Periodontal Inflammation and Systemic Diseases: An Overview

Association between periodontitis and fracture-related infection in patients with severe open fractures of the upper and/or lower extremities

BACKGROUND

Periodontitis is a chronic inflammatory condition that affects the oral cavity and has systemic implications beyond its localized impact, potentially increasing the risk of various health issues. This study aimed to investigate the role of periodontitis as a risk factor for fracture-related infection (FRI), a severe complication encountered in orthopaedic trauma.

METHODS

A prospective cohort study was conducted to analyze data from 235 patients with severe open fractures (grades II, IIIA, or IIIB) who were monitored for at least 12 months. During the perioperative period, the periodontal health of these patients was evaluated through various clinical measures, including clinical attachment levels, bleeding on probing (BOP), and probing depth, which were used to identify instances of periodontitis. Additionally, the Simplified Oral Hygiene Index (OHI-S) was employed as part of the assessment. Comprehensive data were collected for subsequent analysis. To explore the associations between periodontal status and the occurrence of FRI, statistical methods, including both univariate and multivariate regression models, were applied FRI, with a significance level set at 5%.

RESULTS

Among 235 patients, 169 individuals (71.9%) exhibited normal wound healing, while 66 patients (28.1%) developed FRI. The data analyses indicated a significant association between periodontitis and an increased risk of FRI, with an adjusted risk ratios (RR) of 3.03 (95% CI: 1.02-9.44, p = 0.045). Additionally, elevated BOP levels were identified as an independent risk factor, with an adjusted RR of 1.02 (95% CI: 1.00-1.04, p = 0.035). Advanced stages of periodontitis, particularly Stage II (adjusted RR 2.63, 95% CI: 1.11-6.18, p = 0.02) and Stage III (adjusted RR 3.06, 95% CI: 1.53-6.20, p = 0.001), were strongly linked to higher rates of FRI. Notably, the presence of periodontitis was significantly associated with early FRI occurrences (proportion difference 0.3658, 95% CI: 0.240-0.491, p < 0.0001), while no significant association was observed with late or delayed FRI cases. Moreover, additional factors influencing the risk of FRI included the severity of open fracture and delayed wound closure.

CONCLUSIONS

Periodontitis was significantly associated with an increased risk of developing FRI in patients with open fractures. Advanced stages of periodontal disease and elevated BOP are recognized as independent risk factors. Additionally, other important contributing factors include the severity of the open fractures and delayed wound closure.

A Novel Postbiotic Reduces Canine Halitosis

A majority of dogs suffer from some form of periodontal disease. This frequently manifests as halitosis or oral malodor, caused by microbes underlying poor oral health. Pathogenic oral microbes process dietary or host proteins into volatile sulfur compounds (VSCs), which are perceived as malodorous and can further contribute to inflammation and periodontal disease progression. This double-blind, placebo-controlled, randomized clinical trial evaluated the ability of Superculture® Pet Oral, a novel canine oral health postbiotic (COHP), to reduce canine oral malodor. In total, 24 dogs were stratified into two groups based on starting VSC levels. The groups received either COHP or a placebo as a powder topper for 14 days. VSC levels were measured via a Halimeter on Days 0, 7, and 14. Perceived malodor was also scored on the same days. COHP significantly decreased VSCs from baseline by Day 7 by 22% (p = 0.002). In the placebo group, VSCs increased over the course of the study. Throughout the study, COHP lowered VSC levels by 27% compared to the placebo (p = 0.004), and fully prevented an increase in VSCs compared to the baseline. Additionally, VSCs were correlated with the human perception of malodor, and twice as many dogs in the COHP group had perceptibly improved breath on Day 7 compared to the placebo, measured through a 10-point scaled survey. These findings validate the ability of this novel postbiotic to effectively reduce canine oral malodor and provide preliminary evidence that it may more broadly help to maintain canine oral health.

Bridging oral and systemic health: exploring pathogenesis, biomarkers, and diagnostic innovations in periodontal disease

PURPOSE

This narrative review explores the multifaceted links between periodontal diseases (gingivitis and periodontitis) and systemic health conditions, including cardiovascular disease, diabetes, adverse pregnancy outcomes, Alzheimer's disease, cancers, rheumatoid arthritis, and respiratory infections. It aims to synthesize evidence on how local oral infections exert systemic effects and evaluate the potential of diagnostic technologies to monitor these interactions.

METHODS

This narrative review synthesizes current scientific literature on periodontal disease pathogenesis, focusing on key pathogens (e.g., Porphyromonas gingivalis, Fusobacterium nucleatum) and their roles in driving local and systemic inflammation via virulence factors and microbial dysbiosis. It examines biomarker-based diagnostic approaches (e.g., IL-1β, TNF-α, microbial DNA) in saliva, blood, and gingival crevicular fluid (GCF) and evaluates current and emerging diagnostic tools (e.g., ELISA, PCR, lateral flow assays, biosensors, microfluidics).

RESULTS

The review highlights that periodontal pathogens contribute to systemic disease through complex mechanisms including persistent inflammation (driven by cytokines like IL-1β, TNF-α), endotoxemia (via LPS, noting pathogen-specific structural variations impacting immune response), molecular mimicry, and immune modulation. Current diagnostic methods provide valuable information but often face limitations in speed, portability, and multiplexing capability needed for comprehensive point-of-care assessment. Emerging technologies, particularly multiplex platforms integrating biosensors or microfluidics, demonstrate significant potential for rapid, user-friendly analysis of multiple biomarkers, facilitating earlier detection and personalized risk stratification, especially in high-risk populations.

CONCLUSION

Periodontal diseases significantly impact systemic health via intricate microbial and inflammatory pathways. The complexity of these interactions necessitates moving beyond conventional diagnostics towards integrated, advanced technologies. Implementing rapid, multiplex biomarker detection platforms within a multidisciplinary healthcare framework holds the potential to revolutionize early detection of linked conditions, improve personalized management strategies, and ultimately reduce the systemic burden of periodontal disease.

Exploring the link between periodontal disease and sperm quality: a comprehensive systematic review study

BACKGROUND

Periodontal diseases are among the most prevalent oral health conditions globally, with evidence suggesting their systemic effects, including potential impacts on male reproductive health. Inflammation associated with periodontitis might interfere with spermatogenesis and alter sperm parameters such as count, motility, morphology, and DNA integrity. This systematic review aims to critically assess existing studies on the relationship between periodontal disease and sperm quality to delineate its clinical implications for male infertility.

METHODS

The research was registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (PROSPERO code: CRD420251005800). A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, ProQuest, Scopus, Web of Science (WOS), and Google Scholar, up to September 2024. Inclusion criteria targeted human studies reporting associations between periodontal health and sperm quality parameters. To assess the quality of the included studies, the Newcastle-Ottawa Scale (NOS) was used. Data were synthesized qualitatively and analyzed for trends.

RESULTS

Nine studies encompassing 1,386 participants were included. Evidence suggests a significant association between periodontitis and decreased sperm motility, abnormal morphology, and increased DNA fragmentation. However, findings on sperm count and concentration were inconsistent. Mechanistic pathways suggest that inflammatory cytokines and oxidative stress contribute to these disruptions.

CONCLUSION

This review highlights the systemic implications of periodontal disease on male reproductive health. Given the global decline in male fertility, maintaining oral health may serve as an adjunct strategy in managing infertility. Future research should prioritize large-scale, longitudinal studies to establish causality and explore preventive interventions.

Clinical and Radiological Markers of Periodontal Status and Risk of Cognitive Decline and Incident Dementia

AIM

There is evidence linking tooth loss with dementia; however, similar findings for periodontitis are inconclusive.

MATERIAL AND METHODS

We conducted cross-sectional (N = 4046) and longitudinal analyses (N = 2769) on data from the Health 2000 and 2011 surveys for establishing any associations of periodontal health with baseline cognition, 11-year risk of cognitive decline and 15-year risk of incident dementia (N = 4073; study period from 1 September 2000 to 31 December 2015). Periodontal health was assessed via multiple clinical and radiographic markers. Based on periodontal pocket depths (PPDs), we defined periodontitis as moderate or severe. Cognitive tests at baseline and follow-up were administered, and dementia diagnoses until 2015 were retrieved from health registers. Analyses included logistic and Cox proportional regression, accounting for reverse causality.

RESULTS

Cross-sectionally, moderate periodontitis was associated with lower overall cognition (OR = 1.19:1.02-1.40), verbal fluency (OR = 1.16:1.00-1.35) and immediate recall (OR = 1.22:1.04-1.42); PPD with lower overall cognition (OR = 1.22:1.04-1.43) and verbal fluency (OR = 1.18:1.02-1.38); and bleeding on probing (BOP) with verbal fluency (OR = 1.26:1.07-1.48) and immediate recall (OR = 1.22:1.02-1.45). Longitudinally, moderate periodontitis was associated with the risk of decline in immediate recall (OR = 1.29:1.04-1.60) and severe periodontitis with verbal fluency (OR = 1.46:1.01-2.11); PPD with immediate recall (OR = 1.23:1.00-1.53); and BOP with verbal fluency (OR = 1.31:1.05-1.63). Edentulism was associated with multiple cognitive tests (OR range:1.71-1.88). No associations with the risk of incident dementia were observed.

