Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

Association between dental scaling and metabolic syndrome and lifestyle

PURPOSE

Periodontal disease is a risk factor for diabetes and metabolic syndrome, and non-surgical periodontal treatment has been shown to help maintain stable blood sugar in diabetic patients. Determining the level of preventive scaling in patients with metabolic syndrome will help manage the disease. The purpose of this study was to investigate the extent to which people with metabolic syndrome or bad lifestyle performed scaling and the association between preventive scaling and metabolic syndrome or lifestyle in a large population.

METHODS

This study was conducted on adults aged 20 years or older from January 2014 to December 2017 in the National Health Insurance System (NHIS) database. Among 558,067 people who underwent health checkups, 555,929 people were included. A total of 543,791 people were investigated for preventive scaling. Metabolic syndrome components were abdominal obesity, lower high density lipoprotein cholesterol (HDL)-C, high triglycerides, high blood pressure and hyperglycemia. Unhealthy lifestyle score was calculated by assigning 1 point each for current smokers, drinkers, and no performing regular exercise.

RESULTS

When multiple logistic regression analysis was performed after adjusting for age, sex, income, body mass index (BMI), smoking, drinking and regular exercise, the Odds ratios (OR) and 95% confidence intervals (CI) of the group with 5 metabolic syndrome components were 0.741 (0.710, 0.773) (p<0.0001). After adjustment for age, sex, income, BMI, smoking, drinking, regular exercise, diabetes, hypertension and dyslipidemia, the OR (95% CI) of the group with unhealthy lifestyle score = 3 was 0.612 (0.586, 0.640) (p<0.0001).

CONCLUSIONS

The more metabolic syndrome components, and the higher unhealthy lifestyle score, the less scaling was performed.

Emerging factors affecting peri-implant bone metabolism

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

Allostatic load and oral health later in life among middle-aged and older adults: An analysis of population-based panel data in China

BACKGROUND

Oral health is a major global public health problem, but its risk factors have not been fully identified. The limited evidence suggests that AL may affect oral health conditions, but most of these studies focus only on middle-aged western populations.

OBJECTIVES

To examine whether allostatic load is associated with oral health conditions later in life among middle-aged and older adults in China and there there is a correlation in both middle-aged and older people.

MATERIALS AND METHODS

Data were collected from the China Health and Retirement Longitudinal Study 2011-2018 (N = 10 890) and were analysed using logistic regressions for the overall sample and subsamples by age.

RESULTS

Results showed that higher inflammation load significantly increased the odds of edentulism (OR = 1.358, 95% CI = 1.020-1.809, p < .05). Higher metabolic load significantly increased the odds of denture use (OR = 1.375, 95% CI = 1.154-1.640, p < 0.001) and difficulty in chewing solid foods (OR = 1.100, 95% CI = 1.035-1.169, p < .01). These associations were manifested in older adults over 60 years of age, while in the middle-aged subsample, the associations were not significant.

CONCLUSION

The findings suggested that higher allostatic load was associated with poorer oral health conditions later in life. It is critical to lower allostatic load and improve oral health conditions, especially for older adults over 60 years of age. Prospective studies and intervention trials help to better understand whether allostatic load is causally linked to oral health.

Transcriptomic analysis identifies diagnostic genes in polycystic ovary syndrome and periodontitis

PURPOSE

To investigate underlying co-mechanisms of PCOS and periodontitis through transcriptomic approach.

METHODS

PCOS and periodontitis gene expression data were downloaded from the GEO database to identify differentially expressed genes. GO and KEGG pathway enrichment analysis and random forest algorithm were used to screen hub genes. GSEA analyzed the functions of hub genes. Correlations between hub genes and immune infiltration in two diseases were examined, constructing a TF-ceRNA regulatory network. Clinical samples were gathered from PCOS and periodontitis patients and RT-qPCR was performed to verify the connection.

RESULTS

There were 1661 DEGs in PCOS and 701 DEGs in periodontitis. 66 intersected genes were involved and were enriched in immune and inflammation-related biological pathways. 40 common genes were selected from the PPI network. RF algorithm demonstrated that ACSL5, NLRP12, CCRL2, and CEACAM3 were hub genes, and GSEA results revealed their close relationship with antigen processing and presentation, and chemokine signaling pathway. RT-qPCR results confirmed the upregulated gene expression in both PCOS and periodontitis.

CONCLUSION

The 4 hub genes ACSL5, NLRP12, CCRL2, and CEACAM3 may be diagnostic genes for PCOS and periodontitis. The created ceRNA network could provide a molecular basis for future studies on the association between PCOS and periodontitis.

Association between periodontal disease and hypertriglyceridemia: Propensity score matching analysis using the 7th Korea National Health and Nutrition Examination Survey

The prevalence of periodontitis and dyslipidemia continues to increase, and several studies have reported an association between the 2. Therefore, we assessed the relationship between periodontitis and hypertriglyceridemia using propensity score matching to efficiently address confounding factors, as well as complex sample analysis with data from Korea National Health and Nutrition Examination Survey VII (2016-2018). To match the 1:1 ratio between the groups with and without periodontitis, the propensity scores of covariates, such as age, sex, education, income, smoking, drinking, obesity, and diabetes mellitus, were calculated using logistic regression. Both results of logistic regression analysis using complex sample design for whole and matched sample after propensity score matching demonstrated a significant association between hypertriglyceridemia and periodontitis, of which the adjusted odds ratio was 1.28 (95% confidence interval = 1.10-1.50) and 1.29 (95% confidence interval = 1.09-1.52), respectively. Our findings suggest that dental healthcare workers can help raise awareness among patients with periodontitis regarding the association between periodontitis and hypertriglyceridemia, which may help them manage the condition and receive treatment.

