Oral health's inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions

An assessment of the oral health status and dental care treatment needs of oncology patients receiving bone modifying agents

OBJECTIVE

The objective of this study was to assess the oral health status and dental care treatment need of oncology patients receiving bone modifying agents (BMAs).

STUDY DESIGN

This was a cross-sectional study conducted in oncology patients. Their oral health status was assessed and dental care treatment needs were completed prior to commencing a BMA. Statistical analysis was conducted to identify certain characteristics which may highlight risk factors for dental disease and dental treatment needs.

RESULTS

A total of 150 patients were assessed, with a mean age of 61.5 years (standard deviation [SD] = 11.75 years). Breast cancer was the most common cancer (n = 96). Sixty-five patients (43.3%) did not have a dentist. The mean Decayed, Missing, and Filled Teeth (DMFT) index was 17.68 (SD = 7.85) and 145 patients (97%) had periodontal disease. Eighty-six restorations were placed and 188 teeth were extracted. One hundred forty-seven patients (98%) achieved dental fitness. Statistical analysis found a significant result for a periodontal extraction and increasing age, which increased by 21.2% every 10 years (P = .0239). Patients who did not have a dentist required 67.5% more restorations and a current smoker was 3.4 times as likely to require an extraction due to periodontal disease (P < .001).

CONCLUSIONS

Our study highlights the vulnerability of this cohort due to their dental treatment needs. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Immunomodulatory peptide DP7-C mediates macrophage-derived exosomal miR-21b to promote bone regeneration via the SOCS1/JAK2/STAT3 axis

Periodontitis, the most prevalent chronic inflammatory disease leading to bone resorption, presents significant challenges for achieving optimal periodontal bone regeneration and repair despite efforts to reduce inflammation and stimulate osteogenesis. Macrophage-derived exosomes have emerged as promising therapeutic agents due to their osteogenic and immunomodulatory potential. Specific stimulation of macrophages can alter the exosomal composition, particularly microRNAs (miRNAs), thereby altering their functions. DP7-C, a cationic immunomodulatory peptide, is known to regulate immune responses and cellular processes by interacting with cell membranes and signaling pathways. However, its effects on macrophage exosomal miRNA profiles remain poorly understood. In this study, we identified differential miRNA expression in macrophage-derived exosomes following DP7-C stimulation, with a notable upregulation of miR-21b. To investigate the osteogenic role of exosomal miR-21b, DP7-C was utilized to facilitate the transfection of miR-21b into macrophages, leading to the secretion of exosomes enriched with miR-21b. These exosomes enhanced osteogenic differentiation in vitro and alleviated periodontal tissue damage in an experimental periodontitis model in vivo. Mechanistically, exosomal miR-21b promotes osteogenesis by directly targeting the suppressor of cytokine signaling (SOCS1), thereby activating the JAK2/STAT3 signaling pathway. This study establishes macrophage-derived exosomal miR-21b as a potent catalyst for bone regeneration, highlighting a promising acellular therapeutic strategy for periodontitis.

Association between periodontitis and prostate cancer: A case-control study

BACKGROUND

Recent evidence suggests that chronic inflammation may play a role in the development and clinical course of cancer. In this context, periodontitis (PE) has been associated with prostate cancer (PC), but the results are still inconsistent. Therefore, the aim of this study was to evaluate the potential association between PE and PC, and their shared risk factors.

METHODS

This case-control study comprised 152 cases with PC and 220 controls. All participants underwent a complete periodontal examination, and sociodemographic and medical variables of interest were collected. The association between occurrence and severity of PC and covariates was assessed by binary and multinomial multivariate logistic regression, respectively.

RESULTS

The cases had a higher prevalence (p = 0.012) and severity (p = 0.007) of PE. The occurrence of PC was associated with an educational level <9 years (adjusted odds ratio [OR] = 1.93), smoking (adjusted OR = 2.62), alcohol consumption (adjusted OR = 3.45), diabetes (adjusted OR = 0.32), chronic hypertension (adjusted OR = 2.03), and PE (adjusted OR = 1.80). Regarding the severity of PC, Gleason grades 1 and 2 were associated with PE (adjusted OR = 1.96), but Gleason grades 3-5 were not.

CONCLUSION

PE was associated with the occurrence of PC. Males diagnosed with PE would potentially benefit from being screened for prostate alterations.

PLAIN LANGUAGE SUMMARY

Periodontitis is an infectious disease that affects the supporting structures of the teeth. It has been characterized as a chronic inflammatory stimulus with potential risk for the occurrence or worsening of the clinical course of cancer. We evaluated the potential relationship between periodontitis and prostate cancer, as well as their shared risk factors, in a case-control study comprising 372 male individuals. The participants were recruited in a urology outpatient clinic and underwent a complete periodontal examination. The results showed that individuals with prostate cancer presented a worse periodontal status and a higher prevalence and severity of periodontitis. Prostate cancer was mainly associated with educational level, smoking, alcohol consumption, and periodontitis. Individuals with periodontitis were 1.8 times more likely to have prostate cancer. Prostate-specific antigen levels in individuals with periodontitis were also significantly higher. We concluded that periodontitis was associated with the occurrence of prostate cancer. Therefore, males diagnosed with periodontitis would potentially benefit from being screened for prostate alterations.

Knowledge and perception of specialties of dentistry among undergraduatein the Northeast China

BACKGROUND

Oral diseases are among the most prevalent non-communicable diseases globally. Due to their lifestyle choices and dietary habits, college students often exhibit poor oral health and are at a higher risk of developing oral diseases. Enhancing their understanding of oral health and increasing their awareness of the dental profession can foster better oral health practices and encourage preventive measures against oral diseases.

METHODS

This cross-sectional study gathered 560 valid responses from undergraduate students divided into three groups: stomatology students, non-dental medical students, and non-medical students. A specifically designed questionnaire assessed the participants' knowledge and attitudes towards dental specialties. Statistical analyses, including Welch's Test and Levene's Test, were performed using SPSS Version 26.0 to examine differences based on gender and undergraduate major.

RESULTS

Analysis of the 560 valid questionnaires revealed that female participants had significantly higher knowledge scores than their male counterparts (p < 0.05). Conversely, males demonstrated more favorable attitudes towards dental specialties (p < 0.05). Stomatology students scored higher than students from both other medical and non-medical major in knowledge and attitude assessments (p < 0.05), reflecting a more profound understanding and identification with their field. These results underscore the significant impact of gender and academic background on students' perceptions of dental specialties.

CONCLUSIONS

A concerning number of medical and non-medical students, including some dental students, exhibit limited awareness of oral health issues and the various dental specialties. It is imperative to implement educational reforms targeting medical students to enhance their understanding of dental specialties. This improvement will enable them to accurately identify oral diseases and make appropriate referrals, ultimately reducing patient suffering in their future medical practice.

Integration of Oral Health and Oral Surgery into Medical Training

As the United States (U.S.) population continues to age, we need to promote a renewed perspective on oral health, helping policy makers understand the impact of poor oral health on older adults with chronic conditions. In this article we describe the issue of lack of oral health education in medical school curricula, the differences in dental school programs, and a brief history of Oral maxillofacial surgery DMD/MD programs in the U.S. In addition to an education focusing on technical skills, dental education should also address scientific, social, and health-related competencies. Not only should the lack of integration of oral health topics in medical curricula be addressed, we should also train future dental professionals on the systemic effects of oral conditions.

Dental care trajectories among formerly incarcerated older adults in the United States

A growing body of research has documented an association between prior incarceration and lower dental care use, yet the longitudinal impact of prior incarceration on dental care patterns over time among older adults remains unexplored. This study aims to investigate whether prior incarceration is associated with differing trajectories of dental care use among older adults in the United States. Data were drawn from the 2012-2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States (n =  5,893). Group-based trajectory modeling was used to estimate dental care use patterns over time. The findings revealed dental care patterns followed three trajectories: regular dental care use (48.1%), moderate-declining dental care use (27.3%), and low dental care use (24.6%). Multinomial logistic regression was used to examine the relationship between prior incarceration and membership in these trajectory groups. Bivariate analyses revealed that prior incarceration was significantly associated with higher relative risks of being in the moderate-declining (Relative Risk Ratio [RRR] =  2.75, 95% CI =  2.08-3.63) and low dental care use trajectories (RRR =  2.88, 95% CI =  2.10-3.94) compared to the regular dental care use group. After adjusting for sociodemographic, economic, and healthcare-related covariates, formerly incarcerated individuals had a 1.52 times higher relative risk of belonging to the moderate-declining dental care trajectory (RRR =  1.52, 95% CI =  1.16-1.98). The association between prior incarceration and membership in the low dental care trajectory group was not statistically significant. These findings underscore the need for targeted interventions to address dental care disparities among formerly incarcerated individuals, which could lead to improved oral and overall health outcomes for this vulnerable population.