CONCLUSIONS

Poor periodontal health may increase the risk of cognitive decline. Future studies into the underlying mechanisms are warranted.

Oral health in inflammatory bowel disease: the overlooked impact and the potential role of salivary calprotectin

BACKGROUND

Inflammatory Bowel Disease (IBD), a chronic condition characterized by gastrointestinal inflammation, is influenced by genetic and environmental factors. Emerging evidence suggests a "mouth-gut axis," with the oral cavity reflecting extra-intestinal manifestations of IBD. This study evaluated the oral health status of IBD patients and the potential of salivary calprotectin (SCP) as a biomarker for assessing IBD activity and oral health.

METHODS

Oral health was assessed in 100 IBD patients [60 with Crohn's disease (CD) and 40 with ulcerative colitis (UC)] and 14 controls. Evaluations included the Decayed, Missing, and Filled Teeth (DMFT) Score, Periodontal Diagnosis and the need for dental or prosthetic treatment. Saliva and stool samples were collected to measure SCP and faecal calprotectin (FCP) levels using the Elia Calprotectin 2 Test. IBD activity was evaluated with FCP, the Harvey-Bradshaw Index for CD, and the Partial Mayo Score for UC.

RESULTS

The DMFT index mean was comparable between IBD patients (mean 7.99, SD 7.73) and controls (mean 10.00, SD 6.49). However, periodontal disease was significantly more prevalent in IBD patients (57% in CD, 70% in UC) than in controls (29%), with severe cases (stages III/IV) more frequent in IBD. Additionally, 89% of IBD patients required dental treatment, and 39% needed prosthetic rehabilitation. SCP levels showed no significant correlation with disease activity or oral health status, while FCP correlated with C-reactive protein and erythrocyte sedimentation rate.

CONCLUSIONS

This study underscores the need for improved oral health management in IBD patients and suggests that SCP may not be a reliable biomarker for monitoring IBD or periodontal disease.

CLINICAL TRIAL NUMBER

Not applicable.

Association of High BMI with Dental History, Sociodemographic Characteristics, and DMFT Index in Female Students at Taif University Sports Center: A Cross-Sectional Analysis

Background/Objectives: Oral health has a significant impact on our overall well-being. The DMFT index assesses dental caries prevalence, whilst the body mass index (BMI) estimates body fat, with obesity defined as BMI ≥ 30 kg/m2. Obesity adversely affects women's health, including increased risks of chronic diseases. In Saudi Arabia, with a rising obesity rate, especially amongst women, highlights the need to investigate the relationship between BMI and oral health. Our aim is to evaluate the association of high BMI (body mass index), dental history, diet, physical activity, and oral hygiene practices with DMFT (decayed, missing, and filled teeth) of female students at Taif University, Saudi Arabia. Methods: This cross-sectional observational study included female students at a sports facility in Taif University, Saudi Arabia, with a high BMI. A convenience sampling technique was used. Participants were categorized into three groups based on their BMI. Data was then collected through structured interviews and oral examinations. The prevalence and types of chief complaints, sociodemographic status, and DMFT index in female students with a high BMI, as well as the possible mechanisms linking BMI, were analyzed. Results: The study included 138 female students, 86 of whom were obese female students, aged 18-27. Compared to the control group, participants with higher BMI were more likely to visit the dentist due to pain and had a higher number of missing teeth. Systemic diseases, such as asthma and type 2 diabetes, were significantly more prevalent among obese participants. No significant correlation was found between BMI and dental hygiene practices or dietary habits. Higher BMI was significantly associated with an increase in missing teeth (β = 0.09, 95% CI: 0.00 to 0.18, p = 0.045). However, it was not found with the overall DMFT index. Conclusions: higher BMI among female university students was associated with an increased prevalence of missing teeth and systemic diseases.

Longitudinal host-microbiome dynamics of metatranscription identify hallmarks of progression in periodontitis

BACKGROUND

In periodontitis, the interplay between the host and microbiome generates a self-perpetuating cycle of inflammation of tooth-supporting tissues, potentially leading to tooth loss. Despite increasing knowledge of the phylogenetic compositional changes of the periodontal microbiome, the current understanding of in situ activities of the oral microbiome and the interactions among community members and with the host is still limited. Prior studies on the subgingival plaque metatranscriptome have been cross-sectional, allowing for only a snapshot of a highly variable microbiome, and do not include the transcriptome profiles from the host, a critical element in the progression of the disease.

RESULTS

To identify the host-microbiome interactions in the subgingival milieu that lead to periodontitis progression, we conducted a longitudinal analysis of the host-microbiome metatranscriptome from clinically stable and progressing sites in 15 participants over 1 year. Our research uncovered a distinct timeline of activities of microbial and host responses linked to disease progression, revealing a significant clinical and metabolic change point (the moment in time when the statistical properties of a time series change) at the 6-month mark of the study, with 1722 genes differentially expressed (DE) in the host and 111,705 in the subgingival microbiome. Genes associated with immune response, especially antigen presentation genes, were highly up-regulated in stable sites before the 6-month change point but not in the progressing sites. Activation of cobalamin, porphyrin, and motility in the microbiome contribute to the progression of the disease. Conversely, inhibition of lipopolysaccharide and glycosphingolipid biosynthesis in stable sites coincided with increased immune response. Correlation delay analysis revealed that the positive feedback loop of activities leading to progression consists of immune regulation and response activation in the host that leads to an increase in potassium ion transport and cobalamin biosynthesis in the microbiome, which in turn induces the immune response. Causality analysis identified two clusters of microbiome genes whose progression can accurately predict the outcomes at specific sites with high confidence (AUC = 0.98095 and 0.97619).

CONCLUSIONS

A specific timeline of host-microbiome activities characterizes the progression of the disease. The metabolic activities of the dysbiotic microbiome and the host are responsible for the positive feedback loop of reciprocally reinforced interactions leading to progression and tissue destruction. Video Abstract.

A Comparative Elemental and Surface Analysis of Root Cementum in Severe Periodontitis and Healthy Teeth

This study aims to compare the elemental composition and surface characteristics of root cementum in teeth affected by severe periodontitis with those of healthy teeth.Forty-seven teeth, including 25 teeth affected by stage III, grade C periodontitis and 22 healthy teeth, were extracted from patients aged 17 to 34 years. The cementum surfaces were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) to evaluate surface morphology and elemental composition.SEM images revealed that healthy teeth exhibited a homogenous, smooth cementum surface, while teeth affected by periodontitis showed an irregular, uneven surface with deep crack lines and resorption areas. EDX analysis indicated significant differences in elemental composition; periodontitis-affected teeth had lower calcium and phosphorus but higher magnesium, sodium, and sulfur levels than healthy teeth.Periodontitis significantly alters the surface characteristics and elemental composition of root cementum, which may contribute to disease progression and impaired periodontal health.

Association between prediabetes and periodontitis: a meta-analysis of observational studies with multivariate analysis

BACKGROUND

Growing evidence suggests that prediabetes may increase the risk of periodontitis, though the extent of this association remains unclear. To provide a clearer understanding, this meta-analysis focused on observational studies that utilized multivariate analyses to adjust for key confounding factors.

MATERIAL AND METHODS

A comprehensive search of PubMed, Embase, and Web of Science was conducted to identify observational studies assessing the relationship between prediabetes and periodontitis. Only studies that utilized multivariate analyses were included to minimize confounding bias. The quality of the studies was evaluated with the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model, with heterogeneity assessed by the I² statistic.

RESULTS

Ten observational studies with 38,727 participants were included. Overall, individuals with prediabetes had a significantly higher risk of periodontitis compared to normoglycemic individuals (OR: 1.27, 95% CI: 1.09 to 1.48, p < 0.001) with moderate heterogeneity (I² = 53%). Subgroup analyses revealed a stronger association in studies where the proportion of men was < 45% compared to those ≥ 45% (OR: 1.75 vs. 1.15, p for subgroup difference = 0.01). Studies with lower quality (NOS score = 7) showed a stronger association compared to higher-quality studies (NOS score = 8 or 9, p for subgroup difference = 0.003).

CONCLUSION

This meta-analysis found that prediabetes may be independently associated with an increased risk of periodontitis. Further research is needed to explore the mechanisms underlying this association and potential sex-specific effects.

Biomaterials for Guided Tissue Regeneration and Guided Bone Regeneration: A Review

This review aims to provide an overview of the types of membranes, bone substitutes, and mucosal substitutes used for GTR and GBR and briefly explores recent innovations for tissue regeneration and their future perspectives. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was conducted. Using biomaterials for GTR and GBR provides a reduction in postoperative morbidity, as it contributes to less invasive clinical procedures, serving as an alternative to autogenous grafts. Moreover, randomized clinical trials (RCTs) and systematic reviews are essential for the evaluation of new biomaterials. These studies provide more robust evidence and help guide clinical practice in the selection of safer and more effective biomaterials, allowing for the personalization of treatment protocols for each patient.

