Periodontitis and systemic diseases: A literature review

Periodontal Disease and Age-Related Maculopathy: A Case Report

Age-related macular degeneration (AMD) is a leading cause of significant vision impairment in individuals aged 50 and older, primarily impacting central vision. This study seeks to investigate potential associations between periodontal disease and age-related maculopathy in the analyzed clinical case. A male subject of 66 years old, with age-related degenerative maculopathy and severe periodontal disease, was evaluated and treated. After an initial phase of non-surgical causal periodontal therapy, the periodontal indices were re-evaluated. In addition, the extraction of hopeless teeth replaced by dental implants was performed. A retinal topography was used to assess possible regression of the pathology, and proper anti-VEGF therapy was administered. The results showed a regression of periodontal disease and an improvement of the degenerative maculopathy. These preliminary results, even if encouraging, should be supported by larger prospective trials.

Evaluation of the Adjunctive Effect of Photodynamic Therapy for the Treatment of Residual Periodontal Pockets: A Systematic Review

Purpose

Adjunctive use of photodynamic therapy in combination with scaling and root planing for periodontal maintenance offers an alternative to antibiotic therapy, potentially mitigating the risk of antibiotic resistance and its genotoxic or mutagenic effects. This systematic review analyzed studies, as of January 2023, that included the effects of a single application of photodynamic therapy in residual periodontal pockets with the probing depth and clinical attachment level as the primary and secondary outcomes, respectively.

Methods

PubMed, Scopus, and Web of Science databases, as well as the US National Institutes of Health and WHO Clinical Trials Registry, were searched for eligible studies on January 14, 2023.

Results

Excluding non-English language articles, a total of nine studies examining 286 subjects were considered. Six of the nine studies resulted in decreased probing depth levels. Likewise, six of the nine studies exhibited a positive trend in terms of clinical attachment levels with photodynamic therapy. A limited number of studies revealed significant probing depth levels and clinical attachment levels after photodynamic therapy. The overall risk of bias was high in four studies, four studies showed some concerns regarding the study limitations, and one study had a low risk of bias.

Conclusions

Photodynamic therapy in combination with scaling and root planing may result in modest reductions in residual periodontal pocket depth levels and improvements in clinical attachment levels. The use of PDT in periodontal maintenance can reduce or eliminate the need for periodontal surgery, which may be more invasive and lead to a longer recovery time.

A systematic review and network meta-analysis of the association between periodontitis and inflammatory bowel diseases

OBJECTIVES

Several earlier studies have shown that IBD (including its two subtypes, ulcerative colitis (UC) and Crohn's disease (CD)) increases the risk of periodontal disease. This study aimed to evaluate the relevance among periodontitis and IBD subcategories.

METHODS

This study was conducted based on PRISMA guidelines. The Web of Science, PubMed, Google Scholar, and Scopus databases were searched up to February 2024 using pertinent keywords. Case series, review articles, and animal studies were excluded. The risk of bias in this research was evaluated through the Joanna Briggs Institute (JBI) criteria. The meta-analysis was conducted using R statistical software.

RESULTS

A total of 9134 patients within 13 studies after the screening process were evaluated. Our study has shown that periodontitis is significantly more prevalent among IBD patients (UC and CD). According to prior meta-analyses, PD morbidity was found to be significantly high among CD patients (OR: 4.30; 95% CI: 3.72-4.98; I2 = 0%). Similarly, UC elevated PD risk (OR: 4.55; 95% CI: 3.76-5.50; I2 = 0%). The risk of periodontitis was not significantly different between CD and UC patients (OR: 0.96; 95% CI: 0.65-1.43; I2 = 34%).

CONCLUSIONS

UC and CD patients were more likely to develop periodontitis, with low heterogeneity between studies, while the prevalence of periodontitis among UC and CD patients was not meaningfully different.

CLINICAL RELEVANCE

The higher risk of periodontitis in patients with IBD indicates the necessity of screening for periodontitis. Considering the various oral manifestations and poor quality of life associated with IBD, it is important to be aware of the symptoms of periodontitis.