Association between oral microbiome and sleep disorders in U.S. adults: analysis of NHANES database 2009-2012

BACKGROUND

The microbiome, especially the gut microbiome, contributes to the regulation, etiology, and pathogenesis of sleep disorder. However, limited evidence regarding the oral microbiome's role in sleep disorder. Therefore, this study aimed to investigate the association between sleep disorder and oral microbial diversity and whether oral microbiota is associated with all-cause mortality in people with sleep disorder.

METHODS

The study included 4,729 individuals in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012 and mortality data until 2019. Sleep disorder was assessed by structured questionnaire. The oral microbiome was characterized by 16 S ribosomal RNA gene sequencing. Logistic regression models were conducted to quantify the association of α-diversity with different sleep status controlling for potential confounding variables, and principal coordinate analysis along with permutational multivariate analysis of variance for β-diversity. The association between the oral microbiome and all-cause mortality was assessed using Cox proportional hazard models.

RESULTS

The α-diversity showed that a lower number of operational taxonomic units (OTUs) (adjusted odds ratio [aOR] = 0.996; 95% confidence interval [CI] = 0.994-0.998), less Faith's phylogenetic diversity (aOR = 0.954, 95% CI = 0.934-0.975), and a lower Shannon-Weiner index (aOR = 0.854, 95% CI = 0.772-0.944) were associated with sleep disorder. β-diversity revealed different oral microbiome communities between the two groups, as measured by the Bray-Curtis dissimilarity (R2 = 0.358%, P = 0.001), unweighted UniFrac distance (R2 = 0.450%, P = 0.001) and weighted UniFrac distance (R2 = 0.709%, P = 0.001). Furthermore, the OTUs (odds ratio [OR] = 0.999; 95% CI = 0.998-0.999; P < 0.05), Faith's phylogenetic diversity (OR = 0.987; 95% CI = 0.975-0.998; P < 0.05), Shannon-Weiner index (OR = 0.924; 95% CI = 0.873-0.979; P < 0.05), and the inverse Simpson index (OR = 0.553; 95% CI = 0.306-0.997; P < 0.05) were all associated with a significant increase in the risk of all-cause death in participants with sleep disorder.

CONCLUSIONS

Intra-population richness, inter-population dispersion, and the phylogenetic diversity of the oral microbiome have all been linked to sleep disorder and all-cause mortality. Overall, these results will help to better understand the etiology and pathogenesis of sleep disorder. Further studies are required to determine the mechanisms underlying the role of microbiome in the pathogenesis of sleep disorder.

Prognostic factors affecting probing depth reduction following non‑surgical periodontal therapy in patients with periodontitis: A linear mixed‑effects model analysis

The present study aimed to elucidate the prognostic factors affecting the probing depth (PD) reduction following the non-surgical periodontal treatment of patients with periodontitis using a linear mixed-effects model. A retrospective analysis was performed on 455 patients who met the specific inclusion criteria. Data were gathered from 3-month re-evaluation records in the electronic periodontal charting system at the Department of Periodontology, School and Hospital of Stomatology at Tianjin Medical University between December 2021 and January 2022. Descriptive statistics were used to assess the changes in PD and certain baseline characteristics of the patients. A three-level nested random-effects mixed-effect model (patient/tooth/site) was used to evaluate the prognostic factors for PD reduction. Variance decomposition was conducted to analyze PD reduction across different nested levels. P<0.05 was considered to indicate a statistically significant difference. The overall mean PD reductions at the patient level for all sites were 0.88 mm. Patients diagnosed with Grade C periodontitis exhibited a greater PD reduction compared with those with Grade B periodontitis (0.96 vs. 0.76 mm; P<0.001). The multivariable coefficient for patients with Grade C periodontitis was 0.20 (95% confidence interval, 0.08-0.33; P<0.001). Random-effects analysis demonstrated that the variability in PD reduction was 59.4, 39.1 and 73.8% at the patient, tooth and site levels, respectively. Grade C periodontitis had the most substantial importance on the effect of PD reduction following NSPT. This reduction in PD could primarily be explained at both the site and patient levels.

Investigating the link between oral health conditions and systemic diseases: A cross-sectional analysis

This study investigates the association between oral health issues, specifically periodontitis and dental caries, and systemic health conditions such as diabetes and hypertension. The goal is to determine the strength of these associations using statistical analysis. We conducted a cross-sectional study utilizing the National Health and Nutrition Examination Survey (NHANES) data from 2017-2020, focusing on 13,772 adults with complete data on oral and systemic health variables. Oral health indicators were periodontitis and dental caries, while systemic health variables included diabetes and hypertension. The statistical analysis involved Cramer's V to assess the strength of associations between these health conditions. The study found statistically significant associations between oral and systemic health conditions. There was a moderate association between periodontitis and diabetes (Cramer's V = 0.14) and a moderate association between dental caries and hypertension (Cramer's V = 0.12). The results underscore the interconnected nature of oral and systemic health, suggesting that poor oral health can be an indicator of broader health issues. These associations could guide integrated health care strategies, emphasizing the need for dental health evaluations in patients with diabetes and hypertension.

An overlooked connection: oral health status in patients with chronic diseases

BACKGROUND

Oral and systemic health are closely linked. Chronic diseases like diabetes mellitus, cardiovascular diseases, and hypertension increase the risk of dental caries, periodontal disease and tooth loss. Moreover, poor oral health can worsen the status of systemic diseases. Despite this, oral health is often overlooked in chronic disease management. This study aimed to evaluate the oral health status of patients with chronic diseases (PWCD) compared to healthy controls using DIMF-T and DMF-S indices.

METHODS

This retrospective study included 205 participants (106 PWCD and 99 healthy controls) attending the Oral Diagnosis & Radiology outpatient clinic at Bahçeşehir University Dental Hospital. Comprehensive intraoral and radiological examinations assessed caries lesions, missing teeth, filled teeth, periodontal disease, denture usage, and the prevalence of apical osteitis, soft tissue lesions, and intraosseous lesions. Oral health status was quantified using DIMF-T and DMF-S indices. Statistical analyses were conducted to identify differences between groups.

RESULTS

The study group (PWCD) exhibited significantly higher median values for missing teeth (MT), decayed surfaces (DS), missing surfaces (MS), DIMF-T, and DMF-S indices compared to the control group (p < 0.001). Chronic periodontitis was more prevalent in PWCD (76.42%) than in controls (45.45%), while gingivitis was more common in the control group (52.53%, p < 0.001). Medication use for systemic diseases was strongly associated with poor oral health outcomes (p < 0.001). However, no significant differences were observed between the groups for decayed teeth (DT), hopeless teeth (IT), or filled teeth (FT).

CONCLUSIONS

PWCD demonstrated worse oral health outcomes compared to healthy controls, highlighting the need for integrated oral and systemic healthcare strategies. Dental professionals should be careful in identifying oral conditions that may signal underlying systemic diseases. Future research should explore the integration of oral health evaluations into routine medical screenings and examine the global practices of oral health management in PWCD.

Link between caries, periodontitis, and pregnancy: The role of personalized oral hygiene

Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus. This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women, with particular emphasis on periodontal disease and dental caries. Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight, many pregnant women do not receive adequate dental care. This gap in care is often due to misconceptions about the safety of dental treatments during pregnancy and lack of awareness on the part of healthcare professionals. Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support, have proven effective in improving oral health in this population. Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient, thereby enhancing maternal and fetal health outcomes. Integration of personalized oral hygiene management into maternal health programs and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.

Oral frailty indicators and cardio- and cerebrovascular diseases in older age: A systematic review

Oral health indicators may contribute to the oral frailty phenotype, an age-related gradual loss of oral function together with a decline in cognitive and physical functions. The present systematic review synthetized current knowledge on the associations of oral frailty indicators and major cardio- and cerebrovascular diseases in older age, including coronary heart disease (CHD), arteriosclerosis, arrhythmias, hypertension, cardiovascular diseases not otherwise specified (NOS), and stroke. The study is registered on PROSPERO-(CRD42023397932). From database inception to March 31, 2024, six different electronic databases were consulted assessing the eligibility of 50,005 records against the inclusion criteria and 20 studies on 226,025 older adults were included. Five different indicators of oral frailty (number of teeth, periodontal disease, general oral health, dry mouth, and bite force) were related to cardio- and cerebrovascular diseases. The number of teeth was associated with all the outcomes except hypertension, followed by periodontal disease associated with CHD, arteriosclerosis, hypertension, and stroke. General oral health and dry mouth were associated with CHD/arrhythmias and CHD/stroke, respectively. Finally, bite force was associated only with cardiovascular diseases NOS. The present findings could help to assess the contribution of each oral frailty indicator to the development of cardio- and cerebrovascular diseases in older age.

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.

Oral health in patients with cleft lip and palate: a systematic literature review and meta-analysis of periodontal and dental disease and oral microbiota (part 1)

INTRODUCTION

Orofacial cleft impacts jawbone and dental development and function, often with consequences for oral health. The first in this two-part systematic review of the literature on oral health in persons with cleft lip and/or palate focuses on periodontal parameters and composition of oral bacterial flora, while the second analyzes data on dental caries.