Atypical antipsychotics olanzapine and clozapine increase bone loss in female rats with experimental periodontitis

BACKGROUND AND OBJECTIVES

Periodontitis is a highly prevalent disease in psychiatric patients, including those undergoing symptomatic treatment with second-generation antipsychotics. Some of these drugs, such as clozapine (CLO) and olanzapine (OLA), have prominent metabolic effects such as weight gain, hyperglycemia, and dyslipidemia, which are risk factors for periodontitis. In addition to the metabolic effects, there are reports of changes in salivary flow, gingival bleeding, and caries. In this context, we aimed to evaluate if the metabolic effects of OLA and CLO alter periodontal parameters in an animal model of periodontitis without the environmental and psychosocial biases inherent to human diseases.

METHODS

In the first set of experiments, male and female adult Wistar rats received oral administration of CLO, OLA, or vehicle for 45 days. They were evaluated for body mass composition and weight gain, blood glucose parameters (fasting and glucose tolerance and insulin resistance tests), and lipid profile (HDL, total cholesterol, and triglycerides). In a second set of experiments, the same measurements were performed in female rats exposed to the antipsychotics for 45 days and ligature-induced periodontitis on the 30th day of treatment. Macroscopic measurements of exposed roots, microtomography in the furcation region of the first molar, and histological evaluation of the region between the first and second molars were evaluated to assess bone loss. Additionally, gingival measurements of myeloperoxidase activity and pro-inflammatory cytokine TNF-α were made.

RESULTS

Only females exposed to OLA had more significant weight gain than controls. They also exhibited differences in glucose metabolism. Ligature-induced periodontitis produced intense bone retraction without changing the density of the remaining structures. The bone loss was even higher in rats with periodontitis treated with OLA or CLO and was accompanied by a local increase in TNF-α caused by CLO. These animals, however, did not exhibit the same metabolic impairments observed for animals without periodontitis.

CONCLUSION

The use of clozapine and olanzapine may be a risk factor for periodontal disease, independent of systemic metabolic alterations.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease, accompanied by oral inflammation and pathological changes in the microbiome, induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A subgroup of NAFLD patients have a severely progressive form, namely nonalcoholic steatohepatitis (NASH), which is characterized by histological findings that include inflammatory cell infiltration and fibrosis. NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma. The oral microbiota may serve as an endogenous reservoir for gut microbiota, and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis. Gut dysbiosis increases the production of potential hepatotoxins, including lipopolysaccharide, ethanol, and other volatile organic compounds such as acetone, phenol and cyclopentane. Moreover, gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall, leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation. In particular, many animal studies support that oral administration of Porphyromonas gingivalis, a typical periodontopathic bacterium, induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis. NAFLD, also known as the hepatic phenotype of metabolic syndrome, is strongly associated with metabolic complications, such as obesity and diabetes. Periodontal disease also has a bidirectional relationship with metabolic syndrome, and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively. In this review, we will describe the link between periodontal disease and NAFLD with a focus on basic, epidemiological, and clinical studies, and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome. In conclusion, it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease, gut microbiota, and metabolic syndrome. Thus, the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics, prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Effect of periodontal treatment on glycated haemoglobin and metabolic syndrome parameters: A randomized clinical trial

AIM

To assess the effect of periodontal treatment on HbA1c and diagnostic parameters of patients with metabolic syndrome (MetS).

MATERIALS AND METHODS

One hundred and fifty-eight patients with MetS and moderate and severe periodontitis were included. They were randomized into a test group (n = 79), which received non-surgical periodontal treatment, and a control group (n = 79), which received no treatment. Medical treatment was delivered to both groups. Clinical periodontal, anthropometric and serological parameters were assessed at baseline, 3 and 6 months. The main outcome was glycated haemoglobin (HbA1c) levels, and the secondary outcomes were changes in the MetS parameters, C-reactive protein (CRP) and HOMA indexes.

RESULTS

Significant reductions in all periodontal parameters were observed in the test group, compared with the control group, at 3 and 6 months (p < .001). HbA1c levels, MetS parameters, CRP and HOMA indexes showed no significant differences between the test group and the control group at 3 and 6 months.

CONCLUSIONS

Periodontal treatment led to a substantial reduction in periodontal inflammation, although there was no significant effect on the parameters used for MetS diagnosis in patients with early diagnosed and well-controlled MetS.