The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review

Periodontitis is a complex, multifactorial chronic inflammatory condition that impacts the adjacent hard and soft tissues. Microorganisms, especially gram-negative anaerobic pathogens, are a causative factor for periodontal disease. Periodontitis is identified by observing deeper periodontal pockets, clinical attachment loss, and the reduction of alveolar bone, often in conjunction with these indicators. The condition can vary in severity and be classified as mild, moderate, or severe. Scaling and root planing, combined with mechanical debridement, may not adequately reduce the bacterial load; therefore, adding local or systemic antimicrobials is advised as an adjunctive treatment. Commonly utilized local drug delivery agents for patients suffering from periodontitis include tetracycline, metronidazole, minocycline, doxycycline, and chlorhexidine. This system targets the pockets and eliminates the pathogens. Metronidazole is a nitroimidazole compound used commonly against gram-negative anaerobes. Its mechanism lies in four basic steps through which bacterial cell death occurs. A 25% metronidazole gel is used widely in periodontitis patients. The effectiveness of metronidazole as a local drug delivery agent has been evaluated in numerous studies, which have shown improvements in clinical parameters. To achieve favorable clinical outcomes, the non-surgical treatment of peri-implantitis should involve the systemic or local administration of metronidazole. Thus, the role of metronidazole in the emergence of periodontal diseases and its therapeutic uses are investigated in this narrative review.

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.

Smart biomaterial gels for periodontal therapy: A novel approach

Periodontitis, a chronic inflammatory condition of the oral cavity, is characterized by the progressive destruction of the supporting structures of the teeth. The pathogenic effects of periodontopathogens extend beyond the local periodontal environment, contributing to systemic health complications, thereby underscoring the need for effective therapeutic strategies. Current standard treatments, which involve mechanical debridement coupled with systemic anti-inflammatory and antibiotic therapies, are often associated with limited efficacy, adverse effects, and the emergence of antibiotic resistance. Recent advancements in localized drug delivery systems present an innovative alternative, offering site-specific targeting with sustained therapeutic action. Smart drug delivery platforms, designed to respond to the unique microenvironment of periodontal pockets, undergo physicochemical transformations such as gelation or controlled drug release, enhancing treatment efficacy. This review comprehensively explores the etiological and prognostic factors of periodontitis, critical diagnostic biomarkers, and an in-depth analysis of stimuli-responsive biomacromolecule-based gels. These systems are evaluated for their structural properties, biological compatibility, and therapeutic potential while addressing their limitations and barriers to clinical translation. By integrating insights into the interplay between material properties and biological performance, this review highlights the future role of these advanced delivery systems in overcoming challenges in periodontal healthcare. Such approaches aim to bridge the gap between bench-side innovation and bedside application, offering the transformative potential to enhance therapeutic outcomes and improve patient quality of life in managing periodontal diseases.

The Association Between Periodontitis, Gingivitis, Tooth Loss and Stroke: An Umbrella Study with Meta-Analysis

BACKGROUND

Cerebrovascular diseases (CVAs) have several risk factors that are categorized as modifiable and nonmodifiable. Periodontal diseases (PD) have a modifiable role in causing CVA, where several studies suggested direct or indirect correlations with systemic diseases. This study aims to summarize, evaluate and analyze all the evidence available in literature, to reach a better understanding of the relation between periodontitis, gingivitis, tooth loss and CVA.

METHODS

PubMed, Cochrane, Scopus and Web of Science databases were searched for all meta-analyses assessing the effect of PD on CVA in accordance with Joanna Briggs Institute guidance for umbrella reviews in March 2024. Assessment of Multiple Systematic Reviews (AMSTAR) was used for quality assessment. Pooled analysis was performed to assess the effect of periodontitis, gingivitis and tooth loss on CVA, depending on the availability of data using Review Manager Version 5.2.11.

