Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way

Manganese dioxide coupled metal-organic framework as mitophagy regulator alleviates periodontitis through SIRT1-FOXO3-BNIP3 signaling axis

Periodontitis is a prevalent chronic inflammatory disease characterized by alveolar bone resorption. Its progression is closely linked to oxidative stress where reactive oxygen species (ROS) generated by mitochondria exacerbate inflammation in positive feedback loops. Strategies for mitochondrial regulation hold potential for therapeutic advances. Metal-organic frameworks (MOFs) have shown promise as nanozymes for ROS scavenging. However, inability to directly regulate cellular processes to prevent further ROS production from damaged mitochondria during persistent inflammation makes MOFs insufficient in treating periodontitis. This study synthesizes MnO2@UiO-66(Ce) by introducing MnO2 within nanoscale mesoporous UiO-66 type MOFs. MnO2 coupled with Ce clusters in MOF channels, forms a superoxide dismutase/catalase cascade catalytic system. More importantnly, manganese endows the MOFs with bioactive effects which enhances mitophagy, facilitating the removal of damaged mitochondria, thereby restoring long-term cellular homeostasis. The results demonstrate that this synergistic antioxidant solution MnO2@UiO-66 restores mitochondrial homeostasis and osteogenic activity of periodontal ligament cells in vitro and alleviates inflammatory bone resorption in a ligature-induced periodontitis model in vivo. The SIRT1-FOXO3-BNIP3 signaling axis plays a key role in this process. This study may provide a design strategy that combines a highly efficient cascade catalytic system with long-term regulation of cellular homeostasis to combat oxidative stress in chronic inflammation.

A nucleoside-based supramolecular hydrogel integrating localized self-delivery and immunomodulation for periodontitis treatment

Periodontitis is a highly prevalent oral disease characterized by bacterial-induced hyperactivation of the host immune system, leading to a sustained inflammatory response and osteoclastic activity, which ultimately results in periodontal destruction. In this work, an immunomodulatory supramolecular hydrogel for the topical treatment of periodontitis was synthesized using a simple one-pot method. This phenylboronate ester-based 8AGPB hydrogel exhibited excellent stability, self-healing properties, injectability, and biocompatibility. During degradation, the 8AGPB hydrogel releases immunomodulatory agent 8-aminoguanosine (8AG), which regulates MAPK and NF-κB signaling pathways by modulation of second messengers in macrophages. In combination with 1,4-phenylenediboronic acid (PBA), which possesses antioxidant properties, 8AG effectively inhibits ROS production and oxidative damage in LPS-stimulated macrophages, lowering the M1/M2 macrophage polarization ratio and reducing the secretion of pro-inflammatory factors. In an experimental periodontitis model using C57BL/6 mice, periodontal injection of the 8AGPB hydrogel reduced inflammatory infiltration and osteoclastic activity through immunomodulation and inhibition of osteoclast differentiation, thereby ameliorating periodontal destruction during periodontitis progression. Overall, the 8AGPB supramolecular hydrogel, serving as an injectable self-delivery platform for 8AG, may represent a promising novel strategy for periodontitis treatment and offer insights for the development of future topical anti-inflammatory systems.

BPIFA1 inhibits periodontitis by regulating the NF-κB/IκB signaling pathway and macrophage M1/M2 polarization

BACKGROUND

Periodontitis is a chronic inflammatory disease characterized by tissue destruction and oxidative stress, primarily driven by the imbalance of immune responses. Bactericidal/permeability-increasing fold-containing family A member 1 (BPIFA1) has emerged as a key modulator of inflammation and immune homeostasis.

OBJECTIVES

This study investigates the role of BPIFA1 in periodontitis by focusing on its regulatory effects on the NF-κB/IκB signaling pathway and macrophage M1/M2 polarization.

METHODS

Saliva and periodontal tissue samples were collected from 20 periodontitis patients and 20 healthy volunteers. BPIFA1 expression was analyzed using qRT-PCR and Western blot. In vivo studies were conducted in wild-type and BPIFA1-knockout (KO) mice, where periodontitis was induced via ligature placement and LPS injections. Oxidative stress markers (ROS, MDA, SOD), inflammatory cytokines (TNF-α, IL-6), and macrophage polarization markers (iNOS, CD86, Arg-1, CD206) were quantified. NF-κB pathway activation was assessed through Western blot analysis.

RESULTS

BPIFA1 expression was significantly reduced in periodontitis patients and BPIFA1-KO mice. Loss of BPIFA1 resulted in increased oxidative stress, heightened NF-κB activation, and an imbalance in macrophage polarization, with increased M1 (pro-inflammatory) and decreased M2 (anti-inflammatory) macrophages. Additionally, BPIFA1 deficiency promoted Th17 differentiation and suppressed Treg cells, exacerbating periodontal inflammation.

CONCLUSION

BPIFA1 plays a critical role in inhibiting periodontitis progression by regulating the NF-κB/IκB signaling pathway and restoring macrophage M1/M2 balance. These findings highlight BPIFA1 as a potential therapeutic target for periodontitis management.

Focusing on ferroptosis in alveolar bone loss during periodontitis: From mechanisms to therapies

Periodontitis is an oral immunoinflammatory disease induced by bacterial infection. During periodontitis, the aggravating destruction of the alveolar bone can result in tooth movement and even tooth loss. Current conventional treatments for periodontitis primarily focus on infection control, but their effectiveness in halting and restoring alveolar bone destruction is limited. To identify additional therapeutic targets, researchers have been dedicated to investigating other pathological mechanisms underlying alveolar bone loss during periodontitis. Recently, findings indicate that ferroptosis plays a role in the development of periodontitis. Ferroptosis is a nonapoptotic type of cell death marked by iron accumulation and lipid peroxidation. Recent investigations have revealed the complex interplay of ferroptosis and inflammation. The positive feedback loop between ferroptosis and inflammation may significantly contribute to the exacerbation of alveolar bone loss. In light of the advancements in research within this field in recent years, this review intends to thoroughly summarize the processes by which ferroptosis aggravates alveolar bone loss during periodontitis, along with relevant ferroptosis-targeted therapeutic agents. By highlighting the latest advancements in this area, we hope this review will inspire researchers to develop novel therapeutic strategies for more effective inflammation control and regeneration of alveolar bone.

Comparison of the effects between catalase and superoxide dismutase on regulating macrophage inflammatory response and protecting osteogenic function of periodontal ligament cells

BACKGROUND

Reactive oxygen species (ROS) have been confirmed closely associated with the pathological process of periodontitis, but the specific roles played by different ROS types are still to be investigated. Catalase (CAT) and Superoxide dismutase (SOD) specifically eliminate hydrogen peroxide (H2O2) and superoxide anion (O2•-), respectively. We for the first time compare the effects and mechanisms of CAT and SOD in protecting periodontal ligament cells (PDLCs) against oxidative damage, reducing the expression of macrophage inflammatory factors, and preserving the osteogenic differentiation function of PDLCs by modulating the inflammatory environment.

METHODS

CAT or SOD in combination with lipopolysaccharide (LPS) were added to the culture medium of RAW 264.7 and PDLCs. The intracellular ROS level, lipid peroxidation and DNA damage were observed by confocal microscope. Inflammation levels were assessed by real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot. A co-culture system of macrophages and PDLCs was established, and the osteogenic differentiation of PDLCs was evaluated by alkaline phosphatase staining, alizarin red S staining, RT-qPCR and Western blot. Finally, differentially expressed genes (DEGs) in CAT and SOD were detected by RNA sequencing and the biological functions and signaling pathways involved were analyzed.

RESULTS

CAT or SOD can effectively inhibit intracellular ROS levels, lipid peroxidation and DNA damage, as well as increase the levels of antioxidative molecules and decrease the levels of inflammatory factors. SOD increased the levels of antioxidative molecules more strongly, while CAT reduced inflammatory factors more effectively. The RNA sequencing results indicate that CAT exhibits stronger inhibitory effects on inflammation-related signaling pathways, which could account for the observed differences.

CONCLUSIONS

In this study, we observed differential antioxidant and anti-inflammatory effects between CAT and SOD, which may be associated with CAT's better inhibition of the activation of inflammatory pathways. Our study will provide scientific references for the future development of highly selective ROS- scavenging antioxidant drugs.

Micro/nanomotors for active inflammatory disease therapy

Inflammation is a carefully orchestrated response of the immune system to repair injured tissues and clear various damage factors. However, dysregulated inflammation can eventually contribute to the development and progression of various inflammatory diseases. Although anti-inflammatory drugs have demonstrated certain therapeutic efficacy in clinical settings, significant limitations still persist, highlighting the necessity for the development of improved approaches to address complex inflammatory conditions. Micro/nanomotors (MNMs) have shown significant promise for applications in the biomedical field due to their micro/nano-scale sizes and autonomous movement. Unlike traditional nanoparticles, which exhibit passive diffusion in biological fluids, MNMs can convert external energy into a driving force for self-propulsion. This capability not only enhances the tissue penetration depth and retention rates but also facilitates interaction with inflammatory lesions. Recent efforts have suggested that MNMs for inflammatory disease therapy could provide an efficient therapeutic effect. Herein, we mainly introduce the recent advances in inflammatory disease therapy based on MNMs. We conclude by discussing both the obstacles and potential opportunities for MNMs innovations in addressing inflammation.

The salivary metabolomics analyses reveal the variable metabolites in distinct staging of periodontitis

OBJECTIVE

Saliva, which is a critical component of the oral ecosystem, undergoes dynamic changes, particularly during the onset and progression of periodontitis.