MATERIALS AND METHODS

Four databases (PubMed, Cochrane, Scopus, Web of Science) were searched for studies that compared periodontal parameters, caries index, and microbiota composition between persons with cleft lip and/or palate and healthy controls. The Newcastle-Ottawa scale and the Joanna Briggs Institute checklist were applied to evaluate study quality.

RESULTS

A total of 24 studies underwent systematic review, 18 of which entered meta-analysis. Twenty studies included a control group, while four included only persons with orofacial cleft. The first part (18 studies) compared periodontal parameters and oral microbiota.

CONCLUSIONS

Meta-analysis of periodontal parameters (plaque index, gingival index, bleeding index, probing pocket depth, clinical attachment level) revealed an association between orofacial cleft and greater risk for poor oral health and periodontal disease. Good oral health relies on correct home oral hygiene and regular visits to the dentist starting at an early age.

Single-cell analysis of peri-implant gingival tissue to assess implant biocompatibility and immune response

PURPOSE

The innate immune response, particularly the reaction of polymorphonuclear neutrophils (PMNs), is crucial in shaping the outcomes of chronic inflammation, fibrosis, or osseointegration following biomaterial implantation. Peri-implantitis or peri-implant mucositis, inflammatory conditions linked to dental implants, pose a significant threat to implant success. We developed a single-cell analysis approach using a murine model to assess the immune response to implant materials, offering a practical screening tool for potential dental implants.

METHODS

We performed bioinformatics analysis and established a peri-implant inflammation model by inserting two titanium implants into the maxillary region, to examine the immune response.

RESULTS

Bioinformatics analysis revealed that titanium implants triggered a host immune response, primarily mediated by PMNs. In the in vivo experiments, we observed a rapid PMN-mediated response, with increased infiltration around the implants and on the implant surface by day 3. Remarkably, PMN attachment to the implants persisted for 7 days, resembling the immune profiles seen in human implant-mediated inflammation.

CONCLUSIONS

Our findings indicate that persistent attachment of the short-living PMNs to titanium implants can serve as an indicator or traits of peri-implant inflammation. Therefore, analyzing gingival tissue at the single-cell level could be a useful tool for evaluating the biocompatibility of candidate dental implants.

Lower Serum IL-10 Linked to Oral Manifestations in Diabetes Patients

Background

Diabetes mellitus (DM) is a chronic disease that remains a global health problem with increasing prevalence, particularly in Indonesia. The presence of oral manifestations in patients with DM is influenced by changes in immune system function. Interleukin-10 (IL-10) is an inflammatory marker implicated in DM. However, no studies have investigated the differences in IL-10 levels between non-DM and DM patients with and without oral manifestations.

Objective

This study aimed to compare the serum levels of IL-10 between non-DM and DM patients with and without oral manifestations at Dr. Hasan Sadikin Hospital Bandung.

Methodology

This observational study used a cross-sectional design. A total of 88 serum samples that met the inclusion criteria were selected, consisting of 37 (42%) samples from non-DM patients, 35 (39.8%) samples from DM patients with oral manifestations, and 16 (18.2%) samples from DM patients without oral manifestations. Serum levels of IL-10 were measured using an enzyme-linked immunosorbent assay (ELISA) kit.

Results

Among the 35 DM patients with oral manifestations, xerostomia was the most common (80%). The mean serum IL-10 level was 0.93 pg/mL in non-DM patients, 0.80 pg/mL in DM patients with oral manifestations, and 1.08 pg/mL in DM patients without oral manifestations. Statistical analysis using the Kruskal-Wallis test showed a p-value of 0.008 (p ≤ 0.05), indicating a significant difference in serum levels of IL-10 between non-DM and DM patients with and without oral manifestations.

Conclusion

DM patients with oral manifestations had lower IL-10 serum levels compared to non-DM patients and DM patients without oral manifestations. These findings suggest that monitoring IL-10 levels could help identify diabetic patients at higher risk for oral complications.

Association between exposure to environmental pollutants and increased oral health risks, a comprehensive review

The burden of disease and death attributable to environmental pollution is a growing public health challenge worldwide, particularly in developing countries. While the adverse effects of environmental pollution on oral health have garnered increasing attention, a comprehensive and systematic assessment remains lacking. This article delves into the intricate relationship between environmental pollution and oral health, highlighting significant impacts on various aspects such as dental caries, periodontal diseases, oral facial clefts, cancer, as well as other oral diseases. Our results suggested that secondhand smoke, particulate matters (PM) and heavy metals are the most important risk factors affecting oral health. Additional contributors, such as radiation pollutants, electronic cigarette, phthalates, gaseous air pollutants, pesticides, solvents, wood dust, formaldehyde and excessive fluoride were investigated, though evidence for their impacts remains limited and often inconclusive. The review also explores potential mechanisms underlying these impacts, including microorganism, inflammation, oxidative stress, genetic influences, and toxicant exposures from heavy metals and other pollutants. For instance, PM2.5 may contribute to dental caries by disrupting oral pH balance and absorbing heavy metals such as lead and cadmium which have been considered as caries promoting elements. It is also associated with adverse inflammatory responses and tissue damage in periodontal tissues by causing oxidative stress, potentially leading to periodontitis. Drawing on current evidence, it provides a comprehensive analysis of these associations, offering critical insights to guide the development of preventive strategies and public health interventions. The findings highlight the pressing need for future research to validate the causal links between environmental pollution and oral diseases and to unravel the underlying biological mechanisms. Ultimately, greater attention must be directed toward addressing the relationship between environmental pollution and oral diseases, with a focus on pollution control and the reduction of preventable environmental risks to safeguard oral health on a broader scale.

Pica practices, anemia, and oral health outcomes: a systemic review

OBJECTIVES

Pica is a non-nutritive eating behavior. The potential impact of pica on oral health and the association between pica and anemia are understudied. We examined the current evidence on the relationship between pica practices, anemia, and oral health outcomes.

METHODS

We used Population, Intervention, Control, and Outcomes (PICO) terms to create MeSH terms to assess 1) the relationship between pica and iron deficiency anemia (IDA), 2) the relationship between IDA and oral health, and 3) the relationship between pica, anemia, and oral health outcomes. The review was registered on Prospero [CRD42022349022]. We searched databases including PubMed, Embase, Web of Science, Cochrane Library, and, clinicaltrials.gov in June 2022.

RESULTS

From 4,159 searched articles, 89 met the inclusion criteria. Studies were published between 1959 and 2022 from 33 countries. Nearly half of these studies (55.1%, n = 49) were case reports. The most common picas included geophagia (soil/dirt) (44.9%, n = 40 papers), pagophagia (ice) (22.5%, n = 20), amylophagia (starch) (15.7%, n = 14), paint/metal (5.6%, n = 5), paper (5.6%, n = 5) and others such as pica for foam and hair. Fifteen case reports and one intervention study showed the effects of pica practice on oral health, such as tooth abrasion, dental caries, and de-papillated tongue. Furthermore, 81% of the papers reported the co-occurrence of pica with anemia and 15 papers reported a significant association (p < 0.05) between pica and low hemoglobin levels ranging from < 12.0 to 2.7g/dL among all age groups, including among pregnant and postpartum women. Pica practices were strongly associated with IDA (serum ferritin < 15.0 - 4.3 mcg/ml) but showed a non-statistically significant trend of association with oral health outcomes.

CONCLUSION

Pica was strongly associated with anemia and IDA. Tooth abrasion and dental caries were observed among pica users. Future studies could define the strength of the pica-oral health association, and the potential mediators, such as anemia.

Dental education in nursing schools: A pan-Canadian study

OBJECTIVES

The aim of this study was to gather data on Canadian nursing programs regarding oral health curriculum and attitudes towards oral health curriculum to evaluate the level of oral health education in nursing programs and provide a reference for understanding dental and oral health in the nursing field.

METHODS

Data to inform models for oral health curriculum in nursing were collected through an online survey using a secured google form. The web-based questionnaire examined main aspects of dental and oral health in nursing educational institutions. Eligibility criteria for this study included faculty members of an accredited nursing program in Canada.

RESULTS

Of the 76 institutions approached, a total of 47 nursing faculty members from 35 nursing programs responded to the online survey. The vast majority (85.1 %) of the participants stated they believe oral health should be taught within nursing programs. Relating to the current curriculum, 70.2 % of the respondents stated their institution currently teaches anatomy relating to the oral cavity, but only 38.3 % reported their institution implemented oral diseases and pathology into the curriculum. Moreover, 48.9 % of the participants noted that dental screening was not covered in the nursing curriculum; 27.7 % of the respondents stated that their institution implemented education regarding gum disease, 25.5 % noted implementing education regarding oral cancer and oral lesions screening. Overall, 80.9 % of the participants noted that future nurses should be educated about oral cancer and disease prevention. However, in order to implement dental and oral health curriculums, participants noted certain needs such as time to implement curriculum (87.2 %) and more knowledge about the topic (83 %).

