review

STATEMENT OF PROBLEM

The use of bioinformatic strategies is growing in dental implant protocols. The current expansion of Omics sciences and artificial intelligence (AI) algorithms in implant dentistry applications have not been documented and analyzed as a predictive tool for the success of dental implants.

PURPOSE

The purpose of this scoping review was to analyze how artificial intelligence algorithms and Omics technologies are being applied in the field of oral implantology as a predictive tool for dental implant success.

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist was followed. A search strategy was created at PubMed and Web of Science to answer the question "How is bioinformatics being applied in the area of oral implantology as a predictive tool for implant success?"

RESULTS

Thirteen articles were included in this review. Only 3 applied bioinformatic models combining AI algorithms and Omics technologies. These studies highlighted 2 key points for the creation of precision medicine: deep population phenotyping and the integration of Omics sciences in clinical protocols. Most of the studies identified applied AI only in the identification and classification of implant systems, quantification of peri-implant bone loss, and 3-dimensional bone analysis, planning implant placement.

CONCLUSIONS

The conventional criteria currently used as a technique for the diagnosis and monitoring of dental implants are insufficient and have low accuracy. Models that apply AI algorithms combined with precision methodologies-biomarkers-are extremely useful in the creation of precision medicine, allowing medical dentists to forecast the success of the implant. Tools that integrate the different types of data, including imaging, molecular, risk factor, and implant characteristics, are needed to make a more accurate and personalized prediction of implant success.

Assessment of the contextual effects on the prevalence of periodontitis: a systematic review

This study reviews the influence of contextual factors on periodontitis based on a systematic search of studies recorded in the PubMed, Scopus, Web of Science, and EMBASE databases. Periodontitis was assessed by clinical attachment loss and probing depth for studies with data on the socioeconomic status (SES) of a specific area (area-level SES) or dental care service (service-level) in a catchment area among individuals aged 18 and over. Two independent reviewers performed study selection, data extraction, and assessment of methodological quality. Of the 646 articles identified, 13 were included in the systematic review, representing 101,362 individuals from five countries (USA, UK, Brazil, China, and Uruguay). A higher prevalence of periodontitis was described in lower SES neighborhoods, more deprived postcodes, and poorer provinces. Gini Index results were mixed and inconclusive. Three studies showed that higher coverage of primary dental care at the municipal level was associated with a lower prevalence of periodontitis. Contextual factors at the area-level SES and dental care service might influence periodontitis, but the existing evidence is unclear. The contextual effect is important for periodontal health and may contribute to the prevalence of periodontitis, independent of well-known risk factors and individual levels.

Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil: a multilevel analysis

This study aimed to examine the effect of dental care services on periodontitis cases in Brazilian municipalities. The sample comprised 3,426 individuals aged 35-44 years. Moderate to severe periodontitis with clinical attachment loss and probing depth was the dependent variable, both > 3mm. Its exploratory variables were grouped into four categories: (1) individual characteristics; (2) contextual development indicators; (3) health service and structural factors; and (4) dental care use. Data were collected using the SBBrasil 2010 Project, the Brazilian Institute of Geography and Statistics, the Brazilian Information System of Primary and Secondary Care, and the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO). Multilevel logistic regression was used to assess associations of periodontitis with individual and context variables. Municipalities with > 1 CEO or > 1 of any centers were associated with periodontitis, with OR = 0.97 (95%CI: 0.55-1.71) and OR = 0.41 (95%CI: 0.17-0.97), respectively. Prevalence of periodontitis was more likely in older people, lower education levels, and individuals that sought dental visits for pain/extraction and periodontal treatment. Other dental care services availability were not associated with the prevalence of periodontitis.

Underdiagnosis in Background of Emerging Public Health Challenges Related to Peri-Implant Diseases: An Interventional Split-Mouth Study

Peri-implant diseases are an emerging public health problem, and it's considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies.

Enfermedad periodontal en latinoamerica: enfoque regional y estrategia sanitaria

La periodontitis es una enfermedad crónica de tipo no transmisible, caracterizada por ser inflamatoria, infecciosa y multifactorial. Es una de las enfermedades más prevalentes en cavidad oral hasta el punto de ser considerada una epidemia. Esta condición se puede prevenir y tratar; sin embargo, las medidas sanitarias siguen siendo insuficientes para lograr un control efectivo en la práctica clínica. La progresión de la periodontitis se basa en la presencia de un microbioma disbiótico que desencadena una respuesta inflamatoria del huésped, lo cual se traduce clínicamente en la pérdida del tejido de soporte dental y provoca su pérdida. Cabe destacar la importancia del conocimiento sobre la relación existente entre la enfermedad periodontal y la salud sistémica, la bidireccionalidad y la necesidad del manejo multidisciplinario. La periodontitis representa un problema para la salud pública de los países de Latinoamérica y es responsabilidad que los estados gubernamentales, así como de todo el personal sanitario, ejecutar estrategias de salud con el fin de reducir el impacto de la enfermedad en las poblaciones más vulnerables. El objetivo del presente ensayo es analizar los factores por los cuales la enfermedad periodontal sigue siendo altamente prevalente y, así mismo, promover la prevención de la enfermedad y medidas de control.