Effects of Vitamin D, Melatonin, and Omega-3 Fatty Acids on Periodontal Health: A Narrative Review

Periodontitis is a chronic inflammatory disease characterized by the destruction of tooth-supporting structures, influenced by immune system dysregulation, oxidative stress, and imbalances in bone metabolism. Given its multifactorial pathogenesis, bioactive compounds such as vitamin D, melatonin, and omega-3 fatty acids have emerged as potential adjuncts to periodontal therapy due to their immunomodulatory, anti-inflammatory, and antioxidative properties. This narrative review explores the role of these three supplements in periodontal health, their potential in synergistic effects, and existing research gaps, providing a foundation for future studies on their clinical applications. Vitamin D is essential for calcium homeostasis, bone remodeling, and immune function. It modulates both innate and adaptive immune responses, enhancing antimicrobial peptide production and reducing inflammatory cytokine expression. Omega-3 fatty acids reduce the production of pro-inflammatory eicosanoids while promoting the synthesis of pro-resolving lipid mediators, contributing to bone preservation and immune balance. Melatonin, known for its antioxidant and osteogenic properties, supports bone remodeling by stimulating osteoblast proliferation and inhibiting osteoclast activity, while also regulating circadian rhythms, which may influence oral health. Although these bioactive compounds show promising effects in preclinical and clinical studies, significant knowledge gaps remain regarding optimal dosages, long-term efficacy, combined use, and standardized treatment protocols. Further clinical trials are necessary to elucidate their therapeutic value in periodontal disease management, especially those focused on their potential synergistic mechanisms. Understanding their synergistic mechanisms may open new avenues for adjunctive strategies in periodontal therapy.

Polybacterial Periodontal Infection Alters oxidative and Inflammatory Biomarkers in Primary Human Aortic Endothelial Cell (pHAECs)

Background

Periodontitis (PD) is a highly prevalent inflammatory disease associated with complex microbial infection in the subgingival cavity. We have previously shown that polybacterial periodontal infection led to aortic atherosclerosis and lipid profile modulation; however, the underlying mechanism(s) has not been yet demonstrated.

Methods

Primary human aortic endothelial cells (pHAECs) were infected periodically for 48 hours either with P. gingivalis (monobacterial infection) or polybacterial periodontal pathogens, P. gingivalis (Pg), T. forsythia (Tf), T. denticola (Td), and F. nucleatum (Fn), using HoxBan coculture technique. Cell viability was assessed using MTT assay. Nitric oxide synthesis was measured in the form of total nitrite released into the media after incubation period. Inflammatory and oxidative gene expression were evaluated in the cell lysate using quantitative real-time polymerase chain reaction (qRT-PCR) at each time point (12-48h). Statistical analysis was performed using two-way ANOVA.

Results

pHAEC cell viability was significantly (p<0.05) reduced in both mono and poly-bacterial infection when compared with non-infected cells in a time dependent manner. Nitrite levels in the media were significantly impaired in both infection groups. mRNA expression for cytokines (TLR-4, IL-6, and TNF-α,) and inducible nitric oxide synthase (iNOS) were significantly (p<0.05) elevated in both experimental groups. In contrast, endothelial (e) NOS, tetrahydrobiopterin (BH4) synthesis, GCH -1, Nrf2, and Nqo 1 were significantly (p<0.05) reduced in both experimental groups. Finally, polybacterial infection group showed greater changes in cell viability, nitrite levels, cytokines, eNOS/BH4/Nrf2 expression in a time dependent manner.

Conclusions

Our study highlights the adverse effects of in vitro PD infection in NO mediated vascular endothelial cell function.

Robusta Coffee Husk Extract Increases the Number of Fibroblast and Collagen Density in Gingival Rat Periodontitis

Introduction: Periodontitis is an infectious disease of periodontal tissue caused by the bacteria Porphyromonas gingivalis which can trigger the formation of free radicals. Periodontitis can be treated using metronidazole but long-term use can cause negative effects. Natural ingredients such as robusta coffee husk can be used as an alternative treatment for periodontitis because of its anti-inflammatory, antioxidant, and antibacterial benefits. Aim: To determine the effect of robusta coffee husk extract on the number of fibroblasts and collagen density in gingival Wistar rats induced by P. gingivalis. Methods: Robusta coffee husk extract was extracted using the maceration process with 96% ethanol. Thirty male Wistar rats divided into 6 treatment groups: healthy rat, negative control (P. gingivalis + Aquades sterile), positive control (P. gingivalis + metronidazole), and 3 treatment groups of extract concentration (P. gingivalis + 125, 250, and 500 mg/kgBW). P. gingivalis injection was carried out in the buccal area of the left mandibular first molar of mice every 3 days. Robusta coffee husk extract and metronidazole were given by using sondase once a day for 21 days. The gingival specimens were then processed histologically. Hematoxylin and Eosin (H&E) staining was performed to observe the number of fibroblast, and collagen density was observed by Thricome Mallory. The SPSS application was used to examine the data calculation which included the Shapiro-Wilk, Levene, One-way ANOVA, and post hoc LSD tests. Result: Robusta coffee husk extract at doses of 125, 250, and 500 mg/kgBW showed increased fibroblasts and collagen density in Wistar rats induced by P. gingivalis. Conclusion: The most effective dose of robusta coffee husk extract is 250 mg/kgBW, with an average value of fibroblast number in a field of view is 37 cells, and the average of collagen density in the field of view is 163 pixels.

The potential crosstalk genes and molecular mechanisms between systemic lupus erythematosus and periodontitis

Background

Several studies have demonstrated an increased risk of periodontitis (PD) among patients diagnosed with systemic lupus erythematosus (SLE). However, the underlying common mechanism between them remains incompletely understood. Accordingly, the aim of this study is to examine diagnostic biomarkers and potential therapeutic targets for SLE and PD by leveraging publicly accessible microarray datasets and transcriptome analysis.

Method

Datasets pertaining to SLE and PD were retrieved from the Gene Expression Omnibus (GEO) database, and subsequently analyzed for differentially expressed genes (DEGs). Key gene modules were identified through weighted gene co-expression network analysis (WGCNA), and shared genes were obtained by overlapping key genes between DEGs and WGCNA. These shared genes were subsequently subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, leading to the establishment of a Protein-Protein Interaction (PPI) network. Random forest (RF) and Least Absolute Shrinkage and Selection Operator (Lasso) regression were employed to identify key hub genes. Receiver operating characteristic (ROC) curves were generated using a new validation dataset to evaluate the performance of candidate genes. Finally, levels of immune cell infiltration in SLE and PD were assessed using CIBERSORTx.

Results

A total of 50 core genes were identified between the genes screened by WGCNA and DEGs. Functional enrichment analysis revealed that these genes are primarily associated with the PI3K-Akt and B-cell receptor signaling pathways. Additionally, using machine learning algorithms and ROC curve analysis, a total of 8 key genes (PLEKHA1, CEACAM1, TNFAIP6, TCN2, GLDC, GNG7, LY96, VCAN) were identified Finally, immune infiltration analysis highlighted the significant roles of neutrophils, monocytes, plasma cells, and gammadelta T cells (γδ T cells) in the pathogenesis of both SLE and PD.

Conclusion

This study identifies 8 hub genes that could potentially serve as diagnostic markers for both SLE and PD, highlighting the importance of VCAN and LY96 in diagnosis. Moreover, the involvement of the PI3K-Akt signaling pathway in both diseases suggests its significant role. These identified key genes and signaling pathways lay the groundwork for deeper comprehension of the interplay between SLE and PD.

The Global Burden of Periodontal Disease: A Narrative Review on Unveiling Socioeconomic and Health Challenges

Periodontal disease is a prevalent chronic inflammatory condition that impacts over a billion people worldwide, leading to substantial tooth loss, reduced quality of life, and heightened systemic health risks. This narrative review synthesizes current evidence regarding the global burden of periodontal disease, its established associations with systemic conditions including cardiovascular disease, diabetes, adverse pregnancy outcomes, respiratory infections, and neurodegenerative disorders, and its significant socioeconomic implications. The review focused on the following research question: What is the global burden of periodontal disease, and how do its systemic and socioeconomic implications necessitate integrated public health strategies? A structured search of the PubMed, Scopus, and WHO databases from 2000 to 2024 was conducted to identify relevant literature using key terms, including "periodontal disease", "global burden", "systemic inflammation", and "public health strategies". Out of 312 initially identified articles, 175 satisfied the inclusion criteria for the final synthesis. The findings underscore the significance of periodontal disease as a modifiable risk factor for various noncommunicable diseases, the influence of healthcare disparities on disease progression, and the critical necessity for integrated public health strategies to mitigate the global burden of periodontal disease and its consequences. The review concludes that coordinated policy reform, health system integration, and enhanced research efforts are crucial for mitigating the global burden of periodontal disease and advancing health equity.