RESULTS

Seven of the identified meta-analyses were of high quality, and they were distributed in different countries. Periodontitis was generally associated with a significant increase in CVA risk (OR = 2.32, 95% CI: 1.70, 3.17, p < 0.00001 and RR = 1.22, 95% CI: 1.15-1.29, p < 0.00001), same as tooth loss, but to a lower degree (0.78). However, the effect of gingivitis was insignificant in terms of CVA (RR = 1.32, 95% CI: 1.12-1.56, p = 0.0008).

CONCLUSIONS

This study confirms the effect of periodontitis and tooth loss on CVA, disregarding any significant role for gingivitis. The relation reached favors the suggested role of some inflammatory changes in the pathogenic pathway leading to atherosclerotic changes.

Analysis of the basement membrane-related genes ITGA7 and its regulatory role in periodontitis via machine learning: a retrospective study

BACKGROUND

Periodontitis is among the most prevalent inflammatory conditions and greatly impacts oral health. This study aimed to elucidate the role of basement membrane-related genes in the pathogenesis and diagnosis of periodontitis.

METHODS

GSE10334 was used for identification of hub genes via the differential analysis, protein-protein interaction network, MCC and DMNC algorithms, and evaluation via LASSO regression and support vector machine analysis to identify basement membrane-related markers in patients with periodontitis. Findings were validated by analysis of the GSE16134 dataset and quantitative reverse transcription PCR. The regulatory interplay among lncRNAs, miRNAs, and mRNAs was investigated through multiple databases. Immune infiltration analysis was performed to assess the immune landscape in periodontitis.

RESULTS

ITGA7 was identified as a key gene for periodontitis, as supported by machine learning analysis, validation of expression, and receiver operating characteristic analysis from external datasets. Immune infiltration analysis revealed significant associations between ITGA7 expression and the infiltration of numerous immune cells implicated in periodontitis. Additionally, our findings suggest that the expression of the lncRNA LINC-PINT is significantly increased in periodontitis, and that it can modulate ITGA7 expression through hsa-miR-1293.

CONCLUSION

ITGA7 is a potential diagnostic and therapeutic target for periodontitis. The LINC-PINT/hsa-miR-1293/ITGA7 axis and the relationship between ITGA7 and immune infiltration provide new insights into the molecular mechanisms underlying periodontitis and highlight potential avenues for clinical intervention.

Comparative Analysis of Thromboxane B2 (TXB2) and Prostaglandin E2 (PGE2) Levels in the Gingival Crevicular Fluid (GCF) of Diabetic Patients With Chronic Periodontitis: An Enzyme Immunoassay Study

INTRODUCTION

A persistent systemic hyperglycemia as observed in patients with type 2 diabetes mellitus (DM) has been associated with periodontal inflammation. Therefore, the primary objective of the present study was to assess the levels of thromboxane B2 (TXB2) and prostaglandin E2 (PGE2) in the gingival crevicular fluid (GCF) of type 2 DM and non-diabetic patients with chronic periodontitis. The secondary objectives were to correlate these levels with various parameters such as age, gender, glycated hemoglobin (HbA1c) levels, probing depth (PD), and fasting blood sugar levels and to determine the significant predictors for PGE2 and TXB2 levels.  Materials and methods: This case-control, cross-sectional study was conducted on 60 patients who were divided into three groups: group 1 (n=20) comprising type 2 DM patients with chronic periodontitis, group 2 (n=20) composed of non-diabetic patients with chronic periodontitis, and group 3 (n=20) as controls comprising of periodontally and systemically healthy individuals. HbA1c, fasting blood glucose levels, PD, and PGE2 and TXB2 levels were checked in GCF for all the patients. The data was subjected to statistical analysis.

RESULTS

The two-way analysis of variance test results revealed statistically significant differences across groups for all parameters. The levels of both biomarkers showed a positive correlation with HbA1c, PD, fasting blood sugar levels, and duration of type 2 DM. Furthermore, PD and fasting blood sugar levels showed the strongest influence on both PGE2 and TXB2 levels. For PGE2, fasting blood sugar levels (p=0.006) and PD (p<0.001) were significant predictors. For TXB2, significant predictors included HbA1c (p=0.003), fasting blood sugar levels (p=0.015), and PD (p<0.001).