Periodontal disease could be a potential risk factor for non-alcoholic fatty liver disease: An 11-year retrospective follow-up study

OBJECTIVE

This study aimed to evaluate the association of periodontal disease with non-alcoholic fatty liver disease (NAFLD).

MATERIALS AND METHODS

A retrospective follow-up study using the National Health Insurance Service-National Sample Cohort was performed from 2002 to 2015 in the Korean population. A total of 165,032 subjects were followed up for incident NAFLD during 11 years. Periodontal disease and NAFLD were defined by a diagnosis using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes. Periodontal status was used as the severity of periodontal status and the number of dental visit due to PD.

RESULTS

Periodontitis was associated with a 4% increase in risk for NAFLD after adjusting for socio-demographic factor, health behaviors, and systemic diseases (adjusted hazard ratio [aHR] = 1.04, 95% CI = 1.01 to 1.07). Between the number of dental visit due to PD and the risk for NAFLD was observed a dose-effect association (aHR = 1.02, 95% CI = 0.99 to 1.05 for once; aHR = 1.10, 95% CI = 1.06 to 1.15 for two times; aHR = 1.14, 95% CI = 1.06 to 1.24 for three times).

CONCLUSIONS

Our data confirmed that periodontitis showed an association with a higher incidence of NAFLD.

CLINICAL RELEVANCE

Prevention and management of periodontal disease could be beneficial for reducing the risk of NAFLD.

Global burden of periodontal disease and its relation with socioeconomic development during 1990-2019

To analyze the global burden of periodontal disease and its relation with socioeconomic development. Data of global disability-adjusted life year (DALY) due to periodontal disease and human development index (HDI) from 1990 to 2019 were obtained from Global Health Data Exchange (GHDx) and human development reports. The trend of the global burden of periodontal disease from 1990 to 2019 was described. The correlation between age-standardized DALY rates and HDI were examined in 2019, and between-country periodontal disease burden inequality from 1990 to 2019 was measured using health-related Gini coefficients and concentration indexes. From 1990 to 2019, the global DALY rate due to periodontal disease increased from 78.63 to 85.48, and the epidemiological burden did not increase significantly. Statistical differences were found across different HDI categories for age-standardized DALY rates of periodontal disease ( 44.315, <0.01) in 2019. Linear regression analysis also revealed a negative correlation between age-standardized DALY rate of periodontal disease and HDI ( = -0.417, <0.01) . Gini coefficients decreased from 0.361 to 0.281 and concentration indexes fell from 0.0339 to -0.0538 between 1990 and 2019. The global burden of periodontal disease did not increase between 1990 and 2019, though the socioeconomic-associated inequality still existed. The burden of periodontal disease was more concentrated in less developed countries, and the socioeconomic-associated inequality has increased since 2000.

Evidence-based Recommendations on Periodontal Practice and the Management of Periodontal Patients During and After the COVID-19 Era: Challenging Infectious Diseases Spread by Airborne Transmission

Background:

Periodontal care, which was completely suspended during the peak of the SARS-Cov-2 pandemic and was delayed and recurrently discontinued during the succeeding waves, must be safely provided in the COVID-19 era.

Objectives:

The study aimed to provide recommendations on periodontal practice, optimizing safety, ergonomics, and economic resources, and the management of periodontal patients, ensuring continuity, timing, and effectiveness of periodontal care in the COVID-19 era.

Methods:

Reported protocols for the dental practice in the context of the COVID-19 and current evidence on periodontitis treatment and prevention were reviewed.

Results:

Evidence-based recommendations on contamination control and ergonomic improvements for periodontal practice and the management of periodontal patients challenging COVID-19 and airborne infectious diseases have been provided.

Conclusion:

Due to the economic, ergonomic, and ethical concerns raised by limited periodontal care due to the SARS-Cov-2 pandemic, and awareness of other emerging airborne transmitted infections, the periodontal practice should integrate measures minimizing airborne cross-infections and optimizing time-space and economic resources. The management of periodontal patients in the COVID-19 era should comprise less complex treatments and more comprehensive and definitive approaches, reducing emergencies, session length and number, and, concurrently, extending the recall and maintenance intervals. Moreover, it should implement prevention strategies through teledentistry tools and apps, improving periodontal awareness and self-care, and also through the self-reporting of periodontitis and periodontal risk assessment tools, performing both “population-based” and “high-risk” surveillance of periodontitis. Finally, it should enhance inter-professional collaboration, through telehealth networks, especially targeting subjects at high-risk of both periodontitis and systemic disorders, each of the two variously linked to COVID-19 onset and worsening.