Silver Nanoparticles Synthesized From Centella asiatica Extract and Asiatic Acid for Enhanced Biofilm Eradication of Streptococcus Associated With Oral Diseases

The biofilm-forming ability of Streptococcus species, particularly Streptococcus mutans, is a key factor in the pathogenesis of dental caries and periodontitis. Current treatments often exhibit limitations such as incomplete biofilm eradication and cytotoxicity to host tissues, highlighting the need for innovative and biocompatible therapeutic approaches. Therefore, this study aimed to investigate the potential of Centella asiatica ethanolic extract, its bioactive triterpenoids (asiatic acid and madecassic acid), and silver nanoparticles (AgNPs) synthesized from the extract as an alternative strategy for targeting S. mutans biofilms. The antibacterial and antibiofilm activities of the synthesized AgNPs against Streptococcus species were evaluated, alongside cytotoxicity assessments on human gingival fibroblast (HGF-1) cells using the MTT assay. The synthesized AgNPs exhibited superior antimicrobial efficacy compared to the extract, with significantly lower minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values (62.5/125 µg/mL) against S. mutans ATCC 25175 and S. mitis ATCC 49456, highlighting their potent bactericidal activity. Moreover, the AgNPs achieved rapid biofilm disruption, reducing biofilm biomass by 76% within 12 h at 1/2 × MIC, significantly outperforming the extract and triterpenoids. Scanning electron microscopy further revealed substantial extracellular polymeric substance degradation and biofilm structural disruption upon AgNP treatment, confirming their pronounced antibiofilm efficacy. In addition, the synthesized AgNPs demonstrated favorable biocompatibility, maintaining 68% cell viability in dental fibroblast cells, suggesting an optimal balance between antimicrobial potency and cytotoxicity. The synergistic interaction between AgNPs and C. asiatica phytochemicals significantly enhanced biofilm disruption compared to nonfunctionalized AgNPs. These findings underscore the potential of C. asiatica-based AgNPs as a novel, plant-derived nanotechnological approach for managing oral infections caused by biofilm-forming Streptococcus species. This study not only contributes to the development of alternative antibiofilm strategies but also paves the way for future clinical applications in oral healthcare.

Association between neutrophil-percentage-to-albumin ratio and periodontitis: insights from a population-based study

Background

Periodontal diseases, characterized by the loss of tooth-supporting structures, are highly prevalent in the general population. The Neutrophil-Percentage-To-Albumin Ratio (NPAR) has been identified as a promising biomarker for systemic inflammation, but its relationship with periodontal disease has not been thoroughly investigated. Despite growing interest in its role in other chronic conditions, the specific connection between NPAR and periodontal disease remains underexplored and requires further examination to understand its potential clinical applications.

Methods

A population-based analysis was performed using data from the National Health and Nutrition Examination Survey (NHANES), with a total of 8,389 participants included with complete full-mouth periodontal examination, NPAR related index and covariates. NPAR was employed as the primary independent variable, the periodontitis and clinical periodontal parameters were set to the outcomes along with tooth counts and functional dentition as the sensitivity outcomes. To investigate its association between NPAR and periodontitis, weighted multivariate linear and logistic regression analyses were conducted. Sensitivity and replication analyses were also carried out to assess the robustness and reliability of the findings.

Results

This population-based study revealed a significant association between elevated NPAR levels and a higher likelihood of periodontitis, increased attachment loss (AL), and probing depth (PD). After full adjustment for potential confounders, NPAR was significantly associated with periodontitis (OR = 1.04, p = 0.005), attachment loss (β = 0.03, p < 0.001), and probing depth (β = 0.02, p < 0.001). Furthermore, the highest quartile of NPAR remained significantly associated with periodontitis (OR = 1.34, p = 0.010), AL (β = 0.15, p < 0.001) and PD (β = 0.09, p < 0.001). A significant trend was observed, with periodontitis strongly associated with increasing NPAR levels. These findings were further validated by the sensitivity analyses with decreased tooth counts (β = -0.08, p < 0.005) and the lower incidence of functional dentition (OR = 0.96, p = 0.030). Additionally, the replication analysis also enhanced the roundness of the results (OR = 1.07, p < 0.001).

Conclusion

This population-based study demonstrated a statistically significant positive relationship between NPAR and the prevalence of periodontitis, NPAR has been recognized as a potential biomarker for periodontal disease. Additional longitudinal research are needed to confirm these findings and investigate the clinical implications of NPAR in managing periodontal conditions.

A Systematic Review and Meta-Analysis Association Between Periodontitis and Age-Related Macular Degeneration: Potential for Personalized Approach

Background/Objectives: Periodontitis is a chronic inflammatory disease that leads to systemic low-grade inflammation. Systemic low-grade inflammation has been found in patients with age-related macular degeneration (AMD). In this systematic review and meta-analysis, we evaluated the association between periodontitis and AMD. Methods: We searched 11 scientific literature databases on 16th December 2024 for studies of a diagnosis of periodontitis and prevalent or incident AMD. Eligible studies underwent a qualitative review and meta-analysis of the association. Study selection, data extraction, and risk of bias within studies were made in duplicate by two authors and conferred with a senior author. Results: Seven studies eligible for review included in total 149,217 individuals. Across the seven studies, different study designs, diagnoses and definitions of periodontitis, and diagnosis and definitions of AMD were employed. Our meta-analysis showed an association between periodontitis and AMD with an odds ratio of 1.42 (95% CI: 1.12 to 1.78; p = 0.003). Conclusions: Periodontitis is significantly associated with AMD. Unlike genetic predisposition and high age, which are important risk factors of AMD that cannot be modified, periodontitis is a risk factor that can be treated and potentially eliminated, thus allowing for a personalized approach for risk elimination in AMD. Attention should be given to the dental health of patients at risk of AMD.

The Bidirectional Effects of Periodontal Disease and Oral Dysbiosis on Gut Inflammation in Inflammatory Bowel Disease

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) flares can lead to excessive morbidity and mortality. This study aimed to determine whether oral dysbiosis/periodontal disease (PD) is common in IBD and is associated with disease activity in IBD.

METHODS

This single-center, prospective, cross-sectional, proof-of-concept, and observational study assessed the frequency of periodontal inflammatory disease and interrogated oral and stool microbiota using 16S rRNA gene amplicon sequencing of active-IBD (aIBD), inactive-IBD (iIBD), and healthy controls (HC). Questionnaires assessed diet, alcohol usage, oral hygiene behavior, and disease activity. A subset of participants underwent comprehensive dental examinations to evaluate PD.

RESULTS

Periodontal disease was severer in aIBD subjects than in HC, as aIBD had poorer quality diets (lower Mediterranean diet scores) than iIBD and HC. Significant differences in microbial community structure were observed in unstimulated saliva, stimulated saliva, gingiva, and stool samples, primarily between aIBD and HC. Saliva from aIBD had higher relative abundances of putative oral pathobionts from the genera Streptococcus, Granulicatella, Rothia, and Actinomyces relative to HC, despite similar oral hygiene behaviors between groups.

CONCLUSIONS

Our study suggests that patients with aIBD have severer periodontal disorders and higher relative abundances of putative 'pro-inflammatory' microbiota in their oral cavity, despite normal oral hygiene behaviors. Our data are consistent with the potential presence of an oral-gut inflammatory axis that could trigger IBD flare-ups in at-risk patients. Routine dental health assessments in all IBD patients should be encouraged as part of the health maintenance of IBD and as a potential strategy to decrease the risk of IBD flares.

Frequency, socio-economic characteristics, and risk factors of oral cavity parasites in diabetes mellitus patients from Lorestan Province, Iran; a case-control study

Background

Numerous studies identify diabetes mellitus (DM) as one of the most significant risk factors for the development of periodontal diseases (gum diseases). Individuals with diabetes experience gingival destruction more rapidly and severely due to the accumulation of microbial plaque in the mouth. Entamoeba gingivalis and Trichomonas tenax are parasites commonly found in the human oral cavity. This study aims to determine, the frequency, socio-economic characteristics, and risk factors of E. gingivalis and T.tenax in DM patients from Lorestan Province, Iran as a case-control study.

Methods

The current case-control study involved 500 DM patients who were referred to health centers in Lorestan province, Iran between December 2022 and June 2024. Furthermore, a control group comprising 500 healthy persons without DM (non-DM) who were referred to health centers during the same study period was incorporated into the research. The prevalence of parasites in the oral cavity was determined using microscopic analysis and conventional polymerase chain reaction (PCR) techniques. A questionnaire was administered to collect demographic information, including age, gender, place of residence, education level, occupation, monthly income, tooth brushing practices, and mouthwash usage.

Results

Out of a total of 500 DM patients, 136 (27.2%) and 146 (29.2%) patients had the oral cavity parasites (E. gingivalis and T. tenax) by microscopic and PCR analysis, respectively. While, in non-DM, 61 (12.2%) and 65 (13.0%) tested positive for parasites using microscopic and PCR methods, respectively (P<0.001). Among several factors, income (P = 0.001, OR = 5.491, 95% CI: 4.089 to 9.723), place of residence (P = 0.006, OR = 1.982, 95% CI: 1.222), education (P = 0.002, OR = 3.577 (1.618, 5.907)), and use mouthwash demonstrated a significant protective effect on the oral cavity parasites.

Conclusion

This research for the first time in Iran highlighted a considerable prevalence of oral cavity parasites in DM patients in Lorestan province, Western Iran. Dental professionals should maintain a heightened awareness of these risk factors to effectively identify and address oral health challenges within this population, thereby reducing the incidence of oral diseases and infections.

