The association of aggressive and chronic periodontitis with systemic manifestations and dental anomalies in a jordanian population: a case control study

Is There Any Association Between Chronic Periodontitis and Anxiety in Adults? A Systematic Review

Periodontitis is a multifactorial disease triggered by dysbiotic biofilms, involving the host's immune response, systemic and behavioral factors, including psychosocial conditions. This systematic review aimed to investigate the possible association between periodontitis and anxiety in adults. Searches were performed in PubMed, Scopus, Web of Science, Lilacs, Cochrane, and OpenGrey databases, without language restrictions, considering studies in adults (P-Participants), with (E-Exposure) and without periodontitis (C- Comparison) in an outcome of association with anxiety (O-outcome). Methodological quality assessment was carried out using the Newcastle-Ottawa protocol for case-control and cross-sectional studies, followed by an analysis of the level of evidence using the GRADE tool. Metanalysis was not performed due to several differences in methods applied by authors in primary studies. Eleven observational studies were selected according to the inclusion criteria from the total of 6,380 studies retrieved from databases. Eight studies demonstrated higher anxiety levels in subjects with periodontitis, among which only one study presented a high risk of bias. The GRADE tool revealed a low level of evidence for the anxiety outcome measured by the State-Trait Anxiety Inventory (STAI), both for case-control and cross-sectional studies. However, since anxiety may affect the quality of life of many subjects, it reinforces the need for further studies that evaluate this association for more extended periods. Clinical Trial Registration:PROSPERO-CRD42020190445.

In situ gel drug delivery system for periodontitis: an insight review

Background

Periodontitis is a microbial disease that leads to inflammation in the tooth-supporting tissues of the oral cavity that is common among the elderly. It is initiated by oral inflammation induced by bacterial dysbiosis. Choosing an appropriate antimicrobial agent with the right course of drug administration is the key to successful periodontal therapy. In recent times, with more biomarkers and the development of new technologies, several point-of-care testing (POCT) platforms have been developed for the diagnosis and monitoring of periodontitis. This review focuses on oral microbiology and the pathogenesis of periodontitis as well as recent insights into the in situ gel system for periodontitis.

Design

An exhaustive search was conducted in the following scientific databases Science Direct, Springer, Pub Med, and Google Scholar to review all relevant literatures. This is a comprehensive narrative review of the literature, summarizing the perspectives of the authors.

Results

Novel in situ forming gel is introduced at the site that shows a promising potential to overcome one of the main practical obstacles associated with the treatment of local periodontitis: partial adhesion to the surrounding tissue, causing in the accidental expulsion of at least parts of the implants from patient’s pockets. This results in a large residence time of the system at the site of action and uncertainty of the final exposure to the drug.

Conclusion

From the reviewed literature, it is concluded that experimental evidence suggests that the in situ gel-forming systems can be useful in treating several common diseases of the oral cavity. Future research should focus on clinical studies to be performed for the in situ gel to make a significant contribution to periodontitis.

Graphical abstract

Periodontal disease and emotional disorders: A meta-analysis

OBJECTIVE

The objective of this study was to evaluate the relationship of periodontal disease with depression and anxiety via a systematic review and meta-analysis.

METHOD

We systematically searched the EMBASE, PubMed, Web of Science, PsycINFO, and SinoMed databases (until August 4, 2019) with language restricted to English and Chinese. Case-control, cross-sectional, and cohort studies that calculated the risk ratio (RR), odds ratio (OR)/prevalence OR (POR), and hazard ratio (HR) of depression/anxiety with periodontal disease or the OR/POR/RR/HR of periodontal disease caused by depression/anxiety were included. Observational studies that reported the depression/anxiety scale score of patients with periodontal disease and healthy periodontal subjects aged ≥14 years were also included. We used the standard format to extract the following information from each included study: author/s, survey year, study design, age of participants, periodontal disease definition, depression/anxiety measurement, and summary of results. The Newcastle-Ottawa scale was used to ascertain the quality of the included citations.

RESULTS

After screening, 40 studies were included. A meta-analysis of the case-control studies showed that periodontal disease was positively associated with depression (OR = 1.70, 95% confidence interval [CI]  = 1.01-2.83). A meta-analysis of 12 studies showed that periodontal disease was significantly correlated with anxiety (OR = 1.36, 95% CI = 1.11-1.66). A meta-analysis of 18 studies showed that subjects with periodontal disease had higher depression scale score (standardized mean difference [SMD] = 1.05, 95% CI = 0.68-1.41) and anxiety scale score (SMD = 0.70, 95% CI = 0.44-0.96).

CONCLUSION

Periodontal disease is associated with emotional disorders. However, the high degree of heterogeneity among studies should be considered. More high-quality prospective studies are required to confirm the relationship.

Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis

OBJECTIVES

To systematically review the literature in order to investigate association between depression and oral diseases.

MATERIAL AND METHODS

Electronic searches were performed in five databases. Studies testing associations between depression and oral diseases as either exposure or outcome were included. Oral disease variable included any tooth loss or edentulism, periodontal disease, and dental caries.