CONCLUSIONS

There is a current lack of content regarding dental and oral health in the curriculum of nursing programs throughout Canada. Due to this deficiency, many nursing graduates lack general knowledge about various aspects of dental and oral health.

Exploring oral health challenges and integration strategies in opioid treatment programs: perspectives from clinicians and clients

Background Despite the paramount importance of oral health, individuals undergoing treatment for opioid use disorder face unique challenges beyond traditional addiction care. This qualitative study explores the challenges Opioid Treatment Program (OTP) clients in Australia encounter when accessing oral health care, aiming to understand the underlying factors and identify effective strategies for integrating oral health into an OTP. Methods Semi-structured interviews were conducted with OTP clients, OTP clinicians and oral health clinicians using tested interview guides. Thematic analysis identified patterns and themes across participants' responses. Results Client behaviour and traits such as inadequate health prioritisation, crisis-driven care and lack of motivation, shaped by a complex social environment, contribute significantly to inconsistent care and neglected oral health. Addiction exacerbates oral health issues as clients prioritise drug use over oral care and financial constraints, resulting in poor oral hygiene and a higher prevalence of dental problems. Psychological barriers such as dental anxiety deter clients from seeking care, while access issues including administrative burdens and system barriers, lost phones and unstable living conditions hinder consistent management of oral health. Stakeholders recommend actionable steps to address OTP clients' challenges, including integrating holistic care, establishing collaborative support systems, improving awareness and education and enhancing accessibility and flexible scheduling. Conclusion This study established a framework for improving OTP clients' oral health through integrated, holistic strategies. By addressing gaps in existing research, it supports the development of public health policies integrating oral health care into OTPs, aiming to foster collaboration, improve access and advance client education for better health outcomes.

Link Between Oral and Gut Microbiomes: The Oral-Gut Axis

In the last decades, groundbreaking research on the human microbiome has changed our reductionist conception of the etiology and pathogenesis of several chronic diseases. As a result, we have come to appreciate the significance of a balanced microbiome in maintaining human health. In this context, the upper and lower gastrointestinal tracts (GITs) comprise the most abundant and diverse microbiotas of the human body. In addition to its diversity, functional redundancy, and temporal stability, a healthy GIT microbiome is characterized by its body site specificity. In fact, current evidence has indicated that the translocation of oral species to the gut environment through the oral-gut axis is increased in an array of illnesses, including chronic inflammatory and metabolic diseases, neurological disorders, and cancer. Oral pathogens have also been shown to promote gut dysbiosis and systemic inflammation in animal models. Yet, some level of overlapping between oral and gut microbiomes may occur without disruption of these microbial communities and loss of site specificity. The uniqueness of each host-microbiome entity may hinder our ability to define a "universal" normal GIT microbiome. Despite that, this chapter summarizes the predominant health-related taxa along the human GIT, as well as their role in the physiology and immunity of the digestive system. Some mechanisms that may lead to disturbances and relevant shifts in the oral and gut microbiomes of major inflammatory chronic diseases are also pointed out. Lastly, oral-fecal microbial signatures are presented as potential biomarkers for several oral and systemic disorders. The recognition of such symbiotic/dysbiotic microbial profiles may provide insights into the development of more accurate early diagnosis and therapeutic ecological approaches to restore the balance of the GIT microbiome.

Salivary features of periodontitis and gingivitis in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is associated with cellular abnormalities, tissue and organ dysfunctions, and periodontitis. This investigation examined the relationship between the oral microbiome and salivary biomarkers in T2DM patients with or without periodontitis. This cohort (35-80 years) included systemically healthy non-periodontitis (NP; n = 31), T2DM without periodontitis (DWoP; n = 32) and T2DM with periodontitis (DWP; n = 29). The oral microbiome [Operational Taxonomic Units (OTUs)] (16 s rRNA sequencing) and targeted host salivary biomarkers (immunoassays) were assessed. We identified 47 OTUs that were significantly different in abundance between NP samples and any disease subset or between disease subgroups. The most unique microbiome patterns were observed in the DWP group. Differences in genera/species abundance were also observed when T2DM patients were stratified by extent of periodontal inflammation and disease (i.e., generalized versus localized gingivitis/periodontitis). Salivary biomarkers showed significant elevations in MMP-8, MMP-9, resistin, IL-1β, IL-6, IFNα, and BAFF (THFSR13b) comparing generalized to localized periodontitis. Salivary analytes showed significant positive correlations with specific microbiome members, predominantly in DWP patients. Odds ratio analyses reinforced that a panel of biologic markers (IL-6, MMP-8) and bacteria (e.g., Bacteroidetes, Fusobacteria, Spirochaetes) discriminated the severity and extent of periodontal disease in this diabetic population.

Icariin suppresses osteogenic differentiation and promotes bone regeneration in Porphyromonas gingivalis-infected conditions through EphA2-RhoA signaling pathway

Periodontitis is associated with multiple systemic diseases and can cause bone loss. Porphyromonas gingivalis (P. gingivalis) is one of the most virulent periodontal pathogens. Icariin is a flavonoid extracted from the traditional Chinese herbal medicine Herba Epimedii, and can regulate bone metabolism. However, its effects on promoting bone metabolism have not been fully elucidated. In this experiment, we infected MC3T3-E1 cells with P. gingivalis. Flow cytometry results show that persistent bacterial infection does not affect cell proliferative activity. Western blotting, ALP activity detection, mineral content determination, and immunofluorescence blotting confirmed that icariin improved osteogenic differentiation in the inflammatory state, and this effect may be more obvious in the early stage of osteogenic differentiation. The antibacterial assays, ROS and MMP fluorescence assays demonstrated that icariin exerted a significant inhibitory effect on bacterial growth and attenuated the inflammatory response in bacterial-infected conditions. The results of in vivo experiments in animals further validated the excellent properties exerted by icariin in the repair of bone defects. Additionally, in the P. gingivalis-infected state, icariin exert a regulatory effect on EphA2-RhoA signaling pathway to augment osteogenic differentiation. These exciting findings suggest that icariin holds significant potential for therapeutic application in the management of periodontal bone loss.

Effects of green tea based oral health strategies on disease activity in rheumatoid arthritis

Aim

In this study, we aimed to evaluate oral health strategies in rheumatoid arthritis (RA) patients with periodontitis.

Methods

We enrolled 110 RA patients with periodontitis who were diagnosed in a Grade A tertiary hospital into an oral health strategies program. The control and test groups comprised 55 cases each. The management effect was evaluated by self-care ability, oral health-related quality of life, RA-related clinical indicators, and the DAS28 score. The control group received routine nursing, whereas the test group was in a self-health management program for 3 months.

Results

After the intervention, compared to the control group, the test group showed better self-care ability, oral health-related quality of life score, RA-related clinical indicators, and DAS28 score (P < 0.05).

Conclusion

Our oral health strategies program slowed down the progression of the disease and can be popularized in patients.

Prior incarceration length and edentulism among formerly incarcerated older adults in the United States

BACKGROUND

This study investigated the association between prior incarceration length and edentulism among US adults 55 years and older. Analyses explored indirect factors such as wealth, smoking status, mental health, and chronic health conditions that may explain this relationship. In addition, the study analyzed how associations between incarceration and edentulism vary by race and ethnicity.

METHODS

The authors used data from the 2012-2014 Health and Retirement Study (unweighted N = 11,630; weighted N = 72,872,877) to assess the relationship between incarceration duration and edentulism through multivariable logistic regression. The Karlson-Holm-Breen method evaluated indirect effects, and multiplicative interaction terms examined variations by race and ethnicity.

RESULTS

Net of control variables analyses showed a positive association between having been incarcerated for more than 1 month and higher odds of edentulism. However, this association was rendered statistically nonsignificant after accounting for wealth, current smoking status, mental health, and chronic disease. Collectively, wealth and smoking explained approximately 60% of the association between prior incarceration length and edentulism. Racial moderation models indicated that longer incarceration times increased edentulism likelihood in non-Hispanic Whites specifically.

CONCLUSIONS

To the authors' knowledge, this is the first study on the association between prior incarceration length and edentulism among older adults. Study findings indicated the relationship between incarceration and edentulism was explained by higher wealth and current smoking status.

PRACTICAL IMPLICATIONS

These findings highlight the need for adequate access to oral health care services for formerly incarcerated older adults to improve oral health and enhance their overall health and quality of life.