SUBJECTS AND METHODS

This study used Gas Chromatography-Mass Spectrometry (GC-MS), a reliable and high-throughput tool for metabolomic analysis, to detect salivary metabolic shifts across various stages of periodontitis (T1-T4). We compared differential changes in metabolites between the HC and T1 groups, the T1 and T2 groups, the T2 and T3 groups, and the T3 and T4 groups.

RESULTS

By analysing saliva samples from 116 individuals-10 healthy controls (HC) and 106 patients with periodontitis across stages T1 (22 individuals) to T4 (28 individuals), we identified differential metabolites including Glucose, 3-Aminobutanoic Acid, N-(1-Cyclopropylethyl) Aniline, and Methylmalonic Acid. Compared to HC, the metabolites in patients with periodontitis exhibited progressive concentration changes correlating with the severity of the disease. Furthermore, KEGG pathway analysis was used to elucidate the metabolic pathways involved in the development of periodontitis.

CONCLUSIONS

Our findings demonstrate the potential of salivary metabolites as biomarkers for monitoring periodontitis progression and offer valuable insights into its pathogenesis and potential therapeutic targets.

Association Between Neutrophil Percentage-to-Albumin Ratio and Periodontitis: A Cross-Sectional Study

INTRODUCTION AND AIMS

Neutrophil percentage-to-albumin ratio (NPAR) is a novel biomarker of systemic inflammation. The aim of this study was to explore the relationship between NPAR and periodontitis.

METHODS

Data from the National Health and Nutritional Examination Survey (NHANES) between 2009 and 2014 (N = 10,128) were utilized in this cross-sectional study. Periodontitis categories were defined according to the Centres for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP) classification. The NPAR was calculated by dividing the neutrophil percentage by serum albumin. Covariates included age, sex, race, education level, annual household income, marital status, smoking status, BMI, recreational activity, work activity, diabetes mellitus, hypertension, and cardiovascular disease. Weighted logistic regression analysis was conducted to investigate the linkage between NPAR and moderate/severe periodontitis, and weighted linear regression analysis was performed to explore the relationship of NPAR with mean attachment loss (AL) and mean probing pocket depth (PPD).

RESULTS

Our analysis revealed a positive linear relationship between NPAR and periodontitis. Specifically, we found that the risk of moderate/severe periodontitis increased by 12% for each standard deviation increase in NPAR. Individuals in the highest tertile of NPAR were 28% more likely to have periodontitis compared to those in the lowest tertile (ORtertile3vs1 = 1.28, 95% CI: 1.10-1.49). These findings were consistent across different subgroups analysed. Furthermore, our study demonstrated that NPAR was also positively correlated with mean AL and PPD, which are key indicators of periodontal health.

CONCLUSIONS

Our results suggest that NPAR is significantly linked to poor periodontal health. However, owing to the cross-section design of this study, additional longitudinal studies are necessary to further enhance our comprehension of the impact of NPAR on periodontal status.

CLINICAL RELEVANCE

Elevated neutrophil counts and low albumin levels correlate with moderate/severe periodontitis. Monitoring these markers may aid in assessing periodontitis risk.

Supersulfides contribute to joint homeostasis and bone regeneration

The physiological functions of supersulfides, inorganic and organic sulfides with sulfur catenation, have been extensively studied. Their synthesis is mainly mediated by mitochondrial cysteinyl-tRNA synthetase (CARS2) that functions as a principal cysteine persulfide synthase. This study aimed to investigate the role of supersulfides in joint homeostasis and bone regeneration. Using Cars2AINK/+ mutant mice, in which the KIIK motif of CARS2 essential for supersulfide production was replaced with AINK, we evaluated the role of supersulfides in fracture healing and cartilage homeostasis during osteoarthritis (OA). Tibial fracture surgery was performed on the wild-type (Cars2+/+) and Cars2AINK/+ mice littermates. Bulk RNA-seq analysis for the osteochondral regeneration in the fracture model showed increased inflammatory markers and reduced osteogenic factors, indicative of impaired bone regeneration, in Cars2AINK/+ mice. Destabilization of the medial meniscus (DMM) surgery was performed to produce the mouse OA model. Histological analyses with Osteoarthritis Research Society International and synovitis scores revealed accelerated OA progression in Cars2AINK/+ mice compared with that in Cars2+/+ mice. To assess the effects of supersulfides on OA progression, glutathione trisulfide (GSSSG) or saline was periodically injected into the mouse knee joints after the DMM surgery. Thus, supersulfides derived from CARS2 and GSSSG exogenously administered significantly inhibited inflammation and lipid peroxidation of the joint cartilage, possibly through suppression of ferroptosis, during OA development. This study represents a significant advancement in understanding anti-inflammatory and anti-oxidant functions of supersulfides in skeletal tissues and may have a clinical relevance for the bone healing and OA therapeutics.

New Advances in Periodontal Functional Materials Based on Antibacterial, Anti-Inflammatory, and Tissue Regeneration Strategies

With the global population aging, awareness of oral health is rising. Periodontitis, a widespread bacterial infectious disease, is gaining attention. Current novel biomaterials address key clinical issues like bacterial infection, gum inflammation, tooth loosening, and loss, focusing on antibacterial, anti-inflammatory, and tissue regeneration properties. However, strategies that integrate the advantages of these biomaterials to achieve synergistic therapeutic effects by clearing oral biofilms, inhibiting inflammation activation, and restoring periodontal soft and hard tissue functions remain very limited. Recent studies highlight the link between periodontitis and systemic diseases, underscoring the complexity of the periodontal disease. There is an urgent need to find comprehensive treatment plans that address clinical requirements. Whether by integrating new biomaterials to enhance existing periodontal treatments or by developing novel approaches to replace traditional therapies, these efforts will drive advancements in periodontitis treatment. Therefore, this review compares novel biomaterials with traditional treatments. It highlights the design concepts and mechanisms of these functional materials, focusing on their antibacterial, anti-inflammatory, and tissue regeneration properties, and discusses the importance of developing comprehensive treatment strategies. This review aims to provide guidance for emerging periodontitis research and to promote the development of precise and efficient treatment strategies.

Proanthocyanidin B2 alleviates Pg.LPS-induced RAW264.7 cellular inflammation and oxidative stress via PI3K/Akt/NFkB pathway

Periodontitis is a multifactorial chronic inflammatory infectious disease associated with systemic diseases. Proanthocyanidin B2 (PB2), a polyphenol, has been investigated to exhibit antioxidant, anti-inflammatory and anti-cancer pharmacological properties. PB2 has shown good efficacy in treating hepatocellular carcinoma, type 2 diabetes mellitus, and ulcerative colitis. There are few studies on PB2 in treating periodontitis, and the molecular mechanism is unknown. This research focused on the effects of PB2 in Porphyromonas gingivalis-derived lipopolysaccharide (Pg. LPS)-stimulated RAW264.7 cells, as well as the potential mechanisms. CCK-8 assay was used to assess the cytotoxic effects of PB2. qRT-PCR assay and ELISA assay were used to evaluate the expression of inflammatory cytokines. DCFH-DA probe and other assay kits were employed to detect oxidative stress indicators. Western blot was conducted to assess important proteins of the PI3K/Akt/NFκB pathway. The results showed that PB2 downregulated the overproduction of pro-inflammatory mediators IL-1β, IL-6, and TNF-α; reduced the generation of ROS, MDA, and NO; Enhanced the activities of anti-inflammatory factor IL-10 and the total antioxidant capacity; and inhibited the activation of PI3K/Akt/NFκB pathway. In addition, the PI3K agonist 740Y-P was able to partially reverse the effects of PB2. This study indicates that PB2 exhibits significant anti-inflammatory and antioxidant effects in P. gingivalis LPS-stimulated RAW264.7 cells, primarily through the inhibition of the PI3K/Akt/NFκB signaling pathway.

Iron Status and Risk of Periodontitis and Dental Caries: A Mendelian Randomization Study

BACKGROUND

Previous studies have indicated a potential relationship between iron status and oral health outcomes, specifically periodontitis and dental caries. This study employed Mendelian randomization (MR) to investigate the causal effects of iron status on these oral health conditions. The focus of this study was on key iron biomarkers, namely serum iron, ferritin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC).

METHODS

This two-sample MR analysis employed genome-wide association study (GWAS) data. The instrumental variables (IVs) were selected based on their genome-wide significance and independence from confounders. The statistical analyses employed the inverse variance weighted (IVW) method, MR-Egger regression, weighted median, and weighted mode. Additionally, sensitivity analyses were conducted to verify the reliability of the causal association results.

RESULTS

The MR analysis indicated a suggestive negative causal relationship between TIBC and periodontitis, with an odds ratios of 0.875 and a 95% CI of 0.766-0.998, with a P-value of .047. No significant other associations were found. The results of sensitivity analyses demonstrated the robustness of these findings.

CONCLUSION

This MR study suggested a potential negative association between TIBC and periodontitis, highlighting the importance of considering iron status in the clinical management of chronic periodontitis. However, more standardized, multi-population studies are needed to confirm this causality.

Healthy Dietary Pattern Improves Cognitive Function in Elderly Persons With Periodontitis: A Cross-Sectional Study of NHANES

AIM

Cognitive decline is thought to be more prevalent in elderly persons with periodontitis. Greater adherence to Healthy Eating Index (HEI)-2015 has been reported to improve cognitive function in the elderly population. However, whether the benefits of HEI-2015 on cognitive function apply to elderly patients with periodontitis remains unknown.