Epigenetics in susceptibility, progression, and diagnosis of periodontitis

Periodontitis is characterized by irreversible destruction of periodontal tissue. At present, the accepted etiology of periodontitis is based on a three-factor theory including pathogenic bacteria, host factors, and acquired factors. Periodontitis development usually takes a decade or longer and is therefore called chronic periodontitis (CP). To search for genetic factors associated with CP, several genome-wide association study (GWAS) analyses were conducted; however, polymorphisms associated with CP have not been identified. Epigenetics, on the other hand, involves acquired transcriptional regulatory mechanisms due to reversibly altered chromatin accessibility. Epigenetic status is a condition specific to each tissue and cell, mostly determined by the responses of host cells to stimulations by local factors, like bacterial inflammation, and systemic factors such as nutrition status, metabolic diseases, and health conditions. Significantly, epigenetic status has been linked with the onset and progression of several acquired diseases. Thus, epigenetic factors in periodontal tissues are attractive targets for periodontitis diagnosis and treatments. In this review, we introduce accumulating evidence to reveal the epigenetic background effects related to periodontitis caused by genetic factors, systemic diseases, and local environmental factors, such as smoking, and clarify the underlying mechanisms by which epigenetic alteration influences the susceptibility of periodontitis.

Association between Four Dietary Patterns and the Risk of Periodontal Diseases: A Systematic Review and Meta-Analysis

Background: Several dietary patterns are reported as risk factors for several chronic diseases including oral diseases. However, thus far, there has been no comprehensive quantitative analysis of nutrition and periodontal diseases. Methods: This systematic review was conducted according to the PRISMA guidelines. Cohort, case–control, and cross-sectional studies were eligible for inclusion in this study. The Newcastle–Ottawa scale was used to qualitatively assess the risk of bias in the included studies. The number of samples was used for odds ratio calculation, followed by the unadjusted value and 95% confidence interval. Results: Nine papers were included for the systematic review and meta-analysis. The results of screening for database search records showed that four diet patterns (western diet, dairy product intake, sugar intake, and vitamin C intake) have enough data for meta-analysis. The risk of periodontal disease in the western-diet group and the lowest dairy product intake group was 1.05 (0.51–2.13) and 1.28 (0.89–1.84), respectively. The risk of periodontal disease in the highest sugar intake group and the lowest vitamin C intake group was 1.52 (0.79–2.91) and 1.15 (1.08–1.23), respectively. Conclusions: With aging of the population globally, the prevalence of periodontal disease increases, and the associated cost also increases. Though this study, we found foods related to the risk of periodontal disease, and we are confident that it will contribute to lowering the incidence of the disease.

Periodontal Disease in the Brazilian Population: A Retrospective Analysis on the 2013 National Health Survey to Identifying Risk Profiles

Periodontal disease (PD) is a global public health problem with prevalence varying according to social and economic contexts; however, few studies have investigated the distribution of PD worldwide. PD is the host response to an infection or progression of a clinical condition, and the identification of modifiable risk factors for adequate clinical management of patients should be a priority in health policies directed to vulnerable population groups. In this context, we investigated the characteristics and risk factors for PD using the Brazilian National Health Survey 2013 (PNS-2013). A cluster analysis using the interdependence technique was applied to explore data on the risk of periodontitis. The presence or absence of a risk factor was analyzed using five variables (ten categories), while ordinal regression assessed risk profiles based on sociodemographic aspects of the Brazilian population. Individuals were classified as low (26.33%), medium (23.34%), or high risk (50.32%) for PD. Age, educational level, ethnicity, and Brazilian regions (except the North region) were significantly associated with risk for PD in the adjusted final regression model. Individual and social contexts were factors related to the high risk of PD in the Brazilian population. Our results highlight the need for public policies on healthy habits to prevent systemic diseases affecting oral health.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310).

MATERIALS AND METHODS

A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach).

RESULTS

This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (OR_adj from 1.27 to 1.90; PR_ajd = 1.19; RR_adj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence).

CONCLUSIONS

MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components.

CLINICAL RELEVANCE

Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Association between periodontitis and the metabolic syndrome in the Hamburg City Health Study

BACKGROUND

Previous studies demonstrated an association between severe chronic periodontitis (CP) and the metabolic syndrome (MetS). However, these studies mostly employed the meanwhile outdated NCEP-ATPIII case definition of the MetS. Additionally, CP was rarely diagnosed based on a full-mouth examination. Thus, the aim of the current study was to re-evaluate the potential association between CP and the MetS in the Hamburg City Health Study (HCHS), a large population-based survey of middle-aged and elderly men and women in Germany, in view of more current definitions of the MetS and CP.

METHODS

A cross-sectional study was performed with baseline-data from participants of the Hamburg City Health Study (HCHS). Periodontitis severity grades were determined in a random sample of 6,209 participants of which 5,456 had sufficient data to call absence or presence of the MetS. Variables defining the MetS according to the currently valid harmonized definition were determined and a full-mouth examination was performed, including determination of the clinical attachment loss (AL), bleeding on probing (BOP), and dental plaque (PI) index. CP was classified in three grades of severity (none/mild, moderate, and severe). The Kruskal-Wallis test or the Chi-squared test were used for descriptive statistics and multivariate logistic regression models with and without adjustments for potential confounders (age, sex, smoking, high sensitivity C-reactive protein (hsCRP), energy intake, and physical activity) were used to test for associations.

