Gender Differences in the Levels of Periodontal Destruction, Behavioral Risk Factors and Systemic Oxidative Stress in Ischemic Stroke Patients: A Cohort Pilot Study

Is periodontitis a risk factor for ischemic stroke?: Systematic review and meta-analysis

Background

Evidence suggests an association between periodontitis and ischemic stroke due to the elevated production of inflammatory markers and damage by infectious agents, which would promote a recurrent prothrombotic state. Therefore, the present systematic review and meta-analysis were carried out to determine whether periodontitis is a risk factor for ischemic stroke.

Material and Methods

A systematic search was conducted in five databases, including cohort and case-control studies published up to April 2024, in which periodontitis was evaluated as a risk factor for ischemic stroke through relative risk (RR), hazard ratio (HR) and odds ratio (OR). The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias, and the GRADE system was used to determine the certainty of the evidence.

Results

Of the 1121 studies found, 16 were included in the qualitative analysis, and 10 were meta-analyzed. The global synthesis showed that periodontitis was a risk factor for ischemic stroke (OR=2.59, I2=96%), with the same result being found for the case-control subgroup (OR=3.44, I²=73%) and the cohort subgroup (OR=2.05, I²=99%). Individuals with periodontitis were also found to be more likely to develop lacunar infarcts (OR=5.00, I2=0%).

Conclusions

Periodontitis is a risk factor for ischemic stroke with very low certainty of evidence and high heterogeneity. Furthermore, individuals with periodontitis were more likely to develop lacunar infarcts, with moderate certainty of evidence and null heterogeneity. Key words:Periodontitis, periodontal diseases, ischemic stroke, lacunar infarction, embolic stroke, thrombotic stroke.

Correlation of Body Mass Index With Severity of Periodontitis: A Cross-Sectional Study

OBJECTIVES

This study aimed to assess the relationship between body mass index (BMI) classification and the severity of periodontitis, recognizing that both obesity and periodontitis involve chronic inflammatory processes, which may exacerbate one another.

MATERIALS AND METHODS

A cross-sectional study was conducted on a convenience sample of 162 consecutive outpatients who reported to the Department of Periodontics, Saveetha Dental College and Hospitals in Chennai from March 2023 to September 2023. Age, gender, Russell's periodontal index, and BMI were recorded. The association between age, gender, BMI, and severity of periodontitis was analyzed using linear-by-linear χ2 association. Ordinal logistic regression analysis was employed to assess the odds ratio (OR) of age, gender, and BMI with the severity of periodontitis.

RESULTS

A statistically significant association was observed between age, gender, BMI, and the severity of periodontitis (p < 0.05). Participants aged 35-60 years had an OR of 1.305 for severe periodontitis (95% CI: 0.754-1.561). Males exhibited a higher risk of severe periodontitis (OR: 1.171; 95% CI: 0.894-2.485). Obese participants showed an OR of 1.417 for severe periodontitis compared to overweight participants (OR: 0.683; 95% CI: 0.817-1.629).

CONCLUSIONS

Severe periodontitis was more prevalent among obese individuals, followed by overweight individuals. Obesity may be considered a potential risk indicator for the development and progression of periodontitis.

Role of oxidative stress in the relationship between periodontitis and systemic diseases

Periodontitis is a common inflammatory disease. It is characterized by destruction of the supporting structures of the teeth and could lead to tooth loss and systemic inflammation. Bacteria in inflamed gingival tissue and virulence factors are capable of entering the bloodstream to induce systemic inflammatory response, thus influencing the pathological process of many diseases, such as cardiovascular diseases, diabetes, chronic kidney disease, as well as liver injury. An increasing body of evidence show the complex interplay between oxidative stress and inflammation in disease pathogenesis. When periodontitis occurs, increased reactive oxygen species accumulation leads to oxidative stress. Oxidative stress contributes to major cellular components damage, including DNA, proteins, and lipids. In this article, the focus will be on oxidative stress in periodontal disease, the relationship between periodontitis and systemic inflammation, and the impact of periodontal therapy on oxidative stress parameters.