METHODS

This is a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). The data were extracted from database 2011-2014. Cognitive function was measured through the Consortium to Establish a Registry for Alzheimer's Disease battery for immediate recall (CERAD-WL) and delayed recall (CERAD-DR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). The data of HEI-2015 were acquired from 24-hour dietary recalls. Weighted linear regression models were performed to investigate the association between HEI-2015 and cognitive function in elderly patients with periodontitis. The associations were further investigated in subgroups of sex, cardiovascular disease status, and depression status.

RESULTS

A total of 1862 participants were included, and 1223 of them had periodontitis. Periodontitis was negatively associated with cognitive function (β = -0.45; 95% confidence interval [CI], -0.87 to -0.03). No statistically significant relationship was observed between HEI-2015 and cognitive function (β = 0.33; 95% CI, -0.02 to 0.69). Low HEI-2015 score was associated with high odds of cognitive decline in patients with periodontitis (β = -0.73; 95% CI, -1.25 to -0.21; P for trend = .01). Higher HEI-2015 was related to the lower incidence of cognitive function decline in patients with periodontitis who were female (β = -0.53; 95% CI, -1.03 to -0.03), had a socioeconomic status from 0 to 3 (β = -0.55; 95% CI, -1.00 to -0.09), did not have cardiovascular disease (β = -0.60; 95% CI, -1.14 to -0.05), and did not have depression (β = -0.57; 95% CI, -1.11 to -0.03).

CONCLUSIONS

Greater HEI-2015 adherence may improve cognitive function amongst elderly patients with periodontitis. Further studies are needed to investigate this putative association in elderly persons with periodontitis.

Clinical efficacy of adjunctive use of coenzyme Q10 in non-surgical periodontal treatment: A systematic review

This systematic review evaluated the effects of coenzyme Q10 (CoQ10) in non-surgical periodontal treatment (PROSPERO: CRD42022311286). Five databases were screened (up to May/2024). It included only randomized controlled trials (RCTs) of subgingival scaling root planing (SRP) with or without adjunct use of the antioxidant CoQ10 in adults with periodontitis. The risk of bias and the certainty of the evidence were assessed. Meta-analyses were conducted to estimate mean differences for probing depth (PD) and clinical attachment level (CAL) between baseline and follow-up. Ten studies were included, of which four administered CoQ10 locally (topical [n = 1]; intra-pocket [n = 3] modalities), and six used oral supplementation. There was no significant effect of local use of CoQ10 on reduction of PD and gain in CAL. Daily oral supplementation (120 mg/day) with CoQ10 resulted in a greater mean reduction of PD by 0.41 mm (95% CI: 0.02-0.80) and a greater mean CAL gain by 0.52 mm (95% CI: 0.26-0.78) than seen in controls. Based on very low certainty of evidence, there was no significant effect of locally delivered Q10 gel on PD/CAL, but daily oral supplementation with CoQ10 resulted in better periodontal health after 12 weeks.

Attenuated NIX in impaired mitophagy contributes to exacerbating cellular senescence in experimental periodontitis under hyperglycemic conditions

Premature accumulation of senescent cells results in tissue destruction, and it is one of the potential primary mechanisms underlying the accelerated progression of diabetes and periodontitis. However, whether this characterized phenomenon could account for periodontal pathogenesis under hyperglycemic conditions remains unclear. In this study, we assessed the senescent phenotypic changes in experimental periodontitis under hyperglycemic conditions. Next, we investigated the mitochondrial function and the potential mitophagy pathways in cellular senescence in vitro and in vivo. Our findings showed that significant senescence occurred in the gingival tissues of diabetic periodontitis mice with increased expression of senescence-related protein p21Cip1 and the senescence-associated secretory phenotype response as well as the decreased expression of NIP3-like protein X (NIX), a mitochondrial receptor. Likewise, we showed that mitochondrial dysfunction (e.g., reduction of mitochondrial membrane potential and accumulation of reactive oxygen species) was attributed to cellular senescence in: human periodontal ligament cells (hPDLCs) through hyperglycemia-induced and Porphyromonas gingivalis lipopolysaccharide (P.g-LPS)-induced oxidative stresses. Notably, the resulting reduced NIX expression was reversed by the use of the mitochondrial reactive oxygen species (ROS) scavenger N-acetyl-l-cysteine (NAC), thus correcting the mitochondrial dysfunction. We further verified the expression of inflammatory mediators and senescence-related factors in mice gingival tissues and identified the possible regulatory pathways. Taken together, our work demonstrates the critical role of cellular senescence and mitochondrial dysfunction in periodontal pathogenesis under hyperglycemic conditions. Hence, restoration of mitochondrial function may be a potential novel therapeutic approach to tackling periodontitis in diabetic patients.

Challenges and improvements in multi-layer mucosa-adhesive films for oral diseases treatment and prognosis

Due to the complexity of oral physiology and pathology, the treatment of oral diseases faces multiple and complex clinical requirements. Mucosa-adhesive films (MAFs) with a single layer have demonstrated considerable potential in delivering therapeutic bioactive ingredients directly to the site of oral diseases. However, their functions are often hindered by certain factors such as limited loading capacity, poor site specificity, and sensitivity to mechanical stimuli. To overcome these limitations, the development of multi-layer MAFs has become a focal point for recent research. This involves the improvement of construction methods for multi-layer MAFs to minimize potential health risks from residual solvents, and conducting comprehensive in vivo studies to evaluate their safety and therapeutic efficacy more accurately, thus paving the way for their commercialization. Additionally, the exploration of multi-layer MAFs as personalized drug delivery systems could further broaden their application prospect. Precisely, multi-layer MAFs compensate for the shortcomings of current therapeutic strategies for oral diseases to a great extent, indicating a promising future in the market.

Comprehensive LC-MS Profiling and Evaluation of Antimicrobial, Antibiofilm, Antioxidant, and Anti-inflammatory Properties of Alcoholic Extracts of Brassica fruticulosa subsp. numidica (Coss.) Maire

Brassica fruticulosa subsp. numidica, an underutilized species in the Brassicaceae family, offers significant potential for discovering bioactive compounds. This study analyzed its ethanolic (EE) and methanolic (ME) extracts for phytochemical composition and bioactivity, identifying key compounds via liquid chromatography-mass spectrometry (LC-MS). EE was rich in phenolic acids, notably cinnamic acid (59.33%) and coumaric acid (24.39%), while ME contained a high concentration of riboflavin (99.25%). EE exhibited potent antimicrobial activity, particularly against Pseudomonas aeruginosa (IZD: 17.5 mm; MIC: 62.5 µg/mL), and reduced biofilm formation by up to 72%, whereas ME demonstrated superior antioxidant (IC50: 67.46 ± 0.03 µg/mL) and anti-inflammatory effects (maximum inhibition: 78.10% at 2500 µg/mL). Neither extract showed efficacy against Staphylococcus aureus or fungal strains. These results underscore the therapeutic potential of B. fruticulosa subsp. numidica and highlight its promise for natural product-based drug discovery, warranting further research on compound isolation, mechanistic studies, and in vivo validation.

DNA Methylation in Periodontal Disease: A Focus on Folate, Folic Acid, Mitochondria, and Dietary Intervention

Although periodontal disease (PD) is reported to be associated with changes in various genes and proteins in both invading bacteria and the host, its molecular mechanism of pathogenesis remains unclear. Changes in immune and inflammatory genes play a significant role in PD pathogenesis. Some reports relate alterations in cellular epigenetic patterns to PD characteristics, while several high-throughput analyses indicate thousands of differentially methylated genes in both PD patients and controls. Furthermore, changes in DNA methylation patterns in inflammation-related genes have been linked to the efficacy of periodontal therapy, as demonstrated by findings related to the cytochrome C oxidase II gene. Distinct DNA methylation patterns in mesenchymal stem cells from PD patients and controls persisted despite the reversal of phenotypic PD. Methyl groups for DNA methylation are supplied by S-adenosylmethionine, which is synthesized with the involvement of folate, an essential nutrient known to play a role in maintaining mitochondrial homeostasis, reported to be compromised in PD. Folate may benefit PD through its antioxidant action against reactive oxygen and nitrogen species that are overproduced by dysfunctional mitochondria. As such, DNA methylation, dietary folate, and mitochondrial quality control may interact in PD pathogenesis. In this narrative/hypothesis review, we demonstrate how PD is associated with changes in mitochondrial homeostasis, which may, in turn, be improved by folate, potentially altering the epigenetic patterns of immune and inflammatory genes in both the nucleus and mitochondria. Therefore, a folate-based dietary intervention is recommended for PD prevention and as an adjunct therapy. At the same time, further research is needed on the involvement of epigenetic mechanisms in the beneficial effects of folate on PD studies.

Genipin attenuates oxidative damage in periodontal tissues by alleviating mitochondrial dysfunction and abnormal glucose uptake through inhibition of UCP2

Introduction

Periodontitis is a chronic inflammatory disease closely associated with mitochondrial dysfunction. Uncoupling protein 2 (UCP2), located in the inner membrane of mitochondria, reduces mitochondrial membrane potential (MMP) and adenosine triphosphate (ATP) synthesis by promoting proton leakage across the membrane. This leads to decreased energy metabolism efficiency, impairing cellular glucose uptake, and disrupting intracellular energy balance. Genipin (GP), a recognized UCP2 inhibitor, exhibits anti-inflammatory and antioxidant properties. This study aimed to investigate the specific role of GP in periodontal tissue redox signaling and the potential mechanism of UCP2 in the development of periodontitis.