RESULTS

The prevalence of the MetS (39.0%) increased according to the severity grades of periodontitis (none/mild: 33.6%; moderate: 38.7%, and severe: 46.8%). Multivariate logistic regression analyses demonstrated that severe but not moderate CP was associated with the MetS after adjusting for age and sex (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.03-1.48; p = 0.02). However, the association was attenuated after additional adjustment for smoking (OR: 1.19; 95% CI: 0.99-1.43; p = 0.058) and hsCRP, energy intake, and physical activity (OR: 1.11; 95% CI 0.91-1.36; p = 0.294).

CONCLUSIONS

The use of the more current definitions for the MetS and CP confirmed previous observations of an age- and sex-adjusted association between severe CP and the MetS. Smoking, high energy intake and low physical activity were identified as important lifestyle-related confounders. Abdominal obesity, as indicated by elevated waist circumference, came out as the most important component of the MetS in relation to CP. This article is protected by copyright. All rights reserved.

Association Between Triglyceride-Glucose Index and Risk of Periodontitis: A Cross-Sectional Study

Background

The purpose of this study was to investigate the TyG index in the occurrence of periodontitis among the United States (US) population.

Methods

We analyzed clinical data from 4813 participants in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. the TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Dose-response curves, univariate and multivariate logistic analyses were used to analyze the adjusted odds ratio (aOR) and 95% confidence interval (CI) between TyG index and periodontitis. In addition, we performed 1:1 propensity score matching (PSM) for periodontitis and no periodontitis participants to further explore the relationship between TyG and periodontitis.

Results

A total of 4813 participants were included in our study, of which 1353 (28.1%) reported periodontitis and 3460 (71.9%) no periodontitis. The dose-response curves showed a non-linear positive association between TyG and periodontitis, with the risk of periodontitis increased with increasing TyG. In addition, similar results were still observed after subgroup analysis and PSM analysis. After adjusting for confounding variables, multivariate logistic analysis showed that TyG was associated with an increased risk of periodontitis (aOR =1.153; 95% CI 1.006-1.322, p=0.034).

Conclusion

Elevated TyG index was significantly associated with a high risk of periodontitis, and people with a high TyG index should be aware of the risk of periodontitis progression in order to establish lifestyle changes at an early stage.

Associations between metabolic biomarkers and localized stage II/III periodontitis in young adults: The CHIEF Oral Health study

AIM

To investigate the associations between metabolic risk factors and periodontitis in young adults.

MATERIALS AND METHODS

The study included 1123 participants, aged 19-40 years, in Taiwan. Metabolic syndrome components were defined by the International Diabetes Federation criteria. Localized periodontitis was graded to healthy (n = 828) and stage II/III (n = 295) according to the 2017 criteria of the World Workshop. Multiple logistic regression analysis with adjustment for sex, age, betel nut consumption, and smoking were used to determine the associations.

RESULTS

Greater waist circumference, serum triglycerides, and serum uric acid were associated with higher localized stage II/III periodontitis risk [odds ratio (OR) and 95% confidence interval (CI): 1.04 (1.02-1.05), 1.004 (1.002-1.006), and 1.10 (1.00-1.21), respectively]. There were no associations for total cholesterol, high-density lipoprotein, and blood pressure. There was a non-linear association between fasting glucose and localized stage II/III periodontitis, where the turning point was 105 mg/dl [OR: 0.97 (0.95-0.99) and 1.06 (1.00-1.13) when the levels were <105 and ≥105 mg/dl, respectively].

CONCLUSIONS

The risks of localized stage II/III periodontitis vary with metabolic components, in which waist circumference, serum triglycerides, and serum uric acid are the risk factors, whereas plasma glucose shows a non-linear relationship in young adults.

Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome

Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.

Early identification of metabolic syndrome risk: A review of reviews and proposal for defining pre-metabolic syndrome status

AIMS

a) To analyze the relationship of known and emerging biomarkers/indicators for early risk identification of cardiometabolic health risk; b) to identify early risk markers to be used in both clinical and nonclinical settings; and c) to propose a definition of early risk identification in terms of pre-metabolic syndrome (PreMetSyn).

DATA SYNTHESIS

Pubmed/Medline, Web of Science, Embase, and Cochrane were searched for Systematic Reviews and Meta-analysis. Selected studies were evaluated, and relevant data were extracted and synthesized.

CONCLUSIONS

Serum uric acid is a good predictive biomarker of metabolic syndrome (MetSyn) and has been associated with non-alcoholic liver fat disease (NAFLD) and type 2 diabetes. NAFLD emerges as an early risk indicator of PreMetSyn by itself. Muscle strength should also be included as an early risk marker of cardiometabolic health. High serum triglycerides and waist circumference confirm their predictive value regarding MetSyn. Indicators related to an inflammatory/pro-inflammatory status usually linked to MetSyn showed limited evidence as robust biomarkers for PreMetSyn. Authors suggest defining PreMetSyn related to cardiometabolic risk. It is also necessary to determine how close people are to the cut-off point of MetSyn components, including emerging indicators proposed by our review. Some biomarkers could be used as indicators of PreMetSyn, before any of the MetSyn components appear, allowing early health interventions to prevent its development. Defining a PreMetSyn status might consider both emerging indicators and those variables already included in the definition of MetSyn. New indicators should be considered to create a new risk score specifically meant for PreMetSyn.

The use of probiotics can reduce the severity of experimental periodontitis in rats with metabolic syndrome: an immunoenzymatic and microtomographic study

BACKGROUND

This study evaluated the effects of Bifidobacterium animalis subsp. lactis HN019 (B. lactis HN019) in the development of periodontitis (PE), associated or not with metabolic syndrome, (MS) in rats.