CONCLUSION

PGE2 and TXB2 levels were significantly increased in type 2 DM with chronic periodontitis, compared with non-diabetic patients with chronic periodontitis and periodontally healthy patients.

Toward Digital Periodontal Health: Recent Advances and Future Perspectives

Periodontal diseases, ranging from gingivitis to periodontitis, are prevalent oral diseases affecting over 50% of the global population. These diseases arise from infections and inflammation of the gums and supporting bones, significantly impacting oral health. The established link between periodontal diseases and systemic diseases, such as cardiovascular diseases, underscores their importance as a public health concern. Consequently, the early detection and prevention of periodontal diseases have become critical objectives in healthcare, particularly through the integration of advanced artificial intelligence (AI) technologies. This paper aims to bridge the gap between clinical practices and cutting-edge technologies by providing a comprehensive review of current research. We examine the identification of causative factors, disease progression, and the role of AI in enhancing early detection and treatment. Our goal is to underscore the importance of early intervention in improving patient outcomes and to stimulate further interest among researchers, bioengineers, and AI specialists in the ongoing exploration of AI applications in periodontal disease diagnosis.

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

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

Exploring the correlation between periodontal disease and serum biomarkers in haemodialysis patients

BACKGROUND

Patients undergoing haemodialysis are more susceptible to infectious diseases, including periodontitis. This study aimed to investigate the Correlation between periodontal disease and serum markers in Yemeni haemodialysis patients.

METHODS

A cross-sectional study was conducted on a sample of 70 haemodialysis patients. Patient interviews, clinical examinations, and laboratory tests were performed to collect data. Serum levels of albumin, calcium, phosphorus, haemoglobin, ferritin, and creatinine were measured, with separate measurements for cystatin C The association between categorical variables was assessed using the chi-square test and Pearson's correlation coefficient, considering a significance level of p < 0.05.

RESULTS

Significant correlations were found between serum biomarkers and periodontal clinical parameters. Phosphorus, creatinine, albumin, ferritin, and creatinine levels correlated significantly with the Plaque Index (p < 0.001, p < 0.001, p = 0.015, p = 0.018, and p = 0.03). While the Ferritin level showed significant correlations with both the Plaque Index and Miller Classes (r = 0.281, p = 0.018 and r = 0.258, p = 0.031), respectively. The Calcium level showed a significant correlation with the Gingival Index (r = 0.266, p = 0.027). Cystatin C level was statistically correlated with mobility (r = 0.258, p = 0.031). Also, the result showed a significant correlation between Creatinine levels and Periodontitis (r = 0.26, p = 0.03).

CONCLUSION

This study provides evidence of a strong association between periodontal disease and chronic kidney disease in Yemeni haemodialysis patients. The findings emphasize the significance of maintaining good oral health in the care of haemodialysis patients.

Overexpression of insulin-like growth factor-2 mRNA-binding protein 1 is associated with periodontal disease

Objective

To investigate the potential role of a novel m6A RNA regulator, Insulin-like Growth Factor-2 mRNA-binding protein 1 (IGF2BP1), in periodontal disease pathogenesis.

Materials and methods

Gingival tissue samples from 60 periodontitis patients and 60 healthy individuals were analyzed for IGF2BP1 mRNA and protein expression via real-time quantitative PCR (RT-qPCR) and Western blotting. Additionally, Porphyromonas gingivalis Lipopolysaccharide (Pg-LPS) -induced human gingival fibroblasts (HGFs) were evaluated for IGF2BP1 and proinflammatory cytokine expression. In silico functional analysis further explored potential molecular mechanisms.

Results

IGF2BP1 mRNA and protein levels were significantly higher in the periodontitis group compared to the healthy group. Functional analysis implicated IGF2BP1 in regulating the IL-17 signaling pathway, a key player in inflammation. Pg-LPS treatment upregulated IGF2BP1 and proinflammatory cytokines in HGFs, supporting this finding.