In vitro evaluation of anti-inflammatory, anti-plaque efficacy, and biocompatibility of Norway spruce (Picea abies) resin extract for oral care applications

The periodontal disease is globally highly prevalent, and calls for novel, effective, and preferably bio-based raw materials. Accumulation of dental plaque causes gingivitis, which is reversible by treatments that control the bacterial biofilm. If left untreated, the gingivitis can lead to gingival inflammation and potentially progress to periodontitis. In this study, a natural antimicrobial and anti-inflammatory Norway spruce (Picea abies) resin extract was evaluated as a potential option in supportive periodontal care. Lipopolysaccharide-induced macrophage-like cells were used to study the anti-inflammatory properties in vitro. The spruce resin extract at 20 % concentration had the highest anti-inflammatory effect, comparable to a corticosteroid's effect on pro-inflammatory cytokines interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinase-3 (MMP-3). Consequently, the 20 % spruce resin extract was selected for toothpaste formulation. Its anti-plaque efficacy was evaluated by total aerobic colony counts and the proportions of streptococci grown on the surfaces of the treated glass rods using pooled human saliva. It was found that the toothpaste effectively reduced dental plaque biofilm, matching the anti-plaque efficacy of Corsodyl mouthwash, containing chlorhexidine digluconate. The toothpaste was also found to be non-damaging in biocompatibility studies on three-dimensional (3D) tissue models of human oral and gingival epithelium. These findings provide scientific validation of spruce resin's effectiveness in oral care, elucidating probable reasons why people have historically chewed resins for oral care purposes.

Periodontal Disease in Saudi Arabia: A Systematic Review of Prevalence and Associated Risk Factors

Background/Objectives: The oral health disorder periodontal disease is widespread around the world and has a public health dimension. This study aimed to perform a systematic review and an appraised analysis that looks at both the prevalence and diversity of risk factors associated with periodontal disease in Saudi Arabia. It places a particular focus on subgroup analyses and pooled prevalence estimates to identify certain populations that could be described as high risk. Methods: Several databases, including PubMed, Scopus, and Google Scholar, were used to conduct the present systematic review. The search was designed to identify relevant studies published from 1980 to 2023. Both quantitative and qualitative studies were included. Subgroup analyses and meta-analyses were performed using a random-effects model to calculate pooled prevalence rates. The studies were evaluated using three criteria that focused on bias. Finally, the authors created a narrative synthesis of the review findings for ease of understanding. Results: The pooled overall prevalence of periodontal disease was 46.2% (95% CI: 40.5-51.8), with high heterogeneity (I2 = 85%). Subgroup analyses identified obese adults as having the highest prevalence of this condition (71.3%), and individuals diagnosed with diabetes also displayed a significantly high prevalence (52.1%). Adolescents aged 15-19 years had an age-specific prevalence of 8.6%, which was significantly lower than that of the other age groups analyzed. Poor oral hygiene, tobacco use, diabetes, and obesity have been recognized as risk factors for periodontal disease. Conclusions: The substantial burden of periodontal disease in Saudi Arabia, especially among high-risk groups, such as obese and diabetic adults, cannot be overstated. Our public health initiatives need to focus on these high-risk individuals, who are likely to be both periodontally and systemically compromised, to provide lifestyle modification counseling and oral hygiene education for them, as well as to routinize their dental care in a way that minimizes the chances of becoming periodontally compromised.

Targeting Epigenetic Plasticity to Reduce Periodontitis-Related Inflammation in Diabetes: CBD, Metformin, and Other Natural Products as Potential Synergistic Candidates for Regulation? A Narrative Review

Periodontitis is unanimously accepted to be the sixth complication of diabetes mellitus (DM), while the inverse relationship of causality is still to be deciphered. Among the proposed mechanisms is gut dysbiosis, which is responsible for the systemic release of proinflammatory mediators. In this process, Gram-negative bacteria from the oral cavity enter the general circulation, leading to the emergence of bi-hormonal beta-pancreatic cells that lack the ability to secrete insulin. Additionally, epigenetic and adaptive mechanisms in affected cells may play a role in reducing inflammation. The release of reactive oxygen species, proinflammatory cytokines, and adipokines, such as interleukins, tumor necrosis factor alpha, leptin, prostaglandin E2, C-reactive protein, or matrix metalloproteinases, determine epigenetic changes, such as the methylation of DNA nucleotides or changes in the activity of histone acetylases/deacetylases. The management of periodontitis involves targeting inflammation, and its potential connection to epigenetic modulation observed in other chronic conditions may help to explain its role in preventing DM in affected patients. This review focuses on the key epigenetic changes in periodontitis that might contribute to DM development, and explores the mechanisms and novel multi-drug therapies that could help to prevent these effects.

Impact of increased Porphyromonas gingivalis peptidylarginine deiminase (PPAD) T2 variant allele on oral microbiota composition and severity of chronic periodontitis

Background

Porphyromonas gingivalis (Pg) is a keystone pathogen in periodontitis, encoding a unique peptidyl arginine deiminase (PPAD) linked to protein citrullination, a process associated with rheumatoid arthritis (RA). Recently, we identified a super-active PPAD variant (T2) in Pg isolates. Here, we evaluated if the presence of the super-active T2 variant of PPAD affects the salivary microbiome, the severity of chronic periodontitis (CP), and subsequently CP's causative association with RA onset/progression.

Patients/Materials and Methods

We examined 56 CP patients and 36 healthy volunteers. Pg and Tannerella forsythia counts were measured via RT-PCR, and PPAD variant was typed via PCR. 16S rRNA from salivary DNA sequencing characterized microbiota composition, while CP severity was assessed through bleeding on probing (BoP), clinical attachment loss (CAL), and pocket depth (PD) parameters.

Results

CP patients exhibited higher Pg and T. forsythia counts, with 30.7% harbouring the PPAD-T2 variant, compared to only one healthy volunteer. Clinical CP parameters were unaffected by the PPAD variant. However, PPAD-T2 influenced oral microbiota composition, enriching certain genera.

Conclusion

While the PPAD variant did not affect CP severity, it influenced oral microbiota composition. Further research is needed to understand citrullination's role in oral microbiota and chronic inflammatory disease development.

Antioxidant Mechanisms of the Protective Action of Selenase in Experimental Chronic Generalized Periodontitis

Inflammatory periodontal diseases, despite all the efforts of modern dentistry, remain an important predictor of tooth loss worldwide. Oxidative stress plays a crucial role in the pathogenesis of periodontitis, making the use of antioxidants an attractive option for its treatment. Our attention was drawn to the selenium compound Selenase as an antioxidant therapeutic agent. In this study, we modeled a calcium-deficient prooxidant chronic generalized periodontitis (CGP) model in white non-linear rats. Then, after 14 days, Selenase (50 μg/kg) and Mexidol (250 mg/kg) were administered intragastrically. Blood samples from the animals were analyzed using ELISA and biochemical methods to determine Cu-Zn SOD, nitrotyrosine, GPX-4, iNOS, NOx, GSH, and GSSG levels. The CGP model led to the typical clinical signs of periodontitis, including hyperemia, edema, gingival pocket formation, bleeding, tooth mobility, as well as an increase in molecular-biochemical markers of nitrosative stress and a reduction of endogenous antioxidants in the blood. Selenase resulted in a decrease in the clinical manifestations of CGP, reduced iNOS, nitrotyrosine, and NOx levels, and an increase in Cu-Zn SOD and GPX-4 compared to the control group (p < 0.05). Mexidol had a less pronounced effect on these markers compared to Selenase (p < 0.05).

Helium cold atmospheric pressure plasma reduces erastin induced inflammation and ferroptosis in human gingival fibroblasts

Oral soft tissue damage can lead to hard tissue damage in the oral cavity, such as periodontal lesions, periapical disorders, cysts, and oral tumors. Cold plasma is known to alleviate inflammation and oxidative stress and promote tissue regeneration, yet the effects of helium plasma on human gingival cells remain poorly understood. In this study, we examined whether helium (He) cold atmospheric pressure plasma (CAP) can induce anti-inflammatory and anti-ferroptotic effects in oral soft tissues by ionizing He gas. Erastin treatment followed by He CAP exposure in human gingival fibroblast-1 (HGF-1) cells reduced the mRNA expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), interleukin-1β (IL-1β), tumor necrosis factor-α (TNFα), and interleukin-6 (IL-6), which are linked to inflammatory responses. Additionally, He CAP exposure decreased nuclear receptor coactivator 4 (NCOA4) expression and increased glutathione peroxidase 4 (GPX4) expression. Furthermore, mitochondrial membrane potential was restored by increased voltage-dependent anion channel 1 (VDAC1) expression, and reactive oxygen species (ROS) levels in mitochondria and cytoplasm were reduced. These results suggest that He CAP exposure may be associated with modulation of mitochondrial ROS production and reduction of inflammation and ferroptosis, but whether mitochondrial repair contributes to these effects requires further investigation.