Methods

In this study, we constructed a model of H2O2-induced oxidative stress in human periodontal ligament cells (hPDLCs). In vivo, a rat periodontitis model was established to evaluate the effects and mechanisms of GP in alleviating oxidative damage in periodontal tissues and cells.

Results

Cell experiments showed that GP effectively alleviated H2O2-induced mitochondrial dysfunction and oxidative damage in hPDLCs by inhibiting UCP2 expression and function, restoring cell viability, and reducing cell apoptosis. Additionally, GP intervention increased the expression of glucose transporter 4 (GLUT4), thereby promoting cellular glucose uptake. The results of animal experiments demonstrated that GP intervention reduced alveolar bone resorption and periodontal tissue destruction in rats with periodontitis, inhibited osteoclast differentiation, improved mitochondrial dysfunction in periodontal tissue, promoted GLUT4 expression, and reduced oxidative stress levels and cell apoptosis.

Discussion

GP regulates oxidative damage in periodontal tissues by maintaining mitochondrial homeostasis, promoting glucose transporter expression, and enhancing glucose uptake, with UCP2 playing a central role.

Ginsenoside Rb3 Inhibits Oxidative Stress and Alleviates Experimental Periodontitis in Rats

OBJECTIVE

This study investigated the anti-inflammatory and antioxidative effects of ginsenoside Rb3 on experimental periodontitis.

METHODS

Experimental periodontitis was established by ligating the maxillary first molars. After 21 days of Rb3 treatment, rats were sacrificed for micro-CT and H&E staining analysis and serum assay. qPCR detected the expression of inflammatory genes. IF detected MAPKs pathway activation in periodontal tissues. The effects were determined using LPS-induced RAW264.7 cells. Gene expression levels were determined by qPCR. Intracellular ROS generation was detected by DCFH-DA staining and flow cytometry. WB detected the activation of signaling pathways.

RESULTS

Rb3 inhibited oxidative stress in experimental periodontitis, showing reduced gingivitis and alveolar bone resorption on H&E staining and micro-CT, and reduced iNOS mRNA in rats. Colorimetric results showed that Rb3 increased serum SOD and GSH-Px activities and decreased MDA levels in rats. IF analysis showed that Rb3 inhibited P38, ERK, and JNK activation. Rb3 pretreatment significantly decreased iNOS and IL-6 mRNA expression and ROS in Raw264.7 cells. WB analysis demonstrated that Rb3 blocked the activation of P38 and ERK.

CONCLUSION

Rb3 inhibits the level of oxidative stress and attenuates gingivitis and alveolar bone resorption in rats via the MAPKs signaling pathway.

Solanesol: a promising natural product

Solanesol, identified as Nonaprenol alcohol, predominates in the Solanaceae family. This compound exists as a white to pale yellow solid at room temperature, characterized by low polarity and water insolubility. Its unique chemical structure-featuring nine non-conjugated double bonds and low polarity-confers remarkable biological activities. Recent studies have demonstrated that solanesol exhibits polypharmacological properties, including antimicrobial, antioxidant, anti-inflammatory, and membrane-stabilizing effects. Mechanistically, solanesol suppresses ROS generation and inhibits pro-inflammatory cytokines (IL-1β, TNF-α). Preclinical studies highlight its therapeutic potential in inflammatory disorders (periodontitis, neuropathic pain) and neurodegenerative diseases (Alzheimer's, Parkinson's). However, current research still faces critical bottlenecks, such as a lack of in vivo pharmacokinetic data, unclear molecular targets, and insufficient toxicity assessments. Future studies urgently need to integrate experimental approaches, including target screening, nanotechnology-based delivery systems, and multi-omics analysis, to elucidate its mechanisms of action and promote clinical translation. As a compound that combines natural safety with multi-target effects, solanesol is not only a research focus for the development of novel drugs but also a bridge connecting natural products and precision medicine, poised to lead the innovation of next-generation biocompatible therapies.

New considerations in selecting donors for dental pulp stem cells: a pilot study

BACKGROUND/PURPOSE

Tissue engineering based on stem cell therapy necessitates a substantial quantity of high-quality stem cells. However, current sources face limitations, including narrow donor pools, compromised biological properties due to cryopreservation, and cellular senescence resulting from in vitro passaging and expansion. This study examines the impact of mild periodontitis on the biological performance of dental pulp stem cells (DPSCs) to explore the potential of broadening the donor pool for these cells.

MATERIALS AND METHODS

The experiment included two variables: age and the presence of periodontitis. DPSCs were isolated from six healthy subjects and six patients with mild periodontitis. Healthy subjects were categorized into Groups A (28-32 years) and B (52-54 years), and patients with mild periodontitis were categorized into Groups C (31-33 years) and D (50-53 years). The analyses included cell morphology, proliferation rate, multilineage differentiation capacity, apoptosis, and surface marker expression.

RESULT

No significant differences in cell morphology, pluripotency, or senescence were observed between healthy controls and periodontitis patients across age groups. Additionally, data on proliferation, pluripotency, and senescence were not significantly different. In healthy subjects, increased age was correlated with more elongated, flattened, and broader cells, alongside greater heterogeneity and intercellular granules. The proliferation and differentiation capacities decreased, whereas the degree of apoptosis increased. Similar trends were noted in patients with periodontitis.

CONCLUSION

The biological properties of DPSCs remain unchanged in teeth with mild periodontitis, providing valuable insights for addressing the shortage of DPSCs in tissue engineering. Teeth with mild periodontitis have the potential to be pulp stem cell donors.

Cyclic di-AMP alleviates periodontitis by activating PI3K/Akt/Nrf2 pathways

Emerging research demonstrates the regulatory effects of c-di-AMP, a bacterial-derived small molecule secondary messenger, on host immune responses and promoting resistance against infection-related diseases. This study aims to elucidate the role of c-di-AMP in the occurrence and development of periodontitis. Using model of ligation-induced periodontitis, we observed that c-di-AMP effectively alleviated alveolar bone resorption. Transcriptomic sequencing in mice gingival tissues demonstrated that treatment with c-di-AMP led to a significant upregulation of the PI3K/Akt signaling pathway and its key components, including Akt3. Concurrently, we observed an upregulation of the cGMP/PKG signaling pathway. To validate our findings, we treated gingival epithelial cells with c-di-AMP and confirmed the activation of the PI3K/Akt pathway by c-di-AMP in gingival epithelial cells. Under LPS-induced inflammation, c-di-AMP significantly suppressed the release of inflammatory factors (such as IL-6 and TNF-α) from gingival epithelial cells. Moreover, key components of the PI3K/Akt pathway, including Akt, and downstream inflammation regulatory gene Nrf2, were upregulated, which were also confirmed at the protein level. Collectively, this study demonstrates that c-di-AMP definitely plays a role in alleviating periodontitis. Our findings highlight the mechanisms by which c-di-AMP modulates periodontitis, including activating the PI3K/Akt pathway and potentially involving the cGMP/PKG pathway, ultimately contributing to improved immune defense and maintenance of bone homeostasis.

Green Tea: A Novel Perspective on the Traditional Plant's Potential in Managing Periodontal Diseases

Green tea (Camellia sinensis) exhibits significant potential in oral health due to its antioxidant, anti-inflammatory, and antimicrobial properties. This review explores its role in managing periodontal disease, a common condition characterized by inflammation, microbial imbalances, and tissue destruction. The primary bioactive components, particularly epigallocatechin-3-gallate (EGCG), contribute to green tea's therapeutic effects by inhibiting bacterial adhesion, modulating inflammatory pathways, and reducing oxidative stress. Clinical studies suggest green tea improves periodontal health by reducing pocket depth, inflammation, and bleeding. It can serve as an adjunct to conventional therapies, including scaling and root planing, and be incorporated into oral care products such as mouthwashes and dentifrices. Furthermore, green tea presents a natural alternative to chemical agents like chlorhexidine, potentially mitigating side effects and addressing concerns about antibiotic resistance. However, its efficacy remains moderate compared to established treatments, highlighting the need for further research to optimize its formulation and therapeutic applications. Green tea represents a sustainable and biocompatible approach to periodontal therapy, supporting its integration into preventive and therapeutic oral health strategies.

Role of Pink1 in Regulating Osteoclast Differentiation during Periodontitis

Periodontitis has recently been recognized as an inflammatory disease caused by oxidative stress, with mitochondrial dysfunction being a key factor leading to oxidative stress. PTEN-induced kinase 1 (PINK1) is an essential protein for mitochondrial quality control, which protects cells from oxidative stress by inducing mitophagy to degrade damaged mitochondria, but its role in periodontitis has not been elucidated. This study aimed to explore the contribution and underlying mechanisms of Pink1 in regulating the differentiation and function of osteoclasts during periodontitis. Here we observed a significant downregulation of PINK1 expression in periodontitis-affected tissues. Then we constructed a periodontitis model in mice with fluorescently labeled mononuclear/macrophages, and the results showed that as the modeling time extended, the alveolar bone destruction gradually worsened and was accompanied by gradually decreased Pink1 expression in osteoclasts and a significantly increased osteoclast number. In vitro experiments further demonstrated a negative correlation between Pink1 and osteoclast differentiation. In addition, alveolar bone destruction in the Pink1 knockout mice was significantly more advanced than that in the littermate wild type mice after ligature-induced periodontitis and enhanced osteoclastogenesis and bone-resorptive capacity in vitro. RNA-sequencing analysis and in vitro validation revealed that the absence of Pink1 led to a decrease in oxidative phosphorylation levels and an enhancement of calcium-mediated signaling, specifically the calcineurin-NFATc1 pathway, via an intracellular calcium source. Further mechanistic studies found that the deficiency of Pink1 inhibited mitophagy but strengthened mitochondrial-endoplasmic reticulum coupling, which, by promoting the interaction of Mfn2-IP3R-VDAC1 proteins, increased the concentration of mitochondrial calcium ions, thereby triggering more active osteoclast differentiation. The aforementioned process can be reversed by the IP3R channel inhibitor Bcl-XL. These findings unveiled that Pink1 was involved in osteoclast differentiation by regulating mitochondrial calcium transport mediated by mitochondria-associated endoplasmic reticulum membranes, providing a new theoretical basis for the pathogenesis and treatment of periodontitis.