Current status and prospect of gut and oral microbiome in pancreatic cancer: Clinical and translational perspectives

Pancreatic cancer is a highly lethal malignancy, and its diagnosis and treatment continue to pose significant challenges. Despite advancements in surgical and comprehensive treatment methods, the five-year survival rate remains below 12 %. With the rapid development of microbiome science, the gut and oral microbiota, which are readily accessible and can be sampled non-invasively, have emerged as a novel area of interest in pancreatic cancer research. Dysbiosis in these microbial communities can induce persistent inflammatory responses and affect the host's immune system, promoting cancer development and impacting the efficacy of treatments like chemotherapy and immunotherapy. This review provides an up-to-date overview of the roles of both gut and oral microbiota in the onset, progression, diagnosis, and treatment of pancreatic cancer. It analyzes the potential of utilizing these microbiomes as biomarkers and therapeutic targets from a clinical application perspective. Furthermore, it discusses future research directions aimed at harnessing these insights to advance the diagnosis and treatment strategies for pancreatic cancer. By focusing on the microbiome's role in clinical and translational medicine, this review offers insights into improving pancreatic cancer diagnosis and treatment outcomes.

Periodontitis Provokes Retinal Neurodegenerative Effects of Metabolic Syndrome: A Cross-Sectional Study

BACKGROUND

This cross-sectional study aims to investigate the retino-choroidal degenerative effects of periodontitis, metabolic syndrome (Mets), and the combination of these diseases using optical coherence tomography (OCT) measurements.

METHODS

Ninety-two patients selected according to inclusion criteria were divided into four groups: systemically and periodontally healthy (control), systemically healthy periodontitis (PD), periodontally healthy metabolic syndrome (MetS), and periodontitis and metabolic syndrome combined (PD-MetS). The systemic inflammatory-oxidative effects of periodontitis and MetS were biochemically evaluated using the serum TNF-α level, IL-1β/IL-10 ratio, and oxidative stress index (OSI: TOS/TAS). Retinal (AMT, pRNFLT, and GCL + T) and choroidal (SFCT) morphometric measurements and vascular evaluations (foveal capillary density) were performed via OCT Angio with swept-source technology.

RESULTS

Both periodontitis and Mets cause systemic inflammatory stress characterized by significant increases in the IL-1β/IL-10 ratio and OSI (p < 0.05). Compared to the control group, the AMT was significantly thinner in the MetS group, the pRNFLT was significantly thinner in the PD-MetS group, and the SFCT was significantly thinner in both groups (p < 0.05). The GCL+ was slightly thicker in the Mets groups. (p > 0.05) Foveal capillary density did not differ significantly among the groups. (p > 0.05).

CONCLUSIONS

Periodontitis-related inflammatory stress alone causes changes in retinal and subfoveal choroidal thicknesses that are not statistically significant. On the other hand, when combined with Mets, it may significantly provoke the retinal neurodegenerative effects of this disease.

Oral Health Literacy and Patient Education Practices Among Non-Dental Professionals in Chongqing, China: A Cross-Sectional Study

BACKGROUND Preventing oral diseases is a critical aim in maintaining general health. Non-dental professionals (NDPs) should understand oral health-related knowledge to help patients maintain oral and general health. We investigated the oral health knowledge, behaviors, and attitudes of NDPs regarding patient education and intersectoral collaborations for oral health. MATERIAL AND METHODS For this cross-sectional study, a web-based questionnaire of 36 questions was designed to collect characteristics, oral health knowledge, behaviors, and attitudes of spreading oral health knowledge. A total of 406 NDPs, including 166 doctors and 240 nurses, at 3 randomly selected hospitals in Chongqing, China, were included. Data were collected electronically and statistically analyzed using the chi-square test. RESULTS Only 35.96% and 39.41% of respondents disagreed with "extraction can cause loosening of adjacent tooth" and "tooth loss is a natural part of aging", respectively. Of the respondents, 92.12% were aware of oral healthcare needs before pregnancy; 67.48% agreed with cleaning the gums before the eruption of children's teeth; only 57.14% and 56.16% knew the start time of dental cleaning for children and the relatively safe period of dental treatment for pregnant women, respectively; 73.40% of respondents were interested in oral health knowledge, and they mainly consulted dental professionals; 95.56% agreed with intersectoral collaborations for oral health; and 68.47% thought to conduct oral health education in the future. CONCLUSIONS NDPs knew about common oral health knowledge; however, the oral healthcare knowledge for special groups was insufficient. NDPs should improve their ability to educate the public on oral health and establish intersectoral collaborations.

Intestinal homeostasis disrupted by Periodontitis exacerbates Alzheimer's Disease in APP/PS1 mice

Periodontitis exacerbates Alzheimer's disease (AD) through multiple pathways. Both periodontitis and AD are intricately correlated to intestinal homeostasis, yet there is still a lack of direct evidence regarding whether periodontitis can regulate the progression of AD by modulating intestinal homeostasis. The current study induced experimental periodontitis in AD mice by bilaterally ligating the maxillary second molars with silk and administering Pg-LPS injections in APPswe/PS1ΔE9 (APP/PS1) mice. Behavioral tests and histological analyses of brain tissue were conducted after 8 weeks. Gut microbiota was analyzed and colon tissue were also evaluated. Then, fecal microbiota from mice with periodontitis was transplanted into antibiotic-treated mice to confirm the effects of periodontitis on AD and the potential mechanism was explored. The results indicated periodontitis exacerbated cognitive impairment and anxious behaviour in APP/PS1 mice, with increased Aβ deposition, microglial overactivation and neuroinflammation in brain. Moreover, the intestinal homeostasis of AD mice was altered by periodontitis, including affecting gut microbiota composition, causing colon inflammation and destroyed intestinal epithelial barrier. Furthermore, AD mice that underwent fecal transplantation from mice with periodontitis exhibited worsened AD progression and disrupted intestinal homeostasis. It also impaired intestinal barrier function, elevated peripheral inflammation, damaged blood-brain barrier (BBB) and caused neuroinflammation and synapses impairment. Taken together, the current study demonstrated that periodontitis could disrupt intestinal homeostasis to exacerbate AD progression potential via causing gut microbial dysbiosis, intestinal inflammation and intestinal barrier impairment to induce peripheral inflammation and damage BBB, ultimately leading to neuroinflammation and synapse impairment. It underscores the importance of maintaining both periodontal health and intestinal homeostasis to reduce the risk of AD.

The emerging role of Toxoplasma gondii in periodontal diseases and underlying mechanisms

Toxoplasma gondii (T. gondii), an obligate intracellular protozoan parasite, is increasingly recognized for its role in various human diseases, including periodontal diseases. Periodontal diseases comprise a wide range of inflammatory conditions that not only affect the supporting structures of the teeth and oral health but also contribute to systemic diseases. The parasite's ability to modulate the host's immune response and induce chronic inflammation within the periodontium is a key factor in periodontal tissue damage. Through its virulence factors, T. gondii disrupts the balance of inflammatory cytokines, leading to dysregulated immune responses, and exacerbates oxidative stress in periodontal tissues. And T. gondii invasion could affect specific proteins in host cells including HSP70, BAGs, MICs, ROPs, SAGs, and GRAs leading to periodontal tissue damage. The indirect role of the host immune response to T. gondii via natural killer cells, monocytes, macrophages, neutrophils, dendritic cells, T cells, and B cells also contributes to periodontal diseases. Understanding these complex interactions of T. gondii with host cells could unravel disease mechanisms and therapeutic targets for periodontal diseases. This review delves into the pathogenic mechanisms of T. gondii in periodontal diseases, offering a detailed exploration of both direct and indirect pathways of its impact on periodontal health.

Exploration of oral hygiene practices, oral health status, and related quality of life of individuals residing in the Rorya district of Tanzania, East Africa

Introduction

Oral health substantially impacts individuals' quality of life, making it an important target for global health interventions. This research describes oral health status, practices, and beliefs within the Rorya district of Tanzania to understand barriers to care.

Methods

To quantify physical oral health status, intraoral examinations were conducted on adults, noting the Decayed Missing and Filled Teeth (DMFT) and Comprehensive Periodontal Inflammatory Burden Index (CPBI). Oral Health-Related Quality of Life (OHRQoL) and semi-structured interviews were conducted to understand oral hygiene behaviors and beliefs. Data was analyzed via two-sample t-tests, Pearson's statistics, and NVIVO.

Results

A purposive sample (n = 139) of participants self-reported to reside in either Burere (n = 32), Nyambogo (n = 52), or Roche (n = 55) were assessed. A two-sample t-test revealed females (n = 67; x¯ = 7.1; SD = 5.4; p < 0.05) have a significantly higher DMFT score than males (n = 72; x¯ = 3.7; SD = 3.9). Moreover, the OHRQoL score of females (n = 67; x¯ = 12.10; SD = 14; p < 0.05) were significantly higher than males (n = 72; x¯ = 10.16; SD = 3). In contrast, males have significantly higher CPBI scores (x¯ = 3.8; SD = 1.5; p=<0.05) than females (x¯ = 3.0; SD = 1.3). Additionally, older age groups presented higher GI and PISA scores, while the younger group (20-30 years) displayed the highest mean DMFT score. The themes that emerged from semi-structured interviews were "pearls of laughter guarded by wisdom teeth," "whispered tales of oral tides and communal echoes," and "tales of the tooth fairy."