Ligature-induced periodontitis in a transgenic mouse model of Alzheimer's disease dysregulates neuroinflammation, exacerbates cognitive impairment, and accelerates amyloid pathology

A growing body of literature has identified periodontal disease among the modifiable risk factors for Alzheimer's disease (AD), but the mechanisms underlying this relationship is unknown. This study investigated this relationship using a ligature-induced preclinical periodontitis (Pd) model in non-transgenic (non-Tg) and 3xTg-AD mice. We found that ligature placement caused significant alveolar bone loss, with 3xTg-AD mice exhibiting exacerbated bone loss, suggesting AD-related genetic risk may amplify disease progression. Pd induced robust local inflammatory gene expression in both genotypes, but 3xTg-AD mice indicated a dysregulated immune response. Cognitive deficits were observed only in Pd-afflicted 3xTg-AD mice, specifically in hippocampus-mediated spatial memory and perirhinal cortex-mediated object recognition memory, while non-Tg mice remained unaffected. Neuroinflammatory responses varied by brain region, with the hippocampus and prefrontal cortex (PFC) showing the most pronounced changes. In these regions, 3xTg-AD mice exhibited significantly altered cytokine gene expression compared to non-Tg mice, particularly at later time points. Synaptic markers revealed vulnerabilities in 3xTg-AD mice, including reduced baseline Syp expression and dysregulated Synpo post-ligature. Pd transiently reduced glutamate receptor gene expression in both genotypes, with non-Tg mice showing persistent changes, potentially linked to preserved memory. Pd also accelerated amyloid-β (Aβ) deposition and sustained neurodegeneration in 3xTg-AD mice. Overall, this study shows that combining Pd and AD-related genetic risk exacerbates inflammation, cognitive impairment, synaptic dysfunction, Aβ pathology, and neurodegeneration. Neither insult alone was sufficient to produce these effects, highlighting the synergistic impact. These findings emphasize the need to explore anti-inflammatory interventions and downstream mechanisms to mitigate the confluence of these diseases.

A Narrative Review of Periodontal Vaccines: Hope or Hype?

Globally, periodontal diseases, mainly driven by polymicrobial biofilms, are a widespread concern of social medicine due to their considerable incidence and tie-up to systemic disorders like diabetes, cardiovascular diseases, and complications during pregnancy. Traditional treatments focus on mechanical debridement and antimicrobial therapies, but these approaches have limitations, including recurrence and antibiotic resistance. Periodontal vaccines offer a promising alternative by targeting the immunological mechanisms underlying periodontal disease. This review explores the current state of periodontal vaccine development, highlighting key antigens, vaccine delivery systems, and preclinical and clinical advancements. Special emphasis is placed on antigen selection, host variability, immune tolerance, and future directions to overcome these barriers. This article highlights the advancements and challenges in periodontal vaccine research, offering insights into the capability of immunoprophylaxis as a groundbreaking way to manage periodontal diseases.

Chitosan-based dental barrier membrane for periodontal guided tissue regeneration and guided bone regeneration: A review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are two common dental regenerative procedures used to repair periodontal defects caused by periodontitis. In both procedures, a barrier membrane is placed at the interface between the soft tissue and the periodontal defect, serving to impede the infiltration of soft tissue while creating a secluded space for periodontal regeneration. Recently, barrier membranes based on chitosan (CS) have emerged as a promising avenue for these applications. However, despite numerous studies on the development of CS-based membranes, comprehensive review articles specifically addressing their progress in GTR/GBR applications remain scarce. Herein, we review recent research and advancements in the use of CS-based membranes for periodontal GTR and GBR. The review begins by highlighting the advantageous properties of CS that make it a suitable biomaterial for GTR/GBR applications. Next, the development of composite CS-based membranes, reinforced with various compositions like bioactive fillers and therapeutic agents, is discussed in detail based on recent literature, with a focus on their enhanced efficacy in promoting periodontal regeneration. Finally, the review explores the emergence of functionally graded CS-based membranes, emphasizing their potential to address specific challenges encountered in GTR/GBR procedures.

A systematic review of the implications of lipocalin-2 expression in periodontal disease

OBJECTIVE

Evidence suggests that lipocalin-2 (LCN-2), a bone-derived protein, is upregulated in periodontal diseases. This systematic review aimed to evaluate LCN-2 concentrations in individuals with periodontal diseases, identifying the most suitable body fluids for its detection, the type of periodontal disease with the highest LCN-2 expression, its association with other inflammatory markers and systemic diseases, and whether its expression can be modified by periodontal treatment.

METHODS

A systematic search of Google Scholar, PubMed, and ProQuest up to August 2024 was conducted. The studies were screened and selected by the authors according to specific eligibility criteria. Quality assessment of the included studies was performed according to the study type using STROBE statement for observational studies or the modified Jadad scale for experimental studies. The review was registered in PROSPERO (CRD42023458565).

RESULTS

In total, three thousand six hundred and thirty-eight reports were identified, of which twenty-seven were full-text assessed for eligibility, including eleven articles. Seven articles were observational, and four were experimental. Significantly elevated LCN-2 levels were reported in patients with periodontal disease across 9 studies, being higher in periodontitis rather than gingivitis. LCN-2 was mainly detected in gingival crevicular fluid (GCF) and saliva. LCN-2 expression is related to the increment of inflammatory markers, and periodontal therapy decreases LCN-2 concentrations. LCN-2 levels were aggravated when periodontitis was accompanied by obesity and type 2 diabetes.

CONCLUSION

LCN-2 is implicated in periodontal diseases, probably through the inflammation process.

Association between apical periodontitis and brain inflammation: a systematic review from animals and human studies

Apical periodontitis (AP) is an oral inflammatory disease induced by dental pulp infection. It is characterized by inflammation, destruction, and resorption of mineralized tissues located around the dental apex. Although this is a local infection, pathogens and their products in the periapical area, as well as inflammatory cytokines, can reach other regions of the body and trigger a systemic immune/inflammatory response in the host. This condition has been associated with several types of systemic diseases. This systematic review aimed to explore the association between AP and neuroinflammation, providing insights into this relationship and discussing potential pathways used by AP microorganisms to reach the central nervous system. Extensive searches in electronic databases (PubMed, Embase, and Cochrane) and hand searches were conducted from January 2013 until May 2024, using the keywords apical periodontitis, endodontic infection, periapical abscess, periodontitis apical, brain inflammation, brain disorders, and neuroinflammation. Initially, 394 studies were selected. After exclusion and inclusion criteria were applied, 12 studies (7 case reports and 1 case series, 3 experimental studies using animal models, and 1 cohort study) were included in this systematic review. All studies showed the presence of AP in upper and/or lower teeth and brain disorders with neuroinflammation. It is important to mention that some cases reported the death of the patient. This systematic review indicates a significant relationship between AP and neuroinflammation based on animal and human studies. Moreover, this study suggests there may be pathways connecting upper and lower teeth with apical periodontitis to the brain, inducing neuroinflammation. Additionally, the oral cavity can become easily accessible when AP is present, allowing for the invasion of microorganisms that are usually non-invasive. This contributes to the development of systemic disorders and/or strengthens their effect, worsening brain pathologies by causing or enhancing neuroinflammation, potentially leading to death. Based on these inferences, periapex health care is essential to improve the health of the world population.Registration number: Prospero registration nº. CRD42023453543.

Temporal Transcriptomic Analysis of Periodontal Disease Progression and Its Molecular Links to Systemic Diseases

Periodontal disease, a prevalent oral inflammatory condition, is implicated in exacerbating systemic diseases. However, the molecular mechanisms underlying this association remain unclear. In this study, we performed RNA sequencing of gingival tissue samples collected from a mouse model of periodontal disease at multiple time points to investigate dynamic transcriptomic changes during disease progression. Our analysis revealed distinct temporal gene expression patterns associated with the key inflammatory and immune response pathways. These findings suggest stepwise molecular progression in the periodontal inflammatory process, potentially contributing to systemic inflammation through shared signaling networks. We further identified specific genes and pathways that may mediate the bidirectional relationship between periodontal disease and systemic conditions such as cardiovascular disease and diabetes. By elucidating the temporal dynamics of molecular changes in periodontal disease, this study provides insights into the pathogenesis and its systemic implications. It identifies potential biomarkers and therapeutic targets for local and systemic disease management.

Unveiling the Molecular Crosstalk Between Periodontal and Cardiovascular Diseases: A Systematic Review

Background/Objectives: Periodontal disease (PD) is a chronic inflammatory condition caused by dysbiosis of the oral microbiome. PD is linked to systemic inflammation and endothelial dysfunction, which associate it with cardiovascular disease (CVD). This systematic review explores the molecular and microbial mechanisms through which periodontal pathogens, including "Red Complex" bacteria (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) and Fusobacterium nucleatum, influence cardiovascular health via inflammatory pathways, immune modulation, and microbial dissemination. Methods: A systematic review was conducted following PRISMA guidelines. A literature search was conducted in the PubMed and ScienceDirect databases using relevant keywords, with strict inclusion and exclusion criteria, from the first week of September 2024 to the first week of October 2024. Studies addressing the relationship between PD and CVD were assessed for methodological rigor, relevance, and data availability. The outcomes were synthesized using a descriptive narrative approach. Out of 591 records screened, 421 full-text articles were sought for retrieval. The final review included 58 articles providing supplementary aggregated data after eligibility assessment. Results: The pathogenesis of PD involves the activation of immune cells and the release of pro-inflammatory cytokines (such as IL-1, IL-6, TNF-α, and PGE2) and chemokines (including IL-8 and MCP-1) along with oxidative stress driven by reactive oxygen species (ROS). Periodontal pathogens trigger endothelial oxidative stress and systemic inflammation via Toll-like receptors (TLRs), NF-κB signaling, and nitric oxide (NO) dysregulation, contributing to endothelial dysfunction and atherogenesis. Biomarkers, such as C-reactive protein, interleukins, and matrix metalloproteinases (MMPs), further highlight the systemic inflammatory response. Conclusions: This review underscores the significant role of periodontal pathogens and inflammatory mediators in systemic health, particularly in the progression of CVD. Although existing evidence illustrates these associations, the underlying molecular mechanisms remain inadequately understood, indicating a need for further research to advance precision medicine and therapeutic strategies.