Bifunctional mesoporous HMUiO-66-NH2 nanoparticles for bone remodeling and ROS scavenging in periodontitis therapy

Periodontal bone defects represent an irreversible consequence of periodontitis associated with reactive oxygen species (ROS). However, indiscriminate removal of ROS proves to be counterproductive for tissue repair and insufficient for addressing existing bone defects. In the treatment of periodontitis, it is crucial to rationally alleviate local ROS while simultaneously promoting bone regeneration. In this study, Zr-based large-pore hierarchical mesoporous metal-organic framework (MOF) nanoparticles (NPs) HMUiO-66-NH2 were successfully proposed as bifunctional nanomaterials for bone regeneration and ROS scavenging in periodontitis therapy. HMUiO-66-NH2 NPs demonstrated outstanding biocompatibility both in vitro and in vivo. Significantly, these NPs enhanced the osteogenic differentiation of bone mesenchymal stem cells (BMSCs) under normal and high ROS conditions, upregulating osteogenic gene expression and mitigating oxidative stress. Furthermore, in vivo imaging revealed a gradual degradation of HMUiO-66-NH2 NPs in periodontal tissues. Local injection of HMUiO-66-NH2 effectively reduced bone defects and ROS levels in periodontitis-induced C57BL/6 mice. RNA sequencing highlighted that differentially expressed genes (DEGs) are predominantly involved in bone tissue development, with notable upregulation in Wnt and TGF-β signaling pathways. In conclusion, HMUiO-66-NH2 exhibits dual functionality in alleviating oxidative stress and promoting bone repair, positioning it as an effective strategy against bone resorption in oxidative stress-related periodontitis.

The Inflammation-Initiating and Resolving Mechanisms and Oxidation: Could Periodontal Therapy and Nutritional Strategy Improve the Systemic Health? A Narrative Review

Periodontitis (PDS) is one of the most common and crippling systemic diseases. It is a chronic inflammatory condition that leads to the loss of periodontal attachment, resulting in tooth loss. In addition to its effects on oral health and nutrition, PDS is closely linked to other systemic conditions such as diabetes mellitus (DM), cardiovascular diseases (CVD), and rheumatoid arthritis (RA). The active role of inflammation and oxidation in systemic health, as well as their relationship with periodontal therapy, has been investigated. This review explores the evidence on how periodontal therapy and dietary lifestyle can help reduce chronic inflammation, limit oxidation, and prevent related pathologies. Nonsurgical periodontal therapy (NSPT) and nutrition have been extensively discussed as potential contributors to positive clinical outcomes by resolving inflammatory pathogenic pathways. NSPT, foods, and dietary supplements represent therapeutic strategies that address the underlying mechanisms of chronic inflammation and oxidation at various stages. A key finding from this review is that periodontal treatment, in conjunction with nutritional counseling, can improve clinical outcomes in PDS, DM, CVD, and RA. However, for NSPT, nutrition, and dietary composition to be effective, they should be integrated into a sustainable, long-term lifestyle.

Alpha-Ketoglutarate Alleviates Systemic Lupus Erythematosus-Associated Periodontitis in a Novel Murine Model

AIM

To establish a reproducible experimental animal model for systemic lupus erythematosus (SLE)-associated periodontitis (PD), investigate the effects of SLE on PD and assess the therapeutic potential of alpha-ketoglutarate (αKG) for SLE-PD treatment.

MATERIALS AND METHODS

An SLE-PD murine model was established via ligature-induced PD in MRL-lpr strain, with MRL/MpJ strain as a non-SLE control. The periodontal state was assessed using micro-CT, real-time PCR, histology, immunofluorescence and flow cytometry assays. αKG levels were analysed, and a thermoresponsive gel was designed as a periodontal dimethyl (DM)-αKG delivery system. αKG levels were analysed in gingival crevicular fluid (GCF) of PD patients with or without SLE.

RESULTS

SLE significantly increased the periodontal inflammation and bone resorption in the SLE-PD model. αKG levels in GCF were lower in PD patients with SLE than in PD patients without SLE. Decreased αKG levels in the gingiva and macrophage M1/M2 imbalance were observed in SLE-PD mice. However, DM-αKG thermoresponsive gel effectively alleviated the periodontal inflammation, bone resorption and macrophage M1/M2 imbalance in SLE-PD mice.

CONCLUSIONS

Our study established, for the first time, a novel SLE-PD murine model and revealed that SLE increases the severity of PD in vivo. Our findings highlight the therapeutic potential of αKG for SLE-associated PD.

Nanotherapies Based on ROS Regulation in Oral Diseases

Oral diseases rank among the most prevalent clinical conditions globally, typically involving detrimental factors such as infection, inflammation, and injury in their occurrence, development, and outcomes. The concentration of reactive oxygen species (ROS) within cells has been demonstrated as a pivotal player in modulating these intricate pathological processes, exerting significant roles in restoring oral functionality and maintaining tissue structural integrity. Due to their enzyme-like catalytic properties, unique composition, and intelligent design, ROS-based nanomaterials have garnered considerable attention in oral nanomedicine. Such nanomaterials have the capacity to influence the spatiotemporal dynamics of ROS within biological systems, guiding the evolution of intra-ROS to facilitate therapeutic interventions. This paper reviews the latest advancements in the design, functional customization, and oral medical applications of ROS-based nanomaterials. Through the analysis of the components and designs of various novel nanozymes and ROS-based nanoplatforms responsive to different stimuli dimensions, it elaborates on their impacts on the dynamic behavior of intra-ROS and their potential regulatory mechanisms within the body. Furthermore, it discusses the prospects and strategies of nanotherapies based on ROS scavenging and generation in oral diseases, offering alternative insights for the design and development of nanomaterials for treating ROS-related conditions.

Chronic Inflammation and Glycemic Control: Exploring the Bidirectional Link Between Periodontitis and Diabetes

Periodontitis and diabetes mellitus are two highly prevalent chronic conditions that share a bidirectional relationship, significantly impacting public health. Periodontitis, a gum inflammation caused by microbial dysbiosis, aggravates glycemic control in diabetics, while uncontrolled diabetes heightens periodontitis severity. These conditions create a vicious cycle, where inflammation and microbial dysbiosis mutually drive disease progression, exacerbating systemic health. The underlying mechanisms involve inflammation, immune dysfunction, and microbial dysbiosis, with both diseases contributing to a chain of chronic inflammation that exacerbates systemic health. This relationship is significant because managing one condition can significantly impact the other. In diabetic individuals, interventions such as periodontal therapy have shown effectiveness in improving glycemic control, underscoring the potential of integrated strategies for managing these conditions simultaneously. In this review, we highlight the importance of a deeper understanding of the molecular and immunological interactions between these diseases is essential for developing integrated therapeutic approaches, with the potential to enhance the quality of life of the patient significantly.

Luteolin alleviates olfactory dysfunction in eosinophilic chronic rhinosinusitis through modulation of the TLR4/NF-κB signaling pathway

OBJECTIVES

Eosinophilic chronic rhinosinusitis (ECRS) is characterized by early, severe olfactory dysfunction and a high recurrence rate, with inadequate treatments. This article aims to elucidate the potential mechanisms by which luteolin may treat olfactory dysfunction in the context of ECRS.

METHODS

Thirty C57 BL/6 mice were randomly assigned to five groups: a control group and four experimental groups (ECRS, ECRS + Luteolin (Low, Medium, High Dose)). We conducted RNA sequencing, behavioral testing, ELISA, PCR, HE staining, Western blot analysis, and immunofluorescence staining. Additionally, human olfactory epithelial Cells (HOEPCs) were treated with Luteolin, TAK-242, QNZ, and Luteolin + LPS to investigate the underlying mechanisms.

RESULTS

Luteolin significantly reduced IL-4, IL-5, and IL-13 levels in the nasal lavage fluid (NLF) of ECRS mice, improving olfactory function and restoring OMP+ mature and Gap43+ immature olfactory sensory neurons (OSNs). RNA sequencing revealed the involvement of the TLR4/NF-κB pathway in ECRS-related olfactory dysfunction and luteolin's therapeutic effects. Luteolin reduced TLR4+ cells, P65 nuclear translocation, and decreased protein levels of IL-1β, TLR4, MyD88, p-P65, P65, and p-P38. The treatment also lowered OSNs cell apoptosis by decreasing the levels of cleaved caspase-3 and caspase-9 levels, and increasing Bcl-2 protein. Antioxidant enzymes SOD, CAT, and GSH-Px were elevated, while MDA levels decreased. In ECRS HOEPCs, luteolin's anti-apoptotic effects on OSNs were reversed by LPS-induced TLR4/NF-κB activation.

CONCLUSIONS

Luteolin ameliorates olfactory dysfunction associated with ECRS by modulating the TLR4/NF-κB signaling pathway. This modulation results in a reduction of TH2-type inflammation, oxidative stress, and apoptosis in OSNs.