Discussion

In this community, proper oral health maintenance techniques are vital yet frequently disregarded, mainly due to disparities in access to resources, reflected in oral health scores. Addressing this is a crucial intervention, presenting an opportunity to uplift overall well-being. Moreover, gender and age disparities in oral health highlight the urgent need for tailored interventions.

Systemic Factors Affecting Prognosis in Periodontics: Part II

This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.

Oral Lactobacillus zeae exacerbates the pathological manifestation of periodontitis in a mouse model

INTRODUCTION

The worldwide prevalence of periodontitis is considerably high, and its pathogenic mechanisms must be investigated and understood in order to improve clinical treatment outcomes and reduce the disease prevalence and burden. The exacerbation of the host immune system induced by oral microbial dysbiosis and the subsequent tissue destruction are the hallmarks of the periodontitis. However, the oral bacteria involved in periodontitis are not fully understood. We used the Oxford Nanopore Technologies (ONT) sequencing system to analyze metagenomic information in subgingival dental plaque from periodontitis and non-periodontitis patients. The number of Lactobacillus zeae (L. zeae) in the periodontitis patients was 17.55-fold higher than in the non-periodontitis patients, suggesting that L. zeae is a novel periodontitis-associated pathogen. Although several Lactobacillus species are used in vivo as probiotics to treat periodontitis and compete with Porphyromonas gingivalis (P. gingivalis), the roles of L. zeae in periodontitis progression, and the relationship between L. zeae and P. gingivalis needs to be investigated.

METHODS

Both L. zeae and P. gingivalis were inoculated in the ligature-implant site of periodontitis mice. We collected mouse gingival crevicular fluid to analyze inflammatory cytokine secretion using a multiplex assay. Intact or sliced mouse maxilla tissue was used for micro-computed tomography analysis or hematoxylin and eosin staining, immunohistochemistry, and tartrate-resistant acid phosphatase staining to evaluate alveolar bone loss, neutrophil infiltration, and osteoclast activation, respectively.

RESULTS

We observed that L. zeae competed with P. gingivalis, and it increased inflammatory cytokine secretion at the ligature-implant site. Similar to P. gingivalis, L. zeae promoted ligature-induced neutrophile infiltration, osteoclast activation, and alveolar bone loss.

DISCUSSION

We, therefore, concluded that L. zeae accelerated the progression of periodontitis in the ligature-induced periodontitis mouse model.

Associations between periodontitis and serum anti-malondialdehyde-acetaldehyde antibody concentrations in rheumatoid arthritis: A case-control study

BACKGROUND

Malondialdehyde-acetaldehyde (MAA) adducts lead to generation of anti-MAA autoantibodies and have been independently identified in inflamed periodontal and rheumatoid arthritis (RA) tissues. This study evaluates serum samples from RA cases and osteoarthritis (OA) controls to quantify associations between periodontal clinical measures, alveolar bone loss (ABL), and anti-Porphyromonas gingivalis, anti-Prevotella intermedia, and anti-Fusobacterium nucleatum antibody concentrations with anti-MAA antibody concentrations.

METHODS

Participants (n = 284 RA cases, n = 330 OA controls) underwent periodontal clinical assessments and ABL measurements. Serum immunoglobulin (Ig) A, IgG, and IgM anti-MAA and serum IgG antibacterial antibody concentrations were quantified by enzyme-linked immunosorbent assay (ELISA). Analyses utilized simple linear regression and multivariable adjusted models.

RESULTS

No significant associations of periodontal clinical measures with serum anti-MAA were found. Moderate (p = 0.038 and p = 0.036, respectively) and high ABL (p = 0.012 and p = 0.014, respectively) in RA cases (but not in OA) were positively associated with IgG and IgM anti-MAA. Anti-P. gingivalis and anti-P. intermedia antibody concentrations were positively associated with IgA (p = 0.001 for both), IgG (p = 0.007 and p = 0.034, respectively), and IgM anti-MAA antibody concentrations (p < 0.001 and p = 0.020, respectively), while anti-F. nucleatum was positively associated with IgG anti-MAA (p = 0.042), findings that were similar across groups.

CONCLUSIONS

A positive association was demonstrated between ABL and serum IgG and IgM anti-MAA antibody concentrations that was unique to RA and not observed in OA. Serum anti-P. gingivalis, anti-P. intermedia, and anti-F. nucleatum antibody concentrations displayed significant associations with anti-MAA antibody in both groups. These findings suggest MAA may play a role in the interrelationship between the periodontium and RA.

Association of periodontitis with gastrointestinal tract disorders: A bidirectional Mendelian randomization study

BACKGROUND

The bidirectional link of periodontitis (PD) and gastrointestinal tract (GIT) disorders has been investigated in previous epidemiological studies; however, the conclusions still remain controversial. The aim of this study was to comprehensively explore the bidirectional causal effect between PD and various GIT diseases.

METHODS

Based on summary-level data of genome-wide association studies (GWASs), a two-sample bidirectional Mendelian randomization (MR) study was undertaken. Single-nucleotide polymorphisms (SNPs) associated with PD or GIT disorders (chronic gastritis [CG], gastric ulcer [GU], duodenal ulcer [DU], gastroesophageal reflux disease [GERD], irritable bowel syndrome [IBS], and diverticular disease of the intestine [DI]) in GWASs were applied as exposure. The primary method employed was the inverse-variance weighted (IVW) method, and several sensitivity analyses were performed to investigate potential pleiotropy.

RESULTS

With regard to the investigation of the causality between PD and GIT disorders, the IVW method revealed that there is a causal impact of PD on GU (odds ratio [OR] 1.088; 95% confidence interval [CI], 1.036-1.141; adjusted p = 0.004) and DI (OR 0.938; 95% CI, 0.911-0.965; adjusted p = 0.000). However, no significant genetic liability was observed for the causal effect of PD on CG, DU, GERD, and IBS. Furthermore, the primary analysis did not demonstrate a causal effect of GIT disorders on PD.

CONCLUSION

This MR study suggests that PD may be associated with an increased risk of GU and a reduced risk of DI, with possibly limited clinical relevance. Further studies are needed to support the conclusions of this MR study.

Evaluating pre-and post-oral health literacy of undergraduate nursing students on an oral-systemic health learning intervention

INTRODUCTION

Oral health is significantly linked with systemic health. Nurses play a crucial role in patient education. Improving oral health literacy in nursing students can pave the way for the seamless integration of oral health into nursing practice.

OBJECTIVE

This study aimed to evaluate an interprofessional co-designed oral-systemic health learning intervention using a pre-and-post study design that measured oral health literacy levels among Year 2 undergraduate nursing students.

METHODS

Evaluation was measured using the validated Comprehensive Measure of Oral Health Knowledge questionnaire before and after the semester-long education intervention. Data were analyzed using independent and paired t-tests and an analysis of variance one-way analysis of variance.

RESULTS

A total of 78 out of 164 students (82% female, 42% aged 21-24, and 52% speaking English as a first language) participated in the pre- and post-study surveys. Statistically significant improvement was noted in pre-and-post total oral health literacy scores (Pre 14.92 [3.85] vs.. Post 15.85 [3.74], p = 0.031). Students showed the highest proficiency in the domain of oral disease prevention, while oral cancer knowledge was the least mastered domain. Those without English as their first language and those with secondary education as the highest qualification showed the greatest improvement in oral health literacy scores post-intervention.

CONCLUSIONS

This study highlights the efficacy of an interprofessional co-designed oral-systemic educational intervention in increasing oral health literacy among undergraduate nursing students. This intervention marks a preliminary step towards integrating oral health into future nursing practice. Further research is warranted to explore the enduring impact of these interventions on their future clinical endeavors.

System-Based Intervention for Medical Providers to Improve Dental Attendance in Adult Primary Care

INTRODUCTION

There are minimal evidence-based outcomes from clinical trials for medical-dental integration. This formative work and pilot study is a precursor to a larger cluster-randomized clinical trial in adult primary care practices to test an electronic health record (EHR) structured workflow for primary care providers (physicians/nurse practitioners [NPs]) and medical staff (medical assistants [MAs] and nurses) with oral health (OH) screening and referral for Medicaid-enrolled adults ≥55 years.

METHODS

This study was conducted in 2 practices with providers, medical staff, and older adults. Focus groups preceded the pilot study to gain stakeholder insights prior to the multilevel interventions of systems changes and provider education. The system-level EHR changes for medical staff included ask (OH screening), advise (visit dentist soon/annually), assess (need for referral: eReferral to co-located dentists or structured referral to community dentists), and connect (referral; resources). Provider education (didactic and skills) was based on the Common-Sense Model of Self-Regulation (CSM) to deliver OH facts to older adults at primary care visits. Descriptive analysis was used to report on process outcomes of reach, adoption, and implementation/fidelity.