Periodontitis and Its Inflammatory Changes Linked to Various Systemic Diseases: A Review of Its Underlying Mechanisms

Periodontitis is a chronic inflammatory disease of the gums. The incidence of periodontitis is increasing all over the world. In patients with periodontitis, there is gradual destruction of the periodontal ligament and the alveolar bone, and later, in advanced stages, there is tooth loss. Different microorganisms, the host’s immune response, and various environmental factors interact in the progression of this chronic inflammatory disease. In the present review, we discuss the epidemiology, clinical features, diagnosis, and complications of periodontitis. We also discuss the association of chronic inflammation found in periodontitis with various other systemic diseases, which include cardiovascular, respiratory, diabetes, Alzheimer’s, cancer, adverse pregnancy, and multiple myeloma, and also highlight microbial carcinogenesis and the microRNAs involved. The latest updates on the molecular mechanism, possible biomarkers, and treatment procedures may be beneficial for diagnostic and therapeutic purposes.

Sex-related differences in endothelium-dependent vasodilation of human gingiva

Background

Sex hormones influence circulation, periodontitis, and wound healing. The aim of the study was to compare the endothelium-dependent and independent vasodilation in human gingiva in men and women.

Methods

Gingival blood flow was evaluated in twelve male and twelve female subjects with healthy gingiva and no systemic conditions after acetylcholine or nitric oxide donor (NitroPOHL). Agonists were administered into the gingival sulcus at the right secondary incisor (test site). Regional gingival blood flow (GBF) was imaged by Laser Speckle Contrast Imager from the marginal gingiva to the mucogingival junction in four consecutive regions (coronal, midway1, midway2 and apical). Blood flow was expressed in Laser Speckle Perfusion Unit (LSPU). The absolute maximal blood flow change (Dmax), the area under the blood flow curve (AUC), and the time to peak (TTP) were calculated.

Results

Males had higher baseline GBF than females (257 ± 18.2 vs. 225 ± 18.8 LSPU, p < 0.001). Acetylcholine and NitroPOHL significantly increased the GBF in all test regions. The Dmax after the acetylcholine was reduced apically compared to the coronal (90 ± 13 LSPU vs. 117 ± 7 LSPU, p < 0.01), but it was similar after NitroPOHL (78 ± 9 LSPU vs. 86 ± 6 LSPU, p = 0.398) in both sexes. The Dmax and AUC were higher, and the TTP was smaller in men in most regions after acetylcholine but not after NitroPOHL.

Conclusion

In the human gingiva, the endothelium-independent vasodilation propagates without attenuation in the line of the vascular supply in both sexes. At the same time, the endothelium-dependent ascending vasodilation attenuates similarly in men and women. However, men had more pronounced endothelium-dependent vasodilation than women. Therefore, it might contribute to the increased severity of periodontal disease in men.

Trial registration

The study was registered with ClinicalTrials.gov on 09.06.2021 (NCT04918563).

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Interaction between and impact of IL-6 genotype and alpha-tocopherol levels on periodontal condition in aging individuals

BACKGROUND AND OBJECTIVES

Few studies have assessed the possible interaction between and impact of IL-6 variants and serum α-tocopherol levels on periodontal condition in older individuals. Here, we assessed the relationship between IL-6 variants and serum α-tocopherol levels on periodontal condition by considering effect modification.

MATERIAL AND METHODS

Among the study participants, 359 who were 71 years of age underwent a dental examination, biochemical analysis, and interview. After dividing the participants into tertiles based on serum α-tocopherol levels, we conducted Poisson regression analysis to compare the prevalence rate ratio (PRR) for periodontal disease markers with the IL-6 genotype (rs1800796) based on each tertile adjusted by the number of teeth present (offset).

RESULTS

The PRRs of the IL-6 genotype for periodontal condition (probing pocket depth [PPD], clinical attachment level [CAL], and bleeding on probing [BOP]) which were adjusted by the number of teeth present (offset) were 1.17 (P < .001), 1.37 (P < .001), and 1.08 (P = .048), respectively. In addition, a significant association was found between the reciprocal number of PRRs of the IL-6 genotype and three serum α-tocopherol levels. The adjusted PRRs (± standard error) of the IL-6 genotypes for PPD were 0.48 (0.12) for the first group (P < .001), 1.54 (0.04) for the second group (P < .001), and 2.11 (0.03) for the third group (P < .001); similar tendencies were seen for CAL and BOP.

CONCLUSION

The results of this study suggest a potential association between the IL-6 genotype and periodontal condition in relation to serum antioxidant concentrations.