Comparison of visfatin levels before and after non-surgical periodontal therapy: A systematic review and meta-analysis

Periodontitis is an inflammatory disease and involves a severe inflammation of the periodontium. On the other hand, visfatin is known as one of the inflammatory markers and can probably preserve inflammation in immune cells. Therefore, the purpose of this systematic review and meta-analysis is to compare the mean visfatin level before and after non-surgical periodontal treatment (NSPT). In this systematic review and meta-analysis, to find relevant studies, PubMed, Web of Science and Scopus were searched. Google Scholar was used to review gray literature. Standardized mean difference (SMD) along with 95% confidence interval (95%CI) was calculated. To perform the meta-analysis, in cases where there was significant heterogeneity between the studies, the random-effects model was used, otherwise the fixed-effects model was used. Sixteen studies were included in the meta-analysis. The results show that one month after the NSPT, there was no significant difference in the mean visfatin level of GCF (SMD: -3.91, 95%CI: -9.83, 2.01, p = 0.195, I-square, 96.6%, random effect model, n = 2) and serum (SMD: -0.33, 95%CI: -0.98, 0.33, p = 0.332, fixed effect model, n = 1), but 2, 3 and 6 months after NSPT, the mean visfatin level of GCF and serum decreased significantly. There is no significant difference one month after NSPT in diabetic patients (SMD: -5.83, 95%CI: -15.5, 3.83, p = 0.237, I-square, 97.4%, random effects model, n = 2), but three (SMD: -2.44, 95%CI: -3.37, -1.15, p = 0.001, I-square, 75.9%, random effects model, n = 3) and six months (SMD: -2.41, 95%CI: -3.81, -1.01, p = 0.001, I-square, 78.7%, random effects model, n = 2) after the treatment, a significant decrease is observed in the mean GCF visfatin level. Following the NSPT, the mean visfatin level of GCF, serum and saliva decreases, and in longer follow up time, the level of visfatin decreases significantly. Also, the mean GCF level of diabetic patients decreased after NSPT. Therefore, visfatin level may be used as a diagnostic and therapeutic noninvasive biomarker in patients with periodontitis, which requires further studies.

Air Pollution and Oral Health: An Overall Insight From Genetic Causality

BACKGROUND

A growing body of epidemiological data consistently links air pollution to various adverse health outcomes. However, the potential connection between air pollution and the risk of oral diseases remains underexplored.

METHODS

This study utilized a two-sample Mendelian randomization approach to assess the causal relationship between air pollution and oral diseases. Six categories of air pollution were considered as exposures: nitrogen oxides (NOx), nitrogen dioxide (NO2), particulate matter (PM2.5, PM2.5-10, PM10), and PM2.5 absorbance. The outcomes included 18 oral health-related diseases drawn from the Finngen R10 dataset, the Gene-Lifestyle Interactions in Dental Endpoints consortium, and the Oncoarray oral cavity and oropharyngeal cancer consortium. Sensitivity analyses were performed to validate the primary inverse-variance weighted estimates using methods such as weighted median, weighted mode, and MR Egger.

RESULTS

The inverse-variance weighted analysis demonstrated a detrimental effect of air pollution on multiple oral health conditions, yielding 5 positive associations including PM2.5 with oral leukoplakia, gingivitis and periodontitis; PM2.5-10 with pulp and periapical diseases, and NO2 with gingivitis and periodontitis, and oral cavity, salivary glands and jaws diseases. Sensitivity tests showed no evidence of heterogeneity or pleiotropy, affirming the robustness of the findings.

CONCLUSION

This study highlights the detrimental impact of air pollution on oral health, emphasizing the need for further research into the underlying mechanisms and interactions. These findings reinforce the importance of implementing environmental interventions to mitigate the associated risks for oral health.

Low folate biomarker concentrations are associated with increase the risk and severity of periodontitis in adults: A cross-sectional study based on the National Health and Nutrition Examination Survey 2009-2014

We sought to test the hypothesis that adult folate biomarker concentrations are negatively associated with the risk and severity of periodontitis. Data were pooled from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. A total of 9252 dentate adult subjects aged 30 years and older who received a periodontal examination and had complete folate biomarker data were included in the analysis. Both logistic regression and linear regression models were built to analyze the associations between folate biomarker concentrations and periodontitis, followed by multisubgroup and sensitivity analyses. In addition, restricted cubic spline models were applied to observe the shape of the associations. We found negative associations between serum folate and periodontitis status (odds ratio [OR] = 0.775, 95% CI: 0.691-0.869), periodontal probing depth (PPD) (β = -0.048, 95% CI: -0.069 to -0.027), and clinical attachment loss (CAL) (β = -0.061, 95% CI: -0.098 to -0.025). A negative association was also found between red blood cell folate and periodontitis status (OR = 0.727, 95% CI: 0.613-0.861), PPD (β = -0.055, 95% CI: -0.086 to -0.024), and CAL (β = -0.084, 95% CI: -0.128 to -0.040). Subgroup and sensitivity analyses showed robust results. Restricted cubic spline models demonstrated significant linearity for associations. Folate biomarker concentrations were negatively associated with periodontitis in adults aged 30 years and older, indicating that folate may have a restrictive effect on the risk and severity of periodontitis. This finding may provide a clinical target for preventive and interventional measures to promote periodontal nutrition and health.

Oxidative balance scores in Korean adults are associated with periodontitis

BACKGROUND

The Oxidative Balance Score (OBS) is a comprehensive metric that assesses the state of a person's oxidative balance. This study aimed to investigate the relationship between the oxidative balance score and moderate and severe periodontitis in a representative sample of Korean adults.

METHODS

Healthcare big data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018) was used, and 16,489 adults aged ≥19 years were included. Multivariate logistic regression analysis was performed to investigate the effect of sex-specific oxidative balance scores on periodontitis.

RESULTS

In comparison with participants with a lower oxidative balance score, those with a higher oxidative balance score had a lower incidence of moderate and severe periodontitis (p < 0.05). After adjusting for covariates, the oxidative balance score was negatively associated with moderate (odds ratio [OR] = 0.952; 95% confidence interval [CI]: 0.934-0.971) and severe (OR = 0.958; 95% CI: 0.931-0.986) periodontitis; however, the result was not significant for severe periodontitis in women's (OR = 0.975; 95% CI: 0.934-1.018). Our study showed a statistically significant association between OBS and moderate and severe periodontitis, the small effect size should be interpreted with caution.

CONCLUSIONS

The oxidative balance score was associated with moderate and severe periodontitis in Korean adults. Therefore, managing this score may help reduce the risk of periodontitis.

Characterization of thioredoxin-thioredoxin reductase system in Filifactor alocis

INTRODUCTION

Filifactor alocis is a newly appreciated member of the periodontal community with a strong periodontal disease correlation. Little is known about the survival mechanisms by which F. alocis copes with oxidative stress and establishes the infection within the local inflammatory microenvironment of the periodontal pocket. The aim of this study is to investigate if F. alocis putative peroxiredoxin/AhpC protein FA768 may constitute an alkyl hydroperoxide reductase system utilizing putative thioredoxin reductase protein FA608, and putative thioredoxin/glutaredoxin homolog FA1411/FA455.

METHODS

FA768, FA608, FA1411 and FA455 proteins from F. alocis were expressed and purified from Escherichia coli. Insulin and 5,5-dithio-bis-2-nitrobenzoic acid (DTNB) reduction assays were performed to determine if purified FA1411 and FA455 proteins could be a substrate for FA608. The peroxidase activity of FA768 was examined by measuring its ability to reduce hydrogen peroxide (H2O2) with FA608 and FA1411/FA455 provided as the reducing systems. Further, the hydroperoxide substrate specificity of FA768 was analyzed by monitoring the NADPH oxidation in the presence of different peroxides, including H2O2, cumyl hydroperoxide (CHP), and tert-butyl hydroperoxide (t-BHP).

RESULTS

In this study, we have demonstrated the existence of a functioning thioredoxin-dependent alkyl hydroperoxide system in F. alocis. This system is comprised of a thioredoxin reductase (FA608), a thioredoxin/glutaredoxin homolog (FA1411/FA455), and a typical 2-cysteine peroxiredoxin/AhpC (FA768). FA608, together with FA1411/FA455, can function as a thioredoxin reductase system to reduce insulin, DTNB, and FA768. FA455 is a glutaredoxin-like protein with thioredoxin functions in F. alocis. Both the FA768/FA608/FA1411 and FA768/FA608/FA455 reductase systems were NADPH-dependent and exhibited specificity for broad hydroperoxide substrates H2O2, CHP, and t-BHP.

CONCLUSIONS

This is the first study of a thioredoxin dependent alkyl hydroperoxide system from a periodontal pathogen. This system is proposed to protect F. alocis against oxidative stress due to the likely absence of a catalase or an additional peroxiredoxin homolog.