Conclusion

Our study suggests that IGF2BP1 overexpression contributes to periodontitis pathogenesis, potentially through IL-17 signaling. Further research is needed to elucidate the precise molecular mechanisms and explore IGF2BP1 as a potential therapeutic target or biomarker for this common oral disease.

Clinacanthus nutans extract lowers periodontal inflammation under high-glucose conditions via inhibiting NF-κB signaling pathway

Periodontal disease is more prevalent in patients with diabetes, and it has a negative impact on their quality of life. Inhibiting the infection and inflammation processes that cause periodontal disease can reduce the severity of the disease and chances of serious complications. In this study, we aimed to demonstrate the effectiveness of Clinacanthus nutans extract in reducing the inflammation in gingival fibroblast cells induced by Porphyromonas gingivalis lipopolysaccharide (LPS). Stimulation with LPS under high-glucose conditions led to increased inflammation compared to low-glucose conditions. Treatment of C. nutans extract significantly reduced the expression of these pro-inflammatory cytokines and chemokines. At a concentration of 50 μg/mL, it reduced the relative expression of IL6, IL8, and CXCL10 to 0.51 ± 0.09, 0.6 ± 0.19, and 0.09 ± 0.02, respectively, compared to the non-treatment control, accompanied by a decrease in secreted protein as measured by ELISA. Additionally, application of C. nutans extract markedly suppressed the NF-κB signaling pathway by reducing the phosphorylated form of IκBα, NF-κB p65, and nuclear translocation of NF-κB, along with a decrease in COX2, a key mediator in the inflammatory pathway. Furthermore, analysis of RNA sequencing data indicated that the extract clearly reversed the gene expression changes induced by LPS. This was particularly true for the signaling mediators and inflammatory genes in response to NF-κB, JAK/STAT, and TNF signaling pathways. Our finding highlights the potential of C. nutans extract to alleviate inflammation and suggests its potential as a treatment for periodontal disease in patients with diabetes.

Knowledge, Attitudes, and Practices Regarding Periodontal Diseases Among First-Year Undergraduates of Different Faculties of Krishna Vishwa Vidyapeeth University

Introduction Periodontal diseases, encompassing gingivitis and periodontitis, are prevalent and complex conditions with significant implications for overall health, particularly in India. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding periodontal diseases among first-year undergraduate students across various faculties at Krishna Vishwa Vidyapeeth Deemed to be University, Karad. Methods A cross-sectional questionnaire-based survey was conducted among 200 students from the medical, dental, physiotherapy, pharmacy, and nursing faculties. Descriptive statistics and Pearson's chi-squared test were utilized for data analysis. Results They revealed suboptimal oral hygiene practices among participants, with only 30% reporting twice-daily tooth cleaning. Additionally, less than half of the participants used soft toothbrushes and fluoridated toothpaste. Notably, 40% had never visited a dentist. While 86% recognized the correlation between gum and systemic health, significant proportions had experienced symptoms of gum disease. Dental first-year undergraduate students have a better understanding, attitude, and practices toward periodontal diseases, while nursing first-year undergraduate students displayed the lowest KAP scores compared to other faculties. Conclusion The first-year dental students demonstrated a better understanding, attitude, and behavior towards periodontal diseases compared to students in other faculties. Our study emphasizes the necessity of incorporating oral and periodontal health education into both healthcare professional curricula and those of higher secondary school students. Such educational programs will empower individuals to enhance their oral and systemic health. Moreover, equipping medical and paramedical practitioners with proper knowledge of periodontal health will ultimately lead to improved oral health outcomes for the general population.