METHODS

96 rats were grouped according to a food protocol: high-fat diet for induction of MS or standard diet for the control groups (C). They were subdivided into groups with (+) and without (-) PE, receiving (*) or not (**) probiotic (PROB): C -**, CP-*, PE+**, PEP+*, MS-**, MSP-*, MSPE+** and MSPEP+*. PROB administration started on the 8^th week of the study and PE was induced on the 14^th week by placing ligature on the animals' lower first molars. Euthanasia occurred in the 16^th week. Biomolecular analyzes, immunoenzymatic assays, and microtomographic analyses were performed. The data obtained were analyzed statistically (p <0.05).

RESULTS

The PEP and MSPEP groups showed lower levels of alveolar bone loss when compared to the PE and MSPE groups, respectively (p <0.05). The immunoenzymatic analysis showed higher levels of interleukin (IL)-1β and a higher receptor activator of NF-kappaB ligand (RANKL)/ osteoprotegerin (OPG) ratio in the MSPE group when compared to the MSPEP group (p <0.05). The PEP group showed lower levels of tumor necrosis factor (TNF)-α and IL-6 when compared to the PE group. The use of PROB attenuated dyslipidemia parameters in animals with MS, with or without PE.

CONCLUSION

B. lactis HN019 reduced more significantly the severity of PE in rats with MS, modulating both systemic metabolic and immunoinflammatory parameters in periodontal tissues. This article is protected by copyright. All rights reserved.

Dynamic Needle Tip Positioning versus Palpation and Ultrasound for Arteriovenous Puncture: A Meta-analysis

At present, dynamic needle-tip positioning (DNTP) technology is applied in arteriovenous puncture, challenging the use of ultrasound technology alone and palpation. Our goals were to extract data from experimental DNTP, ultrasound and palpation studies, using Review Manager, Version 5.3, for data analysis, and to evaluate whether DNTP has certain advantages in puncture. PubMed, EMBASE, the Cochrane Library, CNKI and WanFang Data Knowledge Service Platform were searched for randomized and non-randomized studies that compared DNTP with conventional ultrasound-guided techniques, no DNTP or palpation. The risk ratio with 95% confidence interval was calculated using the model corresponding to the I² value. Studies were identified to compare clinical indexes. With respect to clinical indexes, DNTP is better in terms of first-attempt success, overall success and complications. However, in infants, first-attempt success, overall success and number of additional punctures did not indicate good efficacy for DNTP compared with palpation. Artery puncture was also not performed well under ultrasound. On the basis of the current evidence, the advantages of DNTP over palpation and ultrasound are reflected in the successful first attempt rate of all groups and in all subgroups except infants. Therefore, for emergencies in elderly patients, DNTP can be used as a general method. Given that some of the studies were of low quality, more trials of high quality should be conducted to further verify the findings.

Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey

Objective: To determine the association of edentulism with different chronic diseases and mental disorders in Mexicans aged 60 years and over. Material and Methods: A cross-sectional study was carried out using data from the World Health Survey for Mexico, in a probabilistic, multi-stage cluster sampling framework. Data for self-report of chronic diseases (diabetes, arthritis, angina pectoris and asthma), mental disorders (depression and schizophrenia) and edentulism were analyzed. Edentulism data were available for 20 of the 32 States of Mexico. Statistical analysis was performed in Stata 14.0 using the svy module for complex sampling (Complex nature under which individuals are sampled). Results: In total 4213 subjects were included, representing a population of 7,576,057 individuals. Mean age was 70.13 ± 7.82 years (range 60 to 98); 56.2% were women. Chronic diseases’ prevalence and mental disorders prevalence were as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which pertained to 1,993,463 people aged 60 years and over. Angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001) were associated with higher prevalence of edentulism. Conclusions: There was generally sparse association between edentulism on chronic diseases and mental disorders included in the study, except for women aged 60 to 69 years for angina, and in men aged 70 and over, for depression. Although our findings are misaligned with previous reports, longitudinal studies are required to test causal and temporal relationships between edentulism with chronic diseases and mental disorders.

Correlations between the properties of saliva and metabolic syndrome: A prospective observational study

Saliva tests, which are easy to perform and non-invasive, can be used to monitor both oral disease (especially periodontal disease) and physical conditions, including metabolic syndrome (MetS). Therefore, in the present study the associations between saliva test results and MetS were investigated based on medical health check-up data for a large population. In total, 1,888 and 2,296 individuals underwent medical check-ups for MetS and simultaneous saliva tests in 2017 and 2018, respectively. In the saliva tests, the buffer capacity of saliva, salivary pH, the salivary white blood cell count, the number of cariogenic bacteria in saliva, salivary occult blood, protein, and ammonia levels were tested using a commercially available kit. The relationships between the results of the saliva tests and MetS components were examined in cross-sectional and longitudinal multivariate analyses. Significant relationships were detected between salivary protein levels and serum HbA1c levels or blood pressure levels and between the buffer capacity of saliva and serum triglyceride levels. In addition, salivary pH was increased irreversibly by impaired renal function. This study suggested that saliva tests conducted during health check-ups of large populations might be a useful screening tool for periodontal disease and MetS/MetS components.