RESULTS

After stakeholder input, the CSM-based didactic and skills curriculum was developed, and 4 physicians were trained. Changes in the Epic EHR were implemented, and 19 medical staff were trained in this new structured workflow together with physicians. In terms of reach, 83% (N = 80) of older adults were enrolled out of 96 approached (female: 66%; non-Hispanic: 83%; Caucasian: 43%). Workflow adoption was 100% of MAs completing the EHR questions and 89% of providers documenting giving OH facts. About 94% of older adults reported their physician giving them OH facts indicating implementation/fidelity of the intervention. About 60% of older adults reported no dental visits in the past year, and 66% requested eReferrals.

CONCLUSION

This study presents an innovative systems-based multilevel intervention for medical-dental integration.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by practice leadership and clinicians when incorporating oral health into primary care for older adults. Considering adoption and implementation costs, this information could lead to a more complete approach to address oral health with patients.

Periodontitis: etiology, conventional treatments, and emerging bacteriophage and predatory bacteria therapies

Inflammatory periodontal diseases associated with the accumulation of dental biofilm, such as gingivitis and periodontitis, are very common and pose clinical problems for clinicians and patients. Gingivitis is a mild form of gum disease and when treated quickly and properly is completely reversible. Periodontitis is an advanced and irreversible disease of the periodontium with periods of exacerbations, progressions and remission. Periodontitis is a chronic inflammatory condition that damages the tissues supporting the tooth in its socket, i.e., the gums, periodontal ligaments, root cementum and bone. Periodontal inflammation is most commonly triggered by bacteria present in excessive accumulations of dental plaque (biofilm) on tooth surfaces. This disease is driven by disproportionate host inflammatory immune responses induced by imbalance in the composition of oral bacteria and changes in their metabolic activities. This microbial dysbiosis favors the establishment of inflammatory conditions and ultimately results in the destruction of tooth-supporting tissues. Apart microbial shift and host inflammatory response, environmental factors and genetics are also important in etiology In addition to oral tissues destruction, periodontal diseases can also result in significant systemic complications. Conventional methods of periodontal disease treatment (improving oral hygiene, dental biofilm control, mechanical plaque removal, using local or systemic antimicrobial agents) are not fully effective. All this prompts the search for new methods of therapy. Advanced periodontitis with multiple abscesses is often treated with antibiotics, such as amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole. However, due to the growing problem of antibiotic resistance, treatment does not always achieve the desired therapeutic effect. This review summarizes pathogenesis, current approaches in treatment, limitations of therapy and the current state of research on the possibility of application of bacteriophages and predatory bacteria to combat bacteria responsible for periodontitis. We present the current landscape of potential applications for alternative therapies for periodontitis based on phages and bacteria, and highlight the gaps in existing knowledge that need to be addressed before clinical trials utilizing these therapeutic strategies can be seriously considered.

Gender differences in the association between transitions in depressive symptoms and oral health among older adults with chronic conditions

BACKGROUND

Oral health influences the quality of life of older adults. Further, depression is negatively associated with oral health. However, little is known about this relationship among older adults with chronic health conditions. Additionally, since oral health and depression differ between genders, this study aimed to investigate the effect of transitions in depressive symptoms on oral health among older adults with chronic health conditions by gender.

METHODS

We used data from the Korean Longitudinal Study of Aging (2020-2022). The study sample comprised 2836 older adults (1104 men; 1732 women). We adopted multiple linear regression to examine the association between depressive symptom transitions and oral health by gender.

RESULTS

The new onset depression symptoms were significantly associated with the deterioration of oral health in men (β = -5.4308) and women (β = -4.8328). Our study showed a gender-specific association between new onset depressive symptoms and particular domains of oral health. For men, the association was slightly more negative in psychosocial function (β = -2.1177) while women presented lower GOHAI scores in both the physical function domain (β = -1.8800) and the psychosocial function domain (β = -1.8801).

LIMITATIONS

The data used in this study were self-reported via a survey; thus, self-report bias may be a relevant concern.

CONCLUSION

To prevent deterioration in oral health, depressive symptoms must be detected and addressed early among older adults with chronic conditions. This study underscores the importance of interventions that consider gender differences in the association between depressive symptoms and psychosocial and physical functioning.

The Indicators of Secretory and Cellular Immunity of Oral Fluid and Periodontal Tissue Before and After Complex Treatment in Patients with Viral Hepatitis B

Background: The pathogenetic commonality of many general somatic processes and inflammatory diseases of the oral cavity is due to the development of mechanisms of cellular damage and modification of tissue structures that are common to the whole organism and acquire autoantigenic properties. The aim of the study was to reveal the immunological changes in the oral cavity with viral hepatitis B and assess the effectiveness of complex treatment. Material and methods: The study involved 95 patients with HBV with periodontal lesions, as well as 100 patients in the control group non- HBV. The dental status and index assessment of the condition of periodontal tissues were studied in all patients. Oral fluid cytokines IL-2, IL-10, IL-4, ɤ-INF were determined. For morphological studies, tissue samples excised from the gums in the area of direct localization of the pathohistological process were used. Immunohistochemical examination of gingival biopsies was performed using mouse monoclonal antibodies to CD3 to detect T lymphocytes. Results: An objective examination of the oral cavity of patients with HBV revealed the presence of a generalized inflammatory process in the area of the marginal and alveolar parts of the gums. Pro-inflammatory IL-2 and ɤ-INF in HBV significantly increase: p<0.001 and p<0.0405, respectively, and anti-inflammatory IL4 sharply decreases compared to the control group by 130 times (p<0.001). After complex treatment, pro-inflammatory IL-2 decreased (p <0.001), the content of anti-inflammatory IL-4 in OF increased 404 times (<0.002). Immunohistochemical research of biopsies periodontium tissue taken from patients with HBV us to evaluate the quantitative composition of infiltrate to T-lymphocytes (CD3+). Conclusion: Thus, the analysis shows that with HBV, gum damage resembles the clinical picture of inflammatory periodontal diseases. Indicators of anti-inflammatory IL4 sharply decrease before complex treatment. A pathomorphological study of periodontal tissues with HBV revealed inflammatory infiltration in all patients. Immunohistochemical study of HBV revealed a positive reaction of lymphocytes for CD3+.

Akkermansia muciniphila as a Potential Guardian against Oral Health Diseases: A Narrative Review

The oral microbiome is a diverse ecosystem containing a community of symbiotic, commensal, and pathogenic microorganisms. One key microorganism linked to periodontal disease (PD) is Porphyromonas gingivalis (P. gingivalis), a Gram-negative anaerobic bacterium known to have several virulence factors that trigger inflammation and immune evasion. On the other hand, Akkermansia muciniphila (A. muciniphila), a symbiotic bacterium, has been recently shown to play an important role in mitigating inflammation and reducing periodontal damage. In vivo and in vitro studies have shown that A. muciniphila decreases inflammatory mediators and improves immune responses, suggesting its role in mitigating PD and related inflammatory systemic conditions such as diabetes, hypertension, and obesity. This review discusses the anti-inflammatory effects of A. muciniphila, its impact on periodontal health, and its potential role in managing systemic diseases. The overall aim is to elucidate how this bacterium might help reduce inflammation, improve oral health, and influence broader health outcomes.

Oral and dental health status in patients with chronic headache

INTRODUCTION

Headache is an illness with high prevalence and adverse effects on quality of life. As oral or dental problems such as pain can trigger or aggravate it, we aimed to investigate and compare oral and dental health status in patients affected with chronic headaches and healthy individuals.

METHODS

The present case-control study included 60 patients with chronic headaches (case) and 60 healthy individuals (control) in Rasht, Iran. The demographic characteristics and clinical examinations, including decayed/missing/filled teeth (DMF-T) and community periodontal index of treatment needs (CPITN) indices, as well as bruxism, frequency of tooth brushing and flossing, and maxillary and mandibular tooth wear were recorded in a checklist. Data analysis was performed using the IBM SPSS version 28 at a significance level of 0.05.

RESULTS

The case group consisted of 25 men (41.7%) and 35 women (58.3%) with an average age of 32.55 ± 6.62 years, while the control group had 27 men (45%) and 33 women (55%) with an average age of 30.95 ± 6.33 years. The study groups were not significantly different in bruxism, frequency of tooth brushing and flossing, DMFT, CPTIN, and maxillary and mandibular tooth wear.

CONCLUSION

It seems that chronic headaches do not significantly affect the oral and dental health of the sufferers. Moreover, it appears that these patients are well aware of the role of oral and dental hygiene in triggering or aggravating the episodes of headaches.

Oral health among refugees and asylum seekers utilizing Médecins du Monde clinics in mainland Greece, 2016-2017

BACKGROUND

The oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 - 2017.

METHODS

A retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest - upper respiratory tract infections (URTIs) and reproductive health consultations - and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs.

RESULTS

Caries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 - 1.77; Or = 1.90; 95% CI: 1.53 - 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 - 1.66; OR = 2.03; 95% CI: 1.49 - 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions.