The effects of thyroid function on periodontal status: a systematic review and meta-analysis

BACKGROUND

Thyroid dysfunction causes various oral manifestations, while periodontal disease is a chronic inflammatory condition affecting the supporting structures of teeth. This systematic review and meta-analysis aimed to evaluate the effects of thyroid dysfunction on periodontal disease indices, synthesizing evidence to clarify the relationship between these conditions.

METHODS

A comprehensive search followed PRISMA guidelines across Medline, Scopus, Web of Science, and Google Scholar from inception to September 2024. Studies included adults with diagnosed thyroid dysfunction and healthy controls. Data were extracted on thyroid function tests and periodontal disease indices. The risk of bias and quality of studies were assessed using funnel plots, Begg's and Egger's indices, and the Cochrane tool. Effect sizes were calculated using standard mean difference (SMD) via Comprehensive Meta-Analysis software.

RESULTS

Eight studies (seven publications) were included. The analysis revealed that patients with thyroid dysfunction exhibited significantly higher periodontal disease indices than controls, with a pooled SMD of 0.369 (95% CI: 0.194-0.545, p < 0.001). The effects of thyroid dysfunction were found on clinical attachment level and pocket probing depth, but not on other indices like the gingival and plaque indexes. Sensitivity analysis confirmed the robustness of these findings. The quality of studies was low, with notable risks of bias.

CONCLUSIONS

Thyroid dysfunction is associated with increased periodontal disease indices, highlighting the need for further research to explore the underlying mechanisms and improve clinical management strategies for affected patients. Future studies should aim for higher methodological rigor to enhance the reliability of findings.

Effectiveness of Herbal Medicines with Anti-Inflammatory, Antimicrobial, and Antioxidant Properties in Improving Oral Health and Treating Gingivitis and Periodontitis: A Systematic Review

OBJECTIVES

This systematic review investigates the effectiveness of natural extracts with anti-inflammatory properties for improving oral health, particularly in managing gingivitis and periodontal disease (PD). With PD being a major global health issue, exacerbated by microbial dysbiosis and oxidative stress, the integration of phytochemicals and herbal formulations into periodontal therapy offers a promising avenue for adjunctive treatments.

METHODS

A systematic review was conducted following PRISMA guidelines and registered under the International Prospective Register of Systematic Reviews (ID: 641944). Databases, including PubMed, Scopus, and Web of Science, were searched between 18-24 December 2024, using Boolean keywords combining terms such as "herbal medicine", "plant extracts", "anti-inflammatory", and "periodontal therapy". Studies involving animal models, in vitro data, or non-peer-reviewed articles were excluded.

RESULTS

Seventeen studies met inclusion criteria. Polyherbal formulations and single-component extracts (e.g., Camellia sinensis, Punica granatum, Zingiber officinale, and Rosmarinus officinalis) demonstrated comparable efficacy to conventional agents like chlorhexidine (CHX). Polyherbal rinses, camellia sinensis gels, and extracts like Punica granatum reduced inflammation, improved gingival health, and showed antimicrobial properties, offering effective natural alternatives.

CONCLUSIONS

Natural products, including single extracts and polyherbal formulations, provide effective and safe alternatives for managing gingivitis and PD. Their anti-inflammatory, antimicrobial, and antioxidant properties support their adjunctive role alongside with scaling and root planning therapy (SRP) in periodontal therapy. However, further large-scale, long-term studies are needed to standardize formulations and establish optimal protocols.

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

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

Betulin inhibits the production of inflammatory cytokines in human gingival fibroblasts and ligature-induced periodontitis

Chronic inflammation of the tissues surrounding and supporting the teeth is known as periodontal disease. Human gingival fibroblasts (HGFs) are among the greatest prevalent cells in gingival tissue and play a crucial role in oral infections. Data from the GSE dataset revealed that the inflammatory cytokines IL-1β, IL-6, and IL-8 were up-regulated in periodontitis patients compared to healthy individuals. Betulin, a lupane-type pentacyclic triterpene alcohol extracted from the birch trees, inhibits lipopolysaccharide (LPS; component of gram-negative bacteria)-induced synthesis of IL-1β, IL-6, and IL-8 in HGFs. We also demonstrated that the MAPK and AP-1 signaling cascades mediate betulin's inhibition of inflammatory cytokine production in HGFs. Importantly, betulin reduces the expression of inflammatory cytokines and prevents the progression of ligature-induced periodontitis in vivo. This study provides evidence that betulin is a promising candidate for the management of periodontal disease.

Extracellular Release of a Disintegrin and Metalloproteinase Correlates With Periodontal Disease Severity

AIM

Periodontal disease is driven by oral pathogens, including Porphyromonas gingivalis, and the release of inflammatory cytokines. These cytokines (e.g., TNF) or their receptors (e.g., IL-1R) are substrates of a disintegrin and metalloproteinases (ADAMs). In this study, we aimed to determine the effects of ADAMs on periodontal disease phenotypes.

MATERIALS AND METHODS

Western blot and FRET-based activity measurements of the gingival crevicular fluid (GCF) of patients were compared with those of infected (P. gingivalis) or cytokine-stimulated oral keratinocytes and primary human neutrophils, respectively. This was accompanied by an analysis of the released extracellular vesicles and MMP9 activity.

RESULTS

In the GCF of patients, ADAM8 protein expression and activity were correlated with disease stage, whereas ADAM10 protein expression was inversely correlated with disease stage. Infection and the resulting cytokine release orchestrated the release of soluble ADAM8 by oral keratinocytes and primary neutrophils as soluble ectodomain and on exosomes, respectively. Furthermore, ADAM8 regulated the release of ADAM10 and MMP9.

CONCLUSION

Dysregulation of cell-associated and extracellular ADAM proteolytic activity may be an essential regulatory element in the progression of periodontal disease driven by ADAM8. The influence of ADAM8 on disease onset and the evaluation of targeting ADAM8 as a potential and novel local treatment option should be addressed in future translational in vivo studies.

Emerging therapeutic strategies targeting bone signaling pathways in periodontitis

Periodontitis is a multifactorial immune-mediated disease exacerbated by dysregulated alveolar bone homeostasis. Timely intervention is crucial for disease management to prevent tooth loss. To successfully manage periodontitis, it is imperative to understand the cellular and molecular mechanisms involved in its pathogenesis to develop novel treatment modalities. Non-surgical periodontal therapy (NSPT) such as subgingival instrumentation/debridement has been the underlying treatment strategy over the past decades. However, new NSPT approaches that target key signaling pathways regulating alveolar bone homeostasis have shown positive clinical outcomes. This narrative review aims to discuss endogenous bone homeostasis mechanisms impaired in periodontitis and highlight the clinical outcomes of preventive periodontal therapy to avoid invasive periodontal therapies. Although the anti-resorptive therapeutic adjuncts have demonstrated beneficial outcomes, adverse events have been reported. Diverse immunomodulatory therapies targeting the osteoblast/osteoclast (OB/OC) axis have shown promising outcomes in vivo. Future controlled randomized clinical trials (RCT) would help clinicians and patients in the selection of novel preventing therapies targeting key molecules to effectively treat or prevent periodontitis.

Extracellular Vesicles Derived From Lipopolysaccharide-Challenged Gingival Fibroblast Reveal Distinct miRNA Expression Patterns Associated With Reduced Cancer Survival

OBJECTIVES

Periodontitis is a prevalent inflammatory disease with established systemic implications. Extracellular vesicles (EVs) have emerged as key mediators of intercellular communication, potentially linking periodontitis to systemic diseases. However, the molecular cargo of EVs from inflamed periodontal cells remains poorly characterized. This study investigates the EV cargo of human gingival fibroblasts (hGF-hTERT) following lipopolysaccharide (LPS) stimulation and explores their potential role in cancer progression.

MATERIALS AND METHODS

EVs were isolated from LPS-treated and untreated fibroblasts via ultracentrifugation. Dynamic light scattering and scanning electron microscopy characterized EV size and morphology. RNA sequencing identified differentially expressed miRNAs, validated by qPCR. Functional pathway enrichment and in-silico analyses using The Cancer Genome Atlas (TCGA) were performed to assess EV-associated miRNA impact on tumorigenesis.

RESULTS

EV size and concentration remained unchanged after LPS stimulation. However, LPS-derived EVs exhibited a 2.6-fold increase in miRNA content, with three significantly upregulated miRNAs: miR-146a-5p, miR-486-5p, and miR-451a. Functional enrichment analysis revealed their involvement in inflammation, immune modulation, and cancer pathways. In vitro, LPS-derived EVs significantly enhanced prostate cancer (LnCap) cell proliferation. TCGA analysis linked the upregulated miRNAs to poor cancer prognosis.

CONCLUSIONS

LPS stimulation alters the miRNA cargo of gingival fibroblast-derived EVs, enhancing pathways associated with inflammation and cancer progression. These findings suggest a mechanistic role for periodontal EVs in systemic disease pathogenesis, warranting further investigation into their diagnostic and therapeutic potential.