The influence of apical periodontitis on the concentration of inflammatory mediators in peripheral blood plasma and the metagenomic profiling of endodontic infections: Study design and protocol

Increased systemic inflammation has been identified in presence of oral disease, specifically endodontic disease. It is important to investigate whether treatment of the oral disease ameliorates systemic inflammation. Furthermore, there is no information about the extent to which different microorganisms may trigger inflammatory response.

Objectives

Primarily (i) to compare the plasma concentrations of inflammatory mediators of apical periodontitis (AP) subjects to controls, (ii) to evaluate whether elimination of the endodontic infection reduces systemic inflammation (iii) to investigate the microbiome of root canal infections. Secondarily i) to correlate the inflammatory mediator data with the microbiome data to investigate whether the type of infection influences the type and severity of the inflammatory condition ii) to examine patterns in the inflammatory mediator data before and after tooth extraction in order to establish a biomarker signature of AP/oral disease.

This is a multi-centre prospective case-control intervention study. The cohort will consist of 30 healthy human volunteers with one or two teeth with a root-tip inflammation and 30 matched healthy controls. Peripheral blood will be drawn at 6 time points, 3 before and 3 after the extraction of the tooth with apical periodontitis. The teeth will be pulverized, DNA extraction and sequencing will be performed.

This study aims to compare the concentration of inflammatory blood plasma proteins in between AP-subjects and controls at different time points before and after the tooth extraction in a systematic and complete way. Additionally the composition of the root canal microbiome in association with the inflammatory response of the host will be assessed.

Comparisons of various anthropometric indexes with localized Stage II/III periodontitis in young adults: The CHIEF oral health study

BACKGROUND

A J-shaped relationship of body mass index (BMI) with severe periodontitis has been reported. However, it is unknown for other anthropometric indexes in young adults.

METHODS

A cross-sectional study examined the relationships in 325 military men and women, aged 20 to 45 years in Taiwan. Anthropometric indexes included BMI, waist circumference (WC), and waist-to-height ratio (WHtR). The severity of localized periodontitis was defined as healthy (n = 42), Stage I (initial) (n = 228), and Stage II/III (moderate/severe) (n = 55) according to the 2017 Periodontal Diseases Classification. Smooth curve fitting and multiple logistic regression analyses adjusting for age, sex, betel nut consumption, and smoking were used to determine the threshold effect between various anthropometric and the risk of localized Stage II/III periodontitis.

RESULTS

In the spline smoothing plot, the turning points for BMI, WC, and WHtR were 26.1 kg/m² , 90.0 cm, and 0.50, respectively, and a J-shaped relationship was found for BMI (the likelihood ratio test, P <0.001). In the multiple logistic regressions, BMI ≥27.0 kg/m² , WC ≥90.0 cm and WHtR ≥0.50 were associated with higher risk of localized Stage II/III periodontitis than their counterparts (24.0 to 26.9 kg/m² for BMI) (odds ratios [OR] and 95% confidence intervals: 4.16 [1.39 to 12.49], 2.65 [1.01 to 7.11], and 2.95 [1.20 to 7.24], respectively; all P values <0.05). However, the risk for BMI <24.0 kg/m² was not significant (OR, 1.47 [0.47 to 4.54]).

CONCLUSION

In young adults, obesity defined by various anthropometrics was consistently associated with localized Stage II/III periodontitis and a J-shaped association was suggestive for BMI.

Periodontitis and the subsequent risk of glaucoma: results from the real-world practice

Periodontitis is a multifactorial inflammatory disease that can cause tooth loss and contribute to systemic inflammation. It is suggested that periodontitis may be associated with the development of glaucoma. Based on data from Taiwan’s National Health Insurance Research Database, a retrospective cohort study was conducted to investigate the risk of developing glaucoma in patients with periodontitis. The periodontitis cohort consisted of newly diagnosed adult patients (n = 194,090, minimum age = 20 years) between 2000 and 2012. The comparison group included age-, gender-, and diagnosis date-matched people without periodontitis (n = 194,090, minimum age = 20 years). Incident glaucoma was monitored until the end of 2013. Hazard ratios (HRs) with confidence intervals (CIs) were established based on the Cox proportional hazard models. The risk of developing glaucoma was higher in patients with periodontitis than those without periodontitis (31.2 vs. 23.3 patients per 10,000 person-years, with an adjusted HR of 1.26 [95% CI 1.21–1.32]). A high risk was evident even after stratifying by age (adjusted HRs = 1.34 [1.26–1.44] for ages 20–49, 1.24 [1.13–1.36] for ages ≥ 65, and 1.20 [1.12–1.29] for ages 50–64 years), sex (adjusted HRs = 1.33 [1.24–1.41] and 1.21 [1.14–1.28] for men and women, respectively), presence of comorbidity (adjusted HRs = 1.38 [1.29–1.47] and 1.18 [1.12–1.25] for without and with comorbidity, respectively), and corticosteroid use (adjusted HRs = 1.27 [1.21–1.33] and 1.21 [1.08–1.35] for without and with corticosteroid use, respectively). Specifically, patients with periodontitis exhibited a significantly high risk of primary open-angle glaucoma (adjusted HR = 1.31 [1.21–1.32]) but not for primary closed-angle glaucoma (adjusted HR = 1.05 [0.94–1.17]). People with periodontitis are at a greater risk of glaucoma than individuals without periodontitis. Ocular health should be emphasized for such patients, and the underlying mechanisms need further investigation.