CONCLUSIONS

Displaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations.

Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial

BACKGROUND

Diabetes mellitus (DM)-associated hyperinflammatory host response significantly provokes periodontal tissue destruction. In this context, the support of nonsurgical periodontal therapy in diabetics with host modulation agents is a current field of study. This clinical study aims to investigate the clinical efficacy of melatonin supplementation and discuss its possible biological mechanisms in nonsurgical periodontal treatment in patients with DM and periodontitis through some fundamental markers.

METHODS

In this randomized controlled and single-blind study, 27 of 55 diabetic patients with periodontitis (stage III/IV and grade C) underwent full-mouth scaling and root planing (fmSRP) alone and 28 patients underwent melatonin administration (6 mg daily, 30 days) in addition to fmSRP (full-mouth scaling and root planing plus melatonin, fmSRP-mel). The potential therapeutic contribution of melatonin was evaluated clinically and biochemically (gingival crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels) at 3rd and 6th months.

RESULTS

Melatonin (tablet, 6 mg daily, 30 days) did not cause any local or systemic side effects. fmSRP alone resulted in significant reduction in serum IL-1β levels, pocket depths, gingival inflammation, and gingival crevicular fluid RANKL and MMP-8 levels (p < 0.05). Moreover, melatonin supplementation resulted in a more significant decrease in bleeding and pocket depth scores at probing, especially at 3 months (p < 0.05). Furthermore, RANKL and MMP-8 levels were significantly lower at 3 months and IL-1β levels at 6 months compared to the control group (p < 0.05). However, OPG levels were not affected significantly by the treatments (p > 0.05).

CONCLUSION

Melatonin, as a host modulation agent, significantly increases the clinical efficacy of fmSRP. The reduction in periodontal inflammation and pocket depths may be a result of marked suppression of RANKL-associated osteoclastogenesis and extracellular matrix damage by melatonin.

Clinical Investigation of Patients with Oral Hematoma and Anemia Linked to Symptoms of Indigestion: A Case Report

Background

Oral cavity is the gateway to the digestive system and a window to general human health. Anemia is one of the health problems in the world characterized by various clinical conditions, including in the oral cavity.

Purpose

This case report aims to present the results of a clinical investigation of a patient who had oral hematoma and anemia with indigestion symptoms.

Case Presentation

A 59-year-old male complained of a lump on his tongue two months prior, which was painless and frequently bleeding. The complaint was followed by abdominal discomfort, difficulty defecating, weight loss, and decreased appetite. The patient only ate porridge and lacked water intake. Intraoral examination showed a blackish-red, irregularly shaped, painless hematoma on the dorsum of the tongue and a negative diascopy test. Hematology examination showed anemia with hemoglobin 6.7g/dL, hematocrit 21.4%, erythrocytes 3.08 x 106/µL, MCV 69.5fL, MCH 21.8pg, and MCHC 31.3g/dL. The diagnosis of the tongue lesion was an oral hematoma.

Case Management

Pharmacologic therapy included antifibrinolytic agents and hematinic supplementation. Non-pharmacologic therapy included dental health education, a balanced lifestyle, and avoiding triggers for tongue bleeding. Management in other fields was also carried out in parallel, including oral surgery and internal medicine. The general condition of the patient general condition improved through multidisciplinary monitoring.

Conclusion

Clinical investigations that include signs and symptoms of disease in a patient with bleeding disorders such as hematoma and anemia need to be carried out in detailed aid examinations, especially if other symptoms are found, such as digestive disorders.

Integration of precision medicine into the dental care setting

This narrative review aims to discuss the incorporation of novel medical concepts and tools into dental practice, with the goal of improving early diagnosis and exploring new personalized treatment options for oral pathologies, such as caries and periodontitis. Preventative dental approaches concentrate on the timely detection of oral infections and the integration of biomarker analysis to recognize pathogenic changes at early stage of disease. Likewise, periodic monitoring after the treatment is relevant to ensure the balance in the oral biofilms and prevent relapse. Additionally, more attention has shifted towards the contributing factors to disease development, such as essential nutrients. Sufficient levels of vitamin C, vitamin D and zinc pre- and post-operatively are employed to boost immune function and reduce the risk of postoperative infections. Omega-3 fatty acids, melatonin, and antioxidants like vitamin E, which have anti-inflammatory properties, are utilized to help minimize excessive inflammation and promote faster recovery. The data presented in this manuscript emphasize the crucial integration of innovative healthcare concepts and tools into dental practices. By adopting a more holistic view of the patient, clinicians can tailor treatments to each individual's predispositions, lifestyle, and oral health conditions. This review also highlights the potential of salivary biomarkers and point-of-care technologies in enhancing early diagnostic accuracy and personalizing treatment. Bridging the gap between oral and systemic health is the most effective approach to improving patient quality of life. These findings underscore the importance of continued interdisciplinary collaboration in dentistry.

Intensive oral prophylaxis does not alter the tongue microbiome in young patients with chronic kidney disease: longitudinal, randomized, controlled study

Introduction

Gingivitis is a common intraoral disease in patients with chronic kidney disease (CKD), which poses a particular interdisciplinary challenge. We aimed to determine the influence of an intensive oral prophylaxis program (OPP) compared to standard prevention measures on the tongue microbiome of young patients with CKD.

Methods

Thirty patients with CKD (mean age 14.2 ± 5.2 years) and generalized gingivitis were included. The effects of the intensive OPP were compared with standard prophylaxis according to statutory health insurance (treatment as usual, TAU) as a control. Tongue swabs were taken from the patients at baseline (t1) and after 3 (t2) and 6 (t3) months. Next-generation sequencing of 16S rDNA genes was used to quantitatively characterize microbial communities.

Results

There were no differences in the abundance, richness, or diversity of the observed genera and species between the two study groups at baseline or after 3 or 6 months. Furthermore, no change in predefined gingivitis and oral health bacterial clusters were found. At the phylum level, Firmicutes were decreased after intervention in the TAU group (t2TAU 42.9 ± 7.1 to t3TAU 34.8 ± 4.7 (npairs=14), p=0.003; false discovery rate 0.02). The decrease of Firmicutes was not significant in the OPP group.

Conclusions

Despite the intensity of dental prophylaxis and decreasing clinical signs of inflammation and decreasing plaque amount, no clinically relevant changes in the tongue microbiome were observed. Our results confirm the conserved and stable nature of the tongue microbiome, even in children with CKD.

Microbiota-Derived Extracellular Vesicle as Emerging Actors in Host Interactions

The human microbiota is an intricate micro-ecosystem comprising a diverse range of dynamic microbial populations mainly consisting of bacteria, whose interactions with hosts strongly affect several physiological and pathological processes. The gut microbiota is being increasingly recognized as a critical player in maintaining homeostasis, contributing to the main functions of the intestine and distal organs such as the brain. However, gut dysbiosis, characterized by composition and function alterations of microbiota with intestinal barrier dysfunction has been linked to the development and progression of several pathologies, including intestinal inflammatory diseases, systemic autoimmune diseases, such as rheumatic arthritis, and neurodegenerative diseases, such as Alzheimer's disease. Moreover, oral microbiota research has gained significant interest in recent years due to its potential impact on overall health. Emerging evidence on the role of microbiota-host interactions in health and disease has triggered a marked interest on the functional role of bacterial extracellular vesicles (BEVs) as mediators of inter-kingdom communication. Accumulating evidence reveals that BEVs mediate host interactions by transporting and delivering into host cells effector molecules that modulate host signaling pathways and cell processes, influencing health and disease. This review discusses the critical role of BEVs from the gut, lung, skin and oral cavity in the epithelium, immune system, and CNS interactions.

Evaluation of a Novel Immunochromatographic Device for Detecting Porphyromonas gingivalis in Patients with Periodontal Disease

Porphyromonas gingivalis is the most pathogenic periodontal bacterium in the world. Recently, P. gingivalis has been considered responsible for dysbiosis during the development of periodontitis. This study aimed to evaluate a novel immunochromatographic device using monoclonal antibodies against P. gingivalis in subgingival plaques. A total of 72 patients with chronic periodontitis and 53 periodontally healthy volunteers underwent clinical and microbiological examinations. Subgingival plaque samples were analyzed for the presence of P. gingivalis and compared using real-time polymerase chain reaction (PCR). In the periodontitis group, a significant positive correlation was observed between the test device scores and the real-time PCR results. The specificity, positive predictive value, negative predictive value, and accuracy of the test device for P. gingivalis, as determined by real-time PCR, were 98%, 94%, 89%, and 90%, respectively. There were significant differences in bacterial counts by real-time PCR among the groups with different ranges of device scores. Additionally, there was a significant positive correlation between the device scores for P. gingivalis and periodontal parameters. These results suggest that this novel immunochromatographic device can be effectively used for rapid detection and semi-quantification of P. gingivalis in subgingival plaques.