Equol promotes osteogenic differentiation of hPDLSCs by inhibiting oxidative stress via IL1B/NF-κB/CXCL1 signaling axis

Oxidative stress (OS) inhibits the osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs). Equol (Eq), a phytoestrogen, exhibits notable antioxidant properties and potential for preventing osteoporosis. However, the research on the regulatory effects of Eq on stem cell osteogenesis remains limited. This investigation aimed to identify whether Eq could protect the osteogenic potential of hPDLSCs under H2O2-induced oxidative microenvironment. We employed a series of assays, including CCK-8, DCFH-DA, ALP staining, ARS, RT-qPCR, and Western Blotting, to assess the changes in cell viability, antioxidant capacity, and osteogenic potential following H2O2 and Eq treatments. Our findings indicated that low concentrations of Eq had no cytotoxic effects on hPDLSCs and promoted their proliferation. Eq pre-treatment (0.5 μmol/L) partially counteracted the inhibitory effect of H2O2, reduced the generation of reactive oxygen species, and increased glutathione levels, thereby inhibiting oxidative damage. Eq suppressed the H2O2-induced inhibition of osteogenic differentiation, presenting as restoring the alkaline phosphatase levels and calcium nodule formation, as well as by upregulating the expression of BMP2 and RUNX2. Furthermore, bioinformatics analysis in this study suggested that the IL1B/NF-κB/CXCL1 signaling pathway might be a key pathway for Eq's enhancement of osteogenic differentiation potential of hPDLSCs under OS conditions. The activation of this axis by H2O2, which Eq can alleviate, was confirmed by validation experiments. This study provides new insights into the potential therapeutic application of Eq in alveolar bone resorption and bone regeneration research.

Revolutionizing oral care: Reactive oxygen species (ROS)-Regulating biomaterials for combating infection and inflammation

The human oral cavity is home to a delicate symbiosis between its indigenous microbiota and the host, the balance of which is easily perturbed by local or systemic factors, leading to a spectrum of oral diseases such as dental caries, periodontitis, and pulp infections. Reactive oxygen species (ROS) play crucial roles in the host's innate immune defenses. However, in chronic inflammatory oral conditions, dysregulated immune responses can result in excessive ROS production, which in turn exacerbates inflammation and causes tissue damage. Conversely, the potent antimicrobial properties of ROS have inspired the development of various anti-infective therapies. Therefore, the strategic modulation of ROS by innovative biomaterials is emerging as a promising therapeutic approach for oral infection and inflammation. This review begins by highlighting the state-of-the-art of ROS-regulating biomaterials, which are designed to generate, scavenge, or modulate ROS in a bidirectional manner. We then delve into the latest innovations in these biomaterials and their applications in treating a range of oral diseases, including dental caries, endodontic and periapical conditions, periodontitis, peri-implantitis, and oral candidiasis. The review concludes with an overview of the current challenges and future potential of these biomaterials in clinical settings. This review provides novel insights for the ongoing development of ROS-based therapeutic strategies for oral diseases.

Photo-curing hyaluronic acid-Janus antibacterial packs as O2 generator precisely modulate the infectious microenvironment for antibiotic-free periodontal therapy

Periodontal disease stands the leading cause of tooth loss in adults. While scaling and root planning is considered the "gold standard" treatment, it is often insufficient in efficiently eliminating anaerobic bacteria from deep periodontal pockets. In this work, an antibiotic-free and photo-curing hyaluronic acid-Janus (H-Janus) antibacterial pack was developed to inhibit the growth and colonization of residual bacteria within the pockets for reducing the recurrence of periodontitis. Our results demonstrated that a 4 wt% precursor solution of the antibacterial packs could be molded into various shapes by exposure to UV irradiation for less than 1 min, allowing the packs to seamlessly fill the irregular spaces of periodontal pockets. In vitro studies showed that the antibacterial packs gradually released lauric acid and oxygen over 7 days, exhibiting significant anti-biofilm effects against both aerobic and anaerobic bacteria. Notably, animal experiments confirmed that H-Janus antibacterial packs markedly improved the clinical scores in rats with periodontitis by inhibiting bacterial growth, alleviating inflammation, and fostering the regeneration of periodontal tissues. In light of their precise elimination of bacterial colonization and modulation of the infectious microenvironment, the H-Janus antibacterial packs show promising therapeutic potential for preventing the recurrence of periodontal pathogens following scaling and root planning.

Triple-Combination Therapy with a Multifunctional Yolk-Shell Nanozyme Au@CeO2 Loaded with Dimethyl Fumarate for Periodontitis

Periodontitis, a chronic inflammatory disease, is the leading cause of tooth loss in adults and is one of the most prevalent and complex oral conditions. Oxidative stress induced by the excessive generation of reactive oxygen species (ROS) leads to periodontitis, which is closely associated with pathological processes, including mitochondrial dysfunction of periodontal cells and local immune dysregulation. However, current treatment modalities that target single pathological processes have limited long-term therapeutic effects. Herein, a multifunctional Yolk-Shell nanozyme, Au@CeO2-dimethyl fumarate (DMF), which comprehensively addresses the oxidative stress-induced pathophysiological processes of periodontitis through antioxidant activity, mitochondrial maintenance, and immune modulation mechanisms, is described. For material design logic, functionally complementary Au and CeO2 formed an excellent photothermally regulated high-efficiency nanozyme, which also provided an ideal drug carrier for DMF. As for the therapeutic logic, Au@CeO2-DMF restores mitochondrial dysfunction and immune dysregulation, which also contributes to endogenous ROS elimination, thereby achieving long-term stable therapeutic effects. In a rat model, local Au@CeO2-DMF photothermal therapy effectively alleviated ROS-induced tissue damage and restored periodontal homeostasis. Altogether, this study presents a novel antioxidant nanozyme for managing alveolar bone loss under prolonged oxidative stress and demonstrates the importance of comprehensive intervention in key pathological processes in periodontitis treatment design.

Two birds with one stone: natural polyphenols boosted periodontitis treatment of chlorhexidine via reducing toxicity and regulating microenvironments

Chlorhexidine (CHX) is considered the gold standard for controlling periodontal plaque and has been extensively used as a topical agent in treating periodontitis. Nevertheless, the practical clinical application of CHX is still constrained by the inherent limitations of its properties, including toxicity, inadequate biofilm scavenging capacity, and single biological effect. In this study, polyphenolic epigallocatechin gallate (EGCG) has been employed to integrate with CHX to form an EGCG-CHX nanoplatform via a facile one-pot method. Due to the dynamic bonding between EGCG and CHX, the EGCG-CHX nanoparticles (NPs) show reduced toxicity and excellent response release behavior. Moreover, a series of in vitro and in vivo studies demonstrated that the EGCG-CHX NPs significantly enhanced the antibiofilm, antioxidative, anti-inflammatory, and autophagic flux activation effects of CHX, ultimately achieving an improved therapeutic effect on periodontitis. This study successfully developed a strategy boosting the efficiency of CHX for periodontitis treatment.

Mitochondrial Dysfunction in Diabetic Periodontitis: Mechanisms and Therapeutic Potential

Diabetic periodontitis is a common oral complication of diabetes characterized by progressive destruction of periodontal tissues. Recent evidence suggests that mitochondrial dysfunction plays a crucial role in the pathogenesis and progression of this condition. This review aims to systematically summarize the role and potential mechanisms of mitochondrial dysfunction in diabetic periodontitis. We first explore the relationship between diabetes and mitochondrial dysfunction, then analyze the specific manifestations of mitochondrial dysfunction in diabetic periodontitis, including morphological changes, energy metabolism disorders, increased oxidative stress, and enhanced apoptosis. We further delve into the connections between mitochondrial dysfunction and the pathogenic mechanisms of diabetic periodontitis, such as exacerbated inflammatory responses, decreased tissue repair capacity, and autophagy dysregulation. Finally, we discuss potential therapeutic targets based on mitochondrial function, including antioxidant strategies, mitochondria-targeted drugs, and autophagy regulators. We also propose future research directions, emphasizing the need for in-depth exploration of molecular mechanisms, development of new diagnostic markers and therapeutic strategies, and personalized treatment approaches. This review provides new insights into understanding the pathogenic mechanisms of diabetic periodontitis and offers a theoretical basis for developing targeted prevention and treatment strategies to improve oral health in diabetic patients.

A Multifunctional miRNA Delivery System Based on Tetrahedral Framework Nucleic Acids for Regulating Inflammatory Periodontal Ligament Stem Cells and Attenuating Periodontitis Bone Loss

Periodontitis is a chronic inflammatory disease that leads to periodontal tissue damage and tooth loss. Therefore, controlling inflammatory bone loss and promoting osteogenesis is a crucial challenge clinically. MicroRNA (miRNA) based gene therapy has shown substantial prospects in recent years, but its application has been limited due to structural instability and easy degradation by enzymes. Research has shown that miRNA-200c is regarded as a key miRNA by regulating multiple signaling pathways during the process of bone resorption. Tetrahedral framework nucleic acid (tFNA) can be considered an ideal carrier of miRNA due to its good tissue permeability, cell uptake efficiency, and biocompatibility. This study developed a tFNA system carrying miR-200c, named T-200c, to exert various biological effects in human periodontal ligament stem cells (PDLSCs). The activation of the NF-κB pathway is diminished, whereas the Akt/β-catenin pathway is enhanced, resulting in a notable decrease in the release of diverse inflammatory mediators and cellular reactive oxygen species. This modulation fosters cell proliferation and osteogenic differentiation, thereby rejuvenating the functionality of PDLSCs. These changes offer a viable alternative for the treatment of periodontitis and the regeneration of periodontal tissues.

Polymer-based antimicrobial strategies for periodontitis

Periodontitis is a chronic inflammatory condition driven by plaque-associated microorganisms, where uncontrolled bacterial invasion and proliferation impair host immune responses, leading to localized periodontal tissue inflammation and bone destruction. Conventional periodontal therapies face challenges, including incomplete microbial clearance and the rise of antibiotic resistance, limiting their precision and effectiveness in managing periodontitis. Recently, nanotherapies based on polymeric materials have introduced advanced approaches to periodontal antimicrobial therapy through diverse antimicrobial mechanisms. This review explored specific mechanisms, emphasizing the design of polymer-based agents that employ individual or synergistic antimicrobial actions, and evaluated the innovations and limitations of current strategies while forecasting future trends in antimicrobial development for periodontitis.