A Roadmap towards Precision Periodontics

Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice.

A Century of Change towards Prevention and Minimal Intervention in Cariology

Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.

Applications of nano-materials in diverse dentistry regimes

Research and development in the applied sciences at the atomic or molecular level is the order of the day under the domain of nanotechnology or nano-science with enormous influence on nearly all areas of human health and activities comprising diverse medical fields such as pharmacological studies, clinical diagnoses, and supplementary immune system. The field of nano-dentistry has emerged due to the assorted dental applications of nano-technology. This review provides a brief introduction to the general nanotechnology field and a comprehensive overview of the synthesis features and dental uses of nano-materials including current innovations and future expectations with general comments on the latest advancements in the mechanisms and the most significant toxicological dimensions.

Epigenetic reprogramming in periodontal disease: Dynamic crosstalk with potential impact in oncogenesis

Periodontitis is a chronic multifactorial inflammatory disease associated with microbial dysbiosis and characterized by progressive destruction of the periodontal tissues. Such chronic infectious inflammatory disease is recognized as a major public health problem worldwide with measurable impact in systemic health. It has become evident that the periodontal disease phenotypes are not only determined by the microbiome effect, but the extent of the tissue response is also driven by the host genome and epigenome patterns responding to various environmental exposures. More recently there is mounting evidence indicating that epigenetic reprogramming in response to combined intrinsic and environmental exposures, might be particularly relevant due its plasticity and potential application towards precision health. The complex epigenetic crosstalk is reflected in the prognosis and progress of periodontal diseases and may also lead to a favorable landscape for cancer development. This review discusses epigenomics modifications focusing on the role of DNA methylation and pathways linking microbial infection and inflammatory pathways, which are also associated with carcinogenesis. There is a more clear vision whereas 'omics' technologies applied to unveil relevant epigenetic factors could play a significant role in the treatment of periodontal disease in a personalized mode, evidencing that public health approach should coexist with precision individualized treatment.

Stem cells in the periodontal ligament differentiated into osteogenic, fibrogenic and cementogenic lineages for the regeneration of the periodontal complex

OBJECTIVE

Human periodontal ligament stem cells (hPDLSCs) are promising for periodontal regeneration. However, to date, there has been no report of hPDLSC differentiation into the fibrogenic lineage. There has been no report demonstrating hPDLSC differentiation into all three (osteogenic, fibrogenic and cementogenic fibrogenic) lineages in the same report. The objectives of this study were to harvest hPDLSCs from the periodontal ligaments (PDL) of the extracted human teeth, and use the same vial of hPDLSCs to differentiate into all three (osteogenic, fibrogenic and cementogenic) lineages for the first time.

METHODS

hPDLSCs were harvested from PDL tissues of the extracted premolars. The ability of hPDLSCs to form bone, cementum and collagen fibers was tested in culture mediums. Gene expressions were analyzed using quantitative real-time polymerase chain reaction (qRT-PCR). Immunofluorescence, alizarin red (ARS), Xylenol orange, picro sirius red staining (PSRS), alcian blue staining (ABS) and alkaline phosphatase (ALP) staining were evaluated.

RESULTS

In osteogenic medium, hPDLSCs had high expressions of osteogenic genes (RUNX2, ALP, OPN and COL1) at 14 and 21 days (15-20 folds of that of control), and produced mineral nodules and ALP activity (5 and 10 folds those of the control). hPDLSCs in fibrogenic medium expressed high levels of PDL fibrogenic genes (COL1, COL3, FSP-1, PLAP-1 and Elastin) at 28 days (20-70 folds of control). They were stained strongly with F-actin and fibronection, and secreted PDL collagen fibers (5 folds of control). hPDLSCs in cementogenic medium showed high expressions of cementum genes (CAP, CEMP1 and BSP) at 21 days (10-15 folds of control) and synthesized mineralized cementum (50 folds via ABS, and 40 folds via ALP staining, compared to those of control).

CONCLUSIONS

hPDLSCs differentiated into bone-, fiber- and cementum-forming cells, with potential for regeneration of periodontium to form the bone-PDL-cementum complex.

Lifestyle and periodontitis: The emergence of personalized periodontics

Personalized medicine is a medical model that involves the tailoring of healthcare - with medical decisions, practices, and/or products being customized to an individual patient. In this model, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the context of a patient's genetic content or other epidemiologic, sociologic, molecular, physiologic, or cellular analyses. With the advent of major advances in periodontal medicine, including genomic discoveries and greater understanding of the multifactorial nature of periodontitis, it seems that the time is ripe to use personalized medicine as a model for personalized periodontics. This volume of Periodontology 2000 explores how new advances in our understanding of periodontitis within a medical model can evolve into new treatment strategies tailor-made for individual patients and not merely based on wholesale treatment paradigms.