The association of periodontal diseases with metabolic syndrome and obesity

Periodontitis is a multifactorial chronic inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Globally, it is estimated that 740 million people are affected by its severe form. Periodontitis has been suggested to be linked to obesity and metabolic syndrome. Obesity, defined as excessive fat accumulation, is a complex multifactorial chronic inflammatory disease, with a high and increasing prevalence. Metabolic syndrome is defined as a cluster of obesity, dyslipidemia, hypertension, and dysglycemia. Obesity, metabolic syndrome and periodontitis are among the most common non-communicable diseases and a large body of evidence from epidemiologic studies supports the association between these conditions. Extensive research has established plausible mechanisms to explain how these conditions can negatively impact each other, pointing to a bidirectional adverse relationship. At present there is only limited evidence available from a few intervention studies. Nevertheless, the global burden of periodontitis combined with the obesity epidemic has important clinical and public health implications for the dental team. In accordance with the common risk factor approach for tackling non-communicable diseases, it has been proposed that oral healthcare professionals have an important role in the promotion of periodontal health and general well-being through facilitation of healthy lifestyle behaviours.

Analyzing the Association between Hyperuricemia and Periodontitis: A Cross-Sectional Study Using KoGES HEXA Data

Hyperuricemia arises from the buildup of excessive uric acid in the blood, and it is implicated in the development of periodontitis. The objective of this study was to investigate the association between hyperuricemia and periodontitis using a cross-sectional study design and Korean Genome and Epidemiology Study Health Examinee (KoGES HEXA) data. This prospective cohort study used epidemiological data from the KoGES from 2004 to 2016. Among 173,209 participants, 8809 with hyperuricemia and 126,465 controls (non-hyperuricemia) were selected. This study defined hyperuricemia as >7.0 mg/dL of uric acid in men and >6.0 mg/dL in women. This study analyzed the history of periodontitis among hyperuricemia and control participants. Participants’ age, gender, income, obesity, smoking, alcohol consumption, and nutritional intake were all examined. Chi-square tests, independent t-tests, and two-tailed analyses were used for statistical analysis. The adjusted OR (aOR) of hyperuricemia for periodontitis was 0.89 (95% confidence interval (CI) = 0.81–0.96, p = 0.005). This study demonstrated that hyperuricemia was associated with periodontitis. This finding meant that elevated uric acid levels could have a positive effect on periodontitis. However, further studies should be performed to determine the range of uric acid levels beneficial to periodontal health.

Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis

Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.

Porphyromonas gingivalis Induces Insulin Resistance by Increasing BCAA Levels in Mice

Insulin resistance is one of the critical pathogeneses of type 2 diabetes mellitus (T2DM). Elevated levels of plasma branched-chain amino acids (BCAAs) are associated with insulin resistance. Recent studies have demonstrated the role of Porphyromonas gingivalis in the development of insulin resistance. However, the mechanisms by which P. gingivalis induces insulin resistance are still unclear. The purpose of this study was to investigate whether P. gingivalis induces insulin resistance through BCAA biosynthesis. We established a murine model of periodontitis by infecting mice with P. gingivalis. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs were measured. A P. gingivalis BCAA aminotransferase-deficient strain (∆bcat) was constructed, and its kinetic growth, biofilm formation, and in vivo colonization were compared with its wild-type strain. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs of the mice infected with either wild-type strain or ∆bcat strain were further measured. We found that periodontal infection with P. gingivalis significantly upregulated the plasma level of BCAAs and aggravated the high-fat diet (HFD)-induced insulin resistance. Bcat deletion did not alter the growth, biofilm formation, and in vivo colonization of P. gingivalis. More important, the ∆bcat strain was unable to upregulate the plasma level of BCAAs and induce insulin resistance in HFD-fed mice. These findings suggest that the BCAA biosynthesis of P. gingivalis plays a critical role in the development of insulin resistance in the HFD-fed mice. The BCAA biosynthesis pathways may provide a potential target for the disruption of linkage between periodontitis and T2DM.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Hyperuricemia as a potential plausible risk factor for periodontitis

Elevated blood uric acid (UA) levels have been positively associated with the severity of periodontitis. It thus brings out a hypothesis that hyperuricemia, a pathological elevation of blood UA, might be a risk factor for periodontitis. Namely, periodontitis individuals with Hu might acquire more severe periodontal destruction compared to those without Hu. To support the hypothesis, four aspects of evidences are proposed. First, hyperuricemia and periodontitis share many metabolic and inflammatory comorbidities such as metabolic syndrome, diabetes and cardiovascular diseases which are commonly related to elevated UA levels and gout. Second, observational and interventional studies have found altered UA levels in blood and saliva in periodontitis patients or after periodontal treatment, suggesting an epidemiological connection between hyperuricemia and periodontitis. Third, plausible immuno-metabolic mechanisms by which hyperuricemia might promote the progression of periodontitis are suggested, such as impaired immune response, oxidative stress, pathological bone remodeling and dysbiosis. The last, our empirical data exhibited elevated UA levels in gingival tissue in periodontitis mice compared to controls. If the hypothesis is true, given the high prevalence of the two conditions, hyperuricemia would be a significant risk factor increasing the global burden of periodontal diseases. Evidences on a directional correlation between hyperuricemia and periodontitis are sparse. Longitudinal and experimental studies would be necessary to determine the magnitude of periodontal risk, if any, exacerbated by hyperuricemia and the underlying mechanisms.