Assessment and Comparison of N-Terminal-Probrain Natriuretic Peptide (NT-proBNP) in Saliva and Serum of Healthy Subjects, Periodontitis Patients, and Periodontitis Patients With Myocardial Infarction

Introduction Periodontitis is a multifactorial oral disease causing destruction of the periodontium. Systemic diseases can exacerbate periodontal inflammation through immune dysregulation. N-terminal-probrain natriuretic peptide (NT-proBNP) a prohormone, released by myocardial cells is a known biomarker for cardiovascular disease (CVD). Existing literature discloses a bidirectional relationship between periodontitis and CVD. NT-proBNP release can be regulated by mediators of the systemic inflammation. Cardiocyte NT-proBNP release might get stimulated through proinflammatory cytokines. NT-proBNP levels can also be influenced by systemic inflammation in the absence of cardiac dysfunction. Accordingly, we postulated that the inflammation of periodontium could aid in increased levels of NT-proBNP in serum and saliva in participants without cardiovascular disorders. Saliva is said to be the mirror of the body. Assessing NT-pro BNP in saliva allows for a non-invasive method. The present research evaluated the salivary and serum concentrations of NT-proBNP in a healthy group, patients suffering from periodontal disease and periodontal disease along with myocardial infarction (MI). Material and method A total of 90 patients, 30 in each group i.e., healthy group, periodontitis patients and patients suffering from periodontitis with myocardial infarction, were enrolled. The periodontitis patients were selected according to the Classification of Periodontal and Peri-implant Diseases and Conditions 2017. Patients clinically diagnosed with MI by the physician were selected following World Health Organization criteria for detection of MI. Case history was recorded and periodontal parameter analysis like plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were measured. Salivary and serum samples were collected from the participants after obtaining informed consent. The samples were subjected to human NT-proBNP sandwich type enzyme-linked immunosorbent assay (ELISA) for quantitative evaluation. The obtained data was analysed and compared using ANOVA, Tukey's post hoc test and Pearson's correlation. The p-value<0.05 was considered statistically significant. Result PI and GI were highest in subjects with periodontitis only (p<0.05). Patients suffering from periodontitis with MI exhibited significantly higher PPD and CAL values (p<0.05). Salivary and serum concentrations of NT-proBNP were significantly higher with p-value=0.000 in subjects suffering from periodontitis with MI. The salivary NT-proBNP levels were significantly higher than serum NT-proBNP levels in periodontitis and periodontitis with MI patients. The levels of NT-proBNP in periodontitis along with MI patients were 1.570 pg/mL in serum and 1.694 pg/mL in saliva. Conclusion Salivary NT-proBNP levels were highest in subjects affected from periodontitis along with MI. Elevated salivary NT-proBNP levels can be due to systemic inflammation and cardiovascular stress linking periodontitis to MI. The positive correlation between periodontal parameters and NT-proBNP levels validates the biomarker's role in reflecting the extent of periodontal destruction and its association with cardiovascular stress. Salivary NT-proBNP can be used as a non-invasive diagnostic marker for diagnosing periodontitis and MI. Future research could explore targeted therapies for the shared inflammatory pathways between periodontitis and MI.

Epidemiology of Periodontal Diseases in Individuals With Diabetes in Saudi Arabia: A Systematic Review

Diabetes mellitus (DM) is one of the most common and prevalent metabolic disorders worldwide. It affects men, women, and children and can cause severe organ damage, including kidney damage. The two most common types of DM are Type 1 DM and Type 2 DM. Similarly, periodontal disease (PD) affects a significant portion of the population and involves the tissues supporting the teeth. The bidirectional relationship between diabetes and PD is a well-established phenomenon. However, no comprehensive study on the prevalence of PD among diabetic patients has been conducted on the Saudi population. This systematic review aims to examine the current literature on the impact of these conditions on the Saudi population. A literature search was conducted from January 2001 through June 2024 using Scopus, PubMed, and Google Scholar. An extensive search was performed, duplicates were removed, and inclusion and exclusion criteria were applied. Nine studies were selected for review, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The retrieved studies confirm the relationship between DM and PDs in regional studies. The review highlights the need for integrated healthcare approaches to manage both conditions effectively. Further research is recommended to understand the causal mechanisms and develop comprehensive treatment strategies.

Status of the oral environment in patients with digestive system tumors during the perioperative period

BACKGROUND

Surgery is an important treatment modality for patients with digestive system tumors, and perioperative management is crucial for the patients' recovery and quality of life. During the perioperative period, significant changes can occur in the oral environment of patients, such as dry mouth, mucosal ulceration, and oral infections. These issues not only cause discomfort to the patients but may also affect postoperative recovery and treatment outcomes. Therefore, it is essential to investigate and analyze the oral environment during the perioperative period in patients with digestive system tumors.