Anti-inflammatory and osteoconductive multi-functional nanoparticles for the regeneration of an inflamed alveolar bone defect

Infected alveolar bone defects pose challenging clinical issues due to disrupted intrinsic healing mechanisms. Thus, the employment of advanced biomaterials enabling the modulation of several aspects of bone regeneration is necessary. This study investigated the effect of multi-functional nanoparticles on anti-inflammatory/osteoconductive characteristics and bone repair in the context of inflamed bone abnormalities. Tannic-acid mineral nanoparticles (TMPs) were prepared by the supramolecular assembly of tannic acid with bioactive calcium and phosphate ions, which were subsequently incorporated into collagen plugs via molecular interactions. Under physiological conditions, in vitro analysis confirmed that tannic acid was dissociated and released, which significantly reduced the expression of pro-inflammatory genes in lipopolysaccharide (LPS)-activated RAW264.7 cells. Meanwhile, the bioactive ions of Ca2+ and PO43- synergistically increased the gene and protein expressions of osteogenic markers of bone marrow-derived stem cells. For in vivo studies, combined endodontic-periodontal lesions were induced in beagle dogs where the plugs were readily implanted. After 2 months of the implantation, analysis of micro-computed tomography and histomorphometry revealed that groups of dogs implanted with the plug incorporating TMPs exhibited a significant decrease in bone surface density as well as structural model index, and significant increase in the mineralized bone content, respectively, with positive OPN expression being observed in reversal lines. Notably, the profound improvement in bone regeneration relied on the concentration of TMPs in the implants, underscoring the promise of multi-functional nanoparticles for treating infected alveolar bones.

Clusters explaining the relation between menopause and self-reported periodontal disease: a cross-sectional study

Background

Menopause is an important milestone in the women's life continuum and is associated with potentially adverse effects, including those related to oral health. This study assessed self-reported periodontal disease in relation to menopausal status.

Methods

A cross-sectional study involving a convenience sample of female university dental hospital attendees was conducted using a validated, self-administered, self-reported periodontal disease questionnaire. A two-step cluster analysis was used to categorize the participants based on menstrual period (MP) continuity, systemic diseases and age. Differences between clusters were analyzed using chi-square test.

Results

From 112 included participants, three clusters resulted from the analysis: Cluster #1 (37 ± 8 years, no systemic diseases and continued MP), Cluster #2 (40 ± 10, with systemic diseases and continued MP) and Cluster #3 (54 ± 9, with systemic diseases and discontinued MP). Cluster #3 tended to have less optimal oral hygiene habits and more missing teeth (p > 0.05). Clusters #1 and #2 insignificantly reported more gingival bleeding, tooth sensitivity and calculus (p > 0.05). Cluster #3, on the other hand, presented with more self-reported oral dryness (p ≤ 0.05).

Conclusions

Within study limits, clusters of menopausal women with systemic diseases reported high symptoms of periodontal disease that were not significantly different from younger individuals, with the exception of oral dryness.

Shaping oral and intestinal microbiota and the immune system during the first 1,000 days of life

The first 1, 000 days of life, from the fetal stage of a woman's pregnancy to 2 years of age after the baby is born, is a critical period for microbial colonization of the body and development of the immune system. The immune system and microbiota exhibit great plasticity at this stage and play a crucial role in subsequent development and future health. Two-way communication and interaction between immune system and microbiota is helpful to maintain human microecological balance and immune homeostasis. Currently, there is a growing interest in the important role of the microbiota in the newborn, and it is believed that the absence or dysbiosis of human commensal microbiota early in life can have lasting health consequences. Thus, this paper summarizes research advances in the establishment of the oral and intestinal microbiome and immune system in early life, emphasizing the substantial impact of microbiota diversity in the prenatal and early postnatal periods, and summarizes that maternal microbes, mode of delivery, feeding practices, antibiotics, probiotics, and the environment shape the oral and intestinal microbiota of infants in the first 1, 000 days of life and their association with the immune system.

The role of Mitofusin-1 and Mitofusin-2 in periodontal disease: a comprehensive review

Periodontal disease is a widespread chronic inflammatory state influencing the supporting anatomy of the teeth, distinguished by oxidative stress, progressive bone loss, and tissue damage. Recent articles have highlighted the significance of mitochondrial dynamics, mainly Mitofusin-1 (MFN1) along with Mitofusin-2 (MFN2), inflammation regulation, tissue homeostasis, and in cellular function. The aim of the current study is to comprehensively review including evaluate the roles of MFN2 and MFN1 in the pathogenesis as well as the progression of periodontal disease, foregrounding their effect on mitochondrial integrity, inflammatory pathways, and oxidative stress. Studies were selected depending on inclusion criteria based on the roles of MFN2 and MFN1 in periodontal disease and health. Data from chosen in vivo, clinical studies, and in vitro were synthesized. Outcomes indicate that MFN2 and MFN1 are important for preserving cellular function, mitigating oxidative damage, and mitochondrial fusion. Decreased levels of these proteins were related to elevated oxidative stress, inflammation, and increased mitochondrial dysfunction in periodontal tissues. The current comprehensive review shows the important roles of MFN1 along with MFN2 in inflammation regulation, cell survival, and mitochondrial dynamics within periodontal disease. The prospective for targeting MFN1 along with MFN2 in therapeutic policy is promising, presenting avenues for upgraded periodontal management and regeneration.

How Will Nanomedicine Revolutionize Future Dentistry and Periodontal Therapy?

Periodontitis is a prevalent inflammatory disease affecting the supporting structures of the teeth, leading to gum recession, tooth loss, and systemic health complications. Traditional diagnostic methods and treatments, such as clinical evaluation and scaling, often fall short in early detection and targeted therapy, particularly in complex or advanced cases. Recent advancements in nanomedicine offer promising solutions for improving both the diagnosis and treatment of periodontitis. Nanoparticles, such as liposomes, quantum dots, and nanorods, have demonstrated potential in enhancing diagnostic accuracy by enabling more precise detection of periodontal pathogens and biomarkers at the molecular level. Furthermore, nanotechnology-based therapies, including drug delivery systems and antimicrobial agents, offer localized and controlled release of therapeutic agents, enhancing efficacy and reducing side effects compared to conventional treatments. This study reviews the current applications of nanomedicine in the diagnosis and treatment of periodontitis, highlighting its potential to revolutionize periodontal care by improving early detection, reducing treatment times, and enhancing therapeutic outcomes.

Precision Medicine Assessment of the Radiographic Defect Angle of the Intrabony Defect in Periodontal Lesions by Deep Learning of Bitewing Radiographs

In dental diagnosis, evaluating the severity of periodontal disease by analyzing the radiographic defect angle of the intrabony defect is essential for effective treatment planning. However, dentists often rely on clinical examinations and manual analysis, which can be time-consuming and labor-intensive. Due to the high recurrence rate of periodontal disease after treatment, accurately evaluating the radiographic defect angle of the intrabony defect is vital for implementing targeted interventions, which can improve treatment outcomes and reduce recurrence. This study aims to streamline clinical practices and enhance patient care in managing periodontal disease by determining its severity based on the analysis of the radiographic defect angle of the intrabony defect. In this approach, radiographic defect angles of the intrabony defect greater than 37 degrees are classified as severe, while those less than 37 degrees are considered mild. This study employed a series of novel image enhancement techniques to significantly improve diagnostic accuracy. Before enhancement, the maximum accuracy was 78.85%, which increased to 95.12% following enhancement. YOLOv8 detects the affected tooth, and its mAP can reach 95.5%, with a precision reach of 94.32%. This approach assists dentists in swiftly assessing the extent of periodontal erosion, enabling timely and appropriate treatment. These techniques reduce diagnostic time and improve healthcare quality.

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

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

Shattering the Amyloid Illusion: The Microbial Enigma of Alzheimer's Disease Pathogenesis-From Gut Microbiota and Viruses to Brain Biofilms

For decades, Alzheimer's Disease (AD) research has focused on the amyloid cascade hypothesis, which identifies amyloid-beta (Aβ) as the primary driver of the disease. However, the consistent failure of Aβ-targeted therapies to demonstrate efficacy, coupled with significant safety concerns, underscores the need to rethink our approach to AD treatment. Emerging evidence points to microbial infections as environmental factors in AD pathoetiology. Although a definitive causal link remains unestablished, the collective evidence is compelling. This review explores unconventional perspectives and emerging paradigms regarding microbial involvement in AD pathogenesis, emphasizing the gut-brain axis, brain biofilms, the oral microbiome, and viral infections. Transgenic mouse models show that gut microbiota dysregulation precedes brain Aβ accumulation, emphasizing gut-brain signaling pathways. Viral infections like Herpes Simplex Virus Type 1 (HSV-1) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may lead to AD by modulating host processes like the immune system. Aβ peptide's antimicrobial function as a response to microbial infection might inadvertently promote AD. We discuss potential microbiome-based therapies as promising strategies for managing and potentially preventing AD progression. Fecal microbiota transplantation (FMT) restores gut microbial balance, reduces Aβ accumulation, and improves cognition in preclinical models. Probiotics and prebiotics reduce neuroinflammation and Aβ plaques, while antiviral therapies targeting HSV-1 and vaccines like the shingles vaccine show potential to mitigate AD pathology. Developing effective treatments requires standardized methods to identify and measure microbial infections in AD patients, enabling personalized therapies that address individual microbial contributions to AD pathogenesis. Further research is needed to clarify the interactions between microbes and Aβ, explore bacterial and viral interplay, and understand their broader effects on host processes to translate these insights into clinical interventions.