Risk of complications among diabetics self-reporting oral health status in Canada: A population-based cohort study

BACKGROUND

Periodontitis has been associated with diabetes and poor health. While clear associations have been identified for the diabetes-oral health link, less is known about the implications of poor oral health status for incident complications of diabetes. This study investigated the risk of diabetes complications associated with self-reported "poor to fair" and "good to excellent" oral health among diabetics living in Ontario, Canada.

METHODS

This was a cohort study of diabetics who took part in the Canadian Community Health Survey (2003 and 2007-08). Self-reported oral health was linked to electronic health records held at the Institute for Clinical Evaluative Sciences. Participants aged 40 years and over, who self-reported oral health status in linked databases were included (N = 5,183). Cox proportional hazard models were constructed to determine the risk of diabetes complications. Participants who did not experience any complications were censored. Models were adjusted for age and sex, followed by social characteristics and behavioural factors. The population attributable risk of diabetes complications was calculated using fully adjusted hazard ratios.

RESULTS

Diabetes complications differed by self-reported oral health; 35% of the total sample experienced a complication and 34% of those reporting "good to excellent" oral health (n = 4090) experienced a complication in comparison to 38% of those with "fair to poor" oral health (n = 1093). For those reporting "poor to fair" oral health, the hazard of a diabetes complication was 30% greater (HR 1.29; 95% CI: 1.03, 1.61) than those reporting "good to excellent" oral health. The population level risk of complications attributable to oral health was 5.2% (95% CI: 0.67, 8.74).

CONCLUSIONS

Our findings indicate that reporting "poor to fair" oral health status may be attributed to health complications among diabetics, after adjusting for a wide range of confounders. This has important public health implications for diabetics in Ontario, Canada.

Periodontal Diseases and the Risk of Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis

Background: Periodontitis and metabolic syndrome (MetS) are two major global health problems that are widely prevalent in the world, although the former is a common infection in developing countries and the latter is a non-infectious but prevalent disease in developed countries. This study aims to provide an updated review on the existence and magnitude of the relationship between periodontal disease and the risk of MetS. Methods: We searched the PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, and Wanfang databases for original studies assessing the association between periodontitis and MetS published before August 2019. We calculated the pooled crude and adjusted odds ratios (ORs) together with the 95% confidence intervals (95% CIs) to estimate the strength of this association. Subgroup analysis was performed by considering the diagnostic method or the country where the studies were performed. Results: We identified 43 potentially eligible articles for this systematic review, including 32 cross-sectional studies, eight case-control studies, and three cohort studies. Among them, 39 articles presented enough information to be included in the meta-analysis. The pooled crude and adjusted ORs were 1.99 (95% CI: 1.75-2.25) and 1.46 (95% CI: 1.31-1.61), respectively. Subgroup analysis showed a consistent relation stratified by either the diagnostic method or the country where the studies were performed. The pooled OR was 1.68 (95% CI: 1.41-2.00) for Japan, 1.75 (95% CI: 1.31-2.34) for the USA, 1.81 (95% CI: 1.35-2.42) for Korea, and 2.29 (95% CI: 1.53-3.41) for China. Conclusion: Our results provide compelling evidence for the association between periodontitis and MetS. Patients with periodontal disease are a critical screening population for MetS. We also recommend that people exhibiting components of MetS should receive a periodontal check-up and pay attention to their oral health.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BACKGROUND

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.

TYPES OF STUDIES REVIEWED

Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.

Epigenetic and inflammatory events in experimental periodontitis following systemic microbial challenge

AIM

The purpose of this study was to determine inflammatory and epigenetic features following induction of oral and gut dysbiosis in experimental periodontitis in order to examine the interplay between oral and systemic infection.

MATERIALS AND METHODS

Periodontitis was induced in 6- to 8-week-old C57BL/6 mice by (a) Ligature placement (Lig group) (oral challenge); (b) P. gingivalis gavage (Pg group) (systemic challenge); and (c) the combination of the two models oral and systemic challenge (Pg + Lig). The duration of the experiment was 60 days, and the animals were then sacrificed for analyses. Alveolar bone loss was assessed, and a multiplex immunoassay was performed. Maxillae and gut tissues were immunostained for DNMT3b (de novo methylation marker), B and T lymphocyte attenuator (BTLA) and IL-18R1 (inflammation markers).

RESULTS

Pg and Pg + Lig groups exhibited higher bone loss when compared to Sham. BAFF, VEGF, RANKL, RANTES and IP-10 were significantly higher with Pg gavage. Likewise, DNMT3b was overexpressed in both gut and maxilla after the Pg administration. The same pattern was observed for BTLA and IL-18R1 in gut tissues.

CONCLUSIONS

The systemic microbial challenge either alone or in combination with local challenge leads to distinct patterns of inflammatory and epigenetic features when compared to simply locally induced experimental periodontitis.