RESULTS

A total of 2504 articles were identified in the electronic database search. Sixteen studies were included in this systematic review being 14 included in the meta-analyses. Eleven studies considered oral health as outcome, whereas three studies considered depression as an outcome variable. Depression was associated to dental caries, tooth loss, and edentulism. Pooled estimates showed that depression increased the odds of dental caries (OR 1.27; 95% CI 1.13-1.44), tooth loss (OR 1.31; 95% CI 1.24-1.37), and edentulism (OR 1.17; 95% CI 1.02-1.34), respectively. When the oral diseases were tested as independent variable and depression as outcome, associations with both edentulism (OR 1.28; 95% CI 1.06-1.55) and periodontal disease (HR 1.73; 95% CI 1.58-1.89) were found.

CONCLUSIONS

The results of our systematic review and meta-analyses show a positive association between depression and oral diseases, specifically dental caries, tooth loss, and edentulism, in adults and elders. More longitudinal studies are required to test causal and temporal relationship between depression and oral health status.

CLINICAL RELEVANCE

Mental and oral health are among the main disabilities worldwide. This article helps to understand more about the relationship between both conditions, highlighting the importance for both clinicians and policy makers of considering individual's psychological status in management of oral health.

Assessment of Pyrexia and Associated Sickness Behavior in Patients with Chronic Periodontitis

BACKGROUND AND OBJECTIVES

The purpose of this study was to assess pyrexia and sickness behavior such as anxiety, depression, lethargy, and weight loss in subjects with chronic periodontitis, and evaluate inflammatory mediators such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the patients with fever.

METHODS

This was a cross-sectional study that consisted of 150 chronic periodontitis and 150 healthy subjects. Sublingual and subgingival temperatures were assessed using a digital temperature probe. Associated sickness behavior was assessed for all the subjects. Pathological tests, i.e., ESR and CRP were done for subjects with fever.

RESULTS

Evaluating the presence of fever with the severity of periodontal disease, 66.7% of the subjects with fever were in the group diagnosed with severe periodontitis, 20.4% had with moderate periodontitis, and 5.3% were in the healthy group. Subjects diagnosed with periodontitis comprised 66.2% of the subjects with higher (i.e., > 36.3°C) subgingival temperatures and healthy subjects made up the remaining 33.8% (p < 0.001). A correlation between the sublingual and subgingival temperature with the Pearson ρ correlation coefficient of 0.227 (p < 0.001) was observed. A statistically significant mean value of 37.05 ± 11.24 of ESR and 1.59 ± 1.11 mg/L of CRP was reported amongst the subjects with fever (p < 0.001). The association of sickness behavior with the severity of periodontitis was found to be significant: depression 40.006, anxiety 50.857, reported weight loss 76.463, and lethargy 141.581 (p < 0.001).

DISCUSSION AND CONCLUSION

The study demonstrated that there is a significant increase in the sublingual temperature amongst patients with severe chronic periodontitis. The subgingival temperature has a positive correlation with the sublingual temperature. There was a linear trend of an association of sickness behavior with the severity of chronic periodontitis. A significant increase in the circulating inflammatory mediators, CRP and ESR, were noticed in subjects with elevated body temperature.

Role of chronic stress and depression in periodontal diseases

An extensive body of experimental and clinical evidence documents the negative impact of chronic psychological stress and depression on the immune system and health. Chronic stress and depression can result in general dysregulation of the immune system, of both cellular and humoral pathways, which may contribute to pathogenic infection and concomitant periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host defense and progression of periodontal infections in patients susceptible to periodontitis. However, substantial evidence also indicates that these conditions can mediate risk for disease, including periodontitis, through changes in health-related behaviors, such as oral hygiene, smoking and diet. The unequivocal interpretation of studies has also been hampered, in part, by issues related to conceptualization of stress and depression, as well as commonly associated comorbidities, such as diabetes, that can modify the onset and progression of periodontal disease. In addition, stress and depression appear to fall into a spectrum, ranging from mild to severe, involving a complex interaction of genetic background, coping strategies and environment. Differences in the conceptualization of stress and depression are probably important in assessing associations with other biologic and clinical measures. Future studies are necessary to clarify the complex interactions of chronic stress and depression in periodontal diseases.

Efficacy of subantimicrobial-dose doxycycline against nitrosative stress in chronic periodontitis

AIM

To evaluate the effectiveness of subantimicrobial-dose doxycycline (SDD) as an adjunct to scaling and root planing (SRP) treatment against the nitrosative stress of moderate to advanced chronic periodontitis.

METHODS

Adults with untreated chronic periodontitis (n=174) were randomly administered SRP+SDD (n=87) (20 mg of doxycycline twice daily) or SRP+placebo (n=87) treatment for 3 months. At baseline and after 3 months, the probing depths (PD), bleeding on probing (BOP) and clinical attachment level (CAL) were measured, and a gingivomucosal biopsy was collected to assay the induction of nitric oxide synthase (iNOS) and 3-nitrotyrosine (3NT), and blood was collected to assay for total nitrites and nitrates (NO(x)) and 3NT.

RESULTS

Compared to baseline, at the completion of treatment, significant decreases in the levels of tissue iNOS and 3NT and serum NO(x) and 3NT were observed in both groups. SRP+SDD yielded a greater reduction in the gingivomucosal and serum nitrosative stress markers than did SRP+placebo. PD, BOP, and CAL reduction were correlated with the nitrosative stress parameters.

CONCLUSION

On a short-term basis, SDD therapy may be used as an adjunct to SRP treatment against nitrosative stress in moderate to advanced chronic periodontitis.