Anti-Inflammatory, Antioxidant and Antibacterial Properties of Tomato Skin and Pomegranate Peel Extracts: A Sustainable Approach for Oral Health Care

Agricultural food waste and by-products could provide high-value compounds that positively affect human and environmental health, thus representing promising ingredients for cosmeceutical products. This study explores the biological activities of tomato skin (HP) and pomegranate peel (PPE) extracts on oral mucosa to evaluate their possible use in mouthwashes. The biological activities of the extracts and the mouthwash (MW) containing them were evaluated in Human Primary Gingival Epithelial cells (HGECs). The antioxidant and anti-inflammatory activities were analyzed in HGECs injured with lipopolysaccharides. After 24 h of treatment with PPE, HP, and MW, significant antioxidant activity and an increased Superoxide Dismutase 1 expression (p < 0.01) were observed. Additionally, the extracts significantly reduced the expression of tumor necrosis factor α (p < 0.05) and Monocyte Chemoattractant Protein 1 (p < 0.001), suggesting an anti-inflammatory role. Lastly, the antibacterial activity was assessed against Streptococcus mutans and Streptococcus sanguinis by the broth microdilution method and agar cup diffusion test for the extracts and the mouthwash, respectively, demonstrating strong effectiveness against both oral streptococcus species. Results demonstrate the potential of HP and PPE in reducing oxidative stress, inflammation, and bacterial proliferation within oral mucosa, highlighting food waste up-cycling as a resource for human health.

Exploring the Molecular Mechanisms of Fisetin in Treating Periodontitis Through Multiomics and Network Pharmacology

BACKGROUND

Periodontitis (PD) is a common chronic inflammatory oral disease that severely affects patients' quality of life. Fisetin has been shown to possess antioxidant and anti-inflammatory properties in various biological systems.

METHODS

This study first identified the molecular targets of fisetin for PD through network pharmacology analysis. The therapeutic effects of fisetin were then evaluated in an animal model of PD and validated through in vitro experiments. Additionally, we utilised single-cell and spatial transcriptomics technologies to identify key cell populations in PD and their spatial distribution.

RESULTS

The study demonstrated that fisetin significantly reduced alveolar bone destruction in the rat model of PD. Single-cell transcriptomics revealed that fisetin primarily affects fibroblast populations. In vitro experiments showed that fisetin alleviated the cytotoxicity caused by high oxidative stress levels in human periodontal ligament fibroblasts (PDLFs) .

CONCLUSION

Fisetin inhibits the progression of periodontitis by reducing oxidative stress levels in fibroblast populations. These findings support the potential of fisetin as a therapeutic agent for periodontitis and provide a scientific basis for future clinical trials and treatment strategies.

CLINICAL RELEVANCE

By significantly reducing alveolar bone destruction and modulating fibroblast function, fisetin presents a novel therapeutic strategy for managing periodontitis. These results provide a scientific foundation for the design of clinical trials aimed at evaluating the efficacy of fisetin in PD patients. If validated in clinical settings, fisetin could be incorporated into treatment regimens, offering a pharmacological option that complements conventional periodontal therapies, thereby improving patient outcomes and quality of life.

Single-Cell and Transcriptome Analysis of Periodontitis: Molecular Subtypes and Biomarkers Linked to Mitochondrial Dysfunction and Immunity

Background

Periodontitis represents an inflammatory disease with multiple contributing factors, affecting both oral and systemic health. The mechanisms linking mitochondrial dysfunction to immune responses in periodontitis remain unclear, limiting the development of individualized diagnostic and therapeutic approaches.

Objective

 This study aims to elucidate the roles of mitochondrial dysfunction and immune responses in the pathogenesis of periodontitis, identify distinct molecular subtypes, and discover robust diagnostic biomarkers to support precision medicine approaches.

Methods

Single-cell RNA sequencing and transcriptome data from periodontitis patients were analyzed to identify gene signatures linked to macrophages and mitochondria. Consensus clustering was applied to classify molecular subtypes. Potential biomarkers were identified using five machine learning algorithms and validated in clinical samples through qPCR and IHC.

Results

Four molecular subtypes were identified: quiescent, macrophage-dominant, mitochondria-dominant, and mixed, each exhibiting unique gene expression patterns. From 13 potential biomarkers, eight were shortlisted using machine learning, and five (BNIP3, FAHD1, UNG, CBR3, and SLC25A43) were validated in clinical samples. Among them, BNIP3, FAHD1, and UNG were significantly downregulated (p < 0.05).

Conclusion

This study identifies novel molecular subtypes and biomarkers that elucidate the interplay between immune responses and mitochondrial dysfunction in periodontitis. These findings provide insights into the disease's heterogeneity and lay the foundation for developing non-invasive diagnostic tools and personalized therapeutic strategies.

Application of Nanomaterials Targeting Immune Cells in the Treatment of Chronic Inflammation

Chronic inflammation is a common characteristic of all kinds of diseases, including autoimmune diseases, metabolic diseases, and tumors. It is distinguished by the presence of low concentrations of inflammatory factors stimulating the body for an extended period, resulting in a persistent state of infection. This condition is manifested by the aggregation and infiltration of mononuclear cells, lymphocytes, and other immune cells, leading to tissue hyperplasia and lesions. Although various anti-inflammatory medications, including glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs), have shown strong therapeutic effects, they lack specificity and targeting ability, and require high dosages, which can lead to severe adverse reactions. Nanoparticle drug delivery mechanisms possess the capacity to minimize the effect on healthy cells or tissues due to their targeting capabilities and sustained drug release properties. However, most nanosystems can only target the inflammatory sites rather than specific types of immune cells, leaving room for further improvement in the therapeutic effects of nanomaterials. This article reviews the current research progress on the role of diverse immune cells in inflammation, focusing on the functions of neutrophils and macrophages during inflammation. It provides an overview of the domestic and international applications of nanomaterials in targeted therapy for inflammation, aiming to establish a conceptual foundation for the utilization of nanomaterials targeting immune cells in the treatment of chronic inflammation and offer new perspectives for the avoidance and management of inflammation.

Periodontitis, Metabolic Syndrome and Diabetes: Identifying Patients at Risk for Three Common Diseases Using the aMMP-8 Rapid Test at the Dentist's Office

Background/Objectives: This narrative review paper highlights the multifaceted influence of dysbiotic biofilm, genetic background, host response, and environmental factors on periodontitis. It explores the roles of type I and II diabetes mellitus, gestational diabetes, and metabolic syndrome in the progression of periodontitis, drawing insights from various empirical studies and theoretical perspectives. Methods: Relevant articles were sourced using keywords in databases like PubMed/Medline, Science Direct, Scopus, and Google Scholar. Additionally, this review examines the relationship between aMMP-8 levels and increased glycemic states, as well as varying degrees of periodontitis severity. Results: The biomarker active-matrix metalloproteinase-8 (aMMP-8), produced by polymorphonuclear leukocytes (PMN), is highlighted as a reliable indicator of ongoing connective tissue degradation. Dysfunctions in PMN activity, accumulation of advanced glycation end products (AGE), and oxidative stress aggravate the periodontal inflammatory response and complications of diabetes. Traditional diagnostics of periodontitis do not provide sufficient information about the current or future disease initiation or activity of periodontitis. Conclusions: The implications of this review point to the need for monitoring periodontal health by utilizing innovative strategies like aMMP-8 point-of-care testing, using oral rinse for screening and treatment monitoring, and harnessing the potential of supportive treatments like low-dose doxycycline and light-activated mouth rinses for restoring periodontal health. Its expression in oral fluids is a promising diagnostic tool to differentiate periodontitis from gingivitis and healthy periodontium, especially when associated with systemic diseases, fostering greater collaboration among healthcare professionals.

Systematic review and meta-analysis of the association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with periodontitis

INTRODUCTION

Recent evidence suggests the relationship between periodontitis and systemic inflammation, which complete blood count can assess (CBC)-derived biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). We conducted this meta-analysis to evaluate the levels of NLR and PLR of patients with periodontitis compared to those of healthy controls.  METHODS: Web of Science, PubMed, ProQuest, Scopus, and Open Grey were searched for studies published before October 20, 2024, without any limitation on date and language; then, using the random-effects model, we reported a standardized mean difference (SMD) with a 95% confidence interval (CI). In order to assess the quality of publications, we used the Newcastle-Ottawa scale (NOS). Our study was registered in PROSPERO (CRD42023475214).

RESULTS

Overall, 11 articles were included in the analysis. We found that patients with periodontitis had elevated levels of NLR compared to healthy controls (SMD = 0.30, 95% CI 0.08-0.52, p = 0.007) In the subgroup analysis according to race, patients with periodontitis had elevated levels of NLR compared to healthy controls in among East Asian patients (SMD = 0.35, 95% CI 0.15-0.55, p = 0.001), but not among Turkish (SMD = 0.15, 95% CI - 0.30-0.61, p = 0.50) and Indian (SMD = 0.38, 95% CI - 0.17-0.94, p = 0.18) patients. In addition, PLR level was not different among patients with periodontitis and healthy controls (SMD = 0.06, 95% CI - 0.71-0.83, p = 0.87).

CONCLUSIONS

The findings of our investigation, which indicate higher NLR levels in periodontitis patients, show that immune dysregulation plays a role in the etiology of the disease.