AIM

This study aims to investigate the oral health status in patients with digestive system tumors during the perioperative period and analyze the influencing factors.

METHODS

In this retrospective study, a total of 242 patients with digestive system tumors admitted to The Seventh Affiliated Hospital, Xinjiang Medical University from September 2021 to June 2023 were selected as the study population (patient group). During the same period, 245 healthy volunteers who received oral examinations were selected as the healthy group. The study compared the oral hygiene environment of the two groups, including the Dental Plaque Index (DI), Calculus Index (CI), and Periodontal Disease Index (PDI). Measurements were taken at admission (T0), 1 hour before surgery (T1), and 3 days after surgery (T2). Based on the PDI index, the patient group was divided into a periodontal disease group (PDI ≥ 3, n = 196) and a periodontal healthy group (PDI < 3, n = 46). The risk factors for the development of periodontal disease in digestive system tumor patients were analyzed, considering variables such as gender, age, BMI, smoking status, alcohol consumption frequency, monthly income, tumor type, oral self-care habits, low-grade inflammation, and nutritional status.

RESULTS

The DI, CI and PDI indexes in patient group were higher than those in healthy group (3.23±0.64 vs 1.46±0.43, 1.92±0.46 vs 1.21±0.41, 3.83±0.79 vs 2.65±0.69, all P < 0.05). DI index, CI index and PDI index at T1 and T2 were significantly lower than those at T0 (P < 0.05), and these indices at T2 were slightly higher than T1, but the difference was not statistically significant (all P > 0.05). Multivariate analyses identified high levels of high-sensitivity C-Reactive Protein [OR: 15.070 (1.611-140.951)], low levels of hemoglobin [OR: 0.239 (0.058-0.981)], and presence of dental caries [OR: 246.737 (1.160-52464.597)] as risk factors associated with periodontal disease in patients with digestive system tumors.

CONCLUSION

It is important to enhance the attention and management of the oral environment during the perioperative period for patients with digestive system tumors.

Quality and Success of Bone Graft from Two Different Mandibular Sites Compared for Maxillary Ridge Augmentation: A Systematic Review

AIM

This systematic review was undertaken to compare the quality of autogenous bone graft harvested from two different mandibular donor sites, that is, from the chin region and from posterior mandibular region for maxillary alveolar ridge augmentation and success after implant placement.

MATERIALS AND METHODS

Systematic searches were performed using PubMed, MEDLINE, and Cochrane electronic databases, which reported on the quality of autogenous harvested bone graft of the recipient site in maxillary alveolar ridge augmentation from a period of January 1995 to December 2020 using PRISMA guidelines. Studies were included if: They reported on bone grafts harvested from the chin and body region of the mandible. Time and nature of postoperative complications were reported. Quality comparison of autogenous bone graft from both chin and posterior mandible was done from the analysis of extracted data of all articles. The risk of bias was assessed by the Cochrane risk of bias tool and Newcastle-Ottawa Scale.

RESULTS

Out of the eight studies that have been included, five studies concluded that graft from the retromolar region of the mandible produced better quality bone graft compared with graft from the chin region. In contrast, two studies showed the opposite that graft from the chin is better in quality than the graft from the retromolar region. Whereas one study mentioned not being able to find any significant difference in the quality of two grafts. The implant placement also showed a maximum success rate in the retromolar region compared with the chin region in four studies whereas in one study, the success rate was better in the chin region and in three studies, no significant difference could be found in the success rate of implant placement in two different graft regions taken from two different donor sites of the mandible.

CONCLUSION

This systematic review demonstrates that the retromolar group has shown better results for ridge augmentation in the maxilla compared with the chin group. The retromolar group also produces better and more successful implant placement with fewer chances of failure compared with the chin group.

CLINICAL SIGNIFICANCE

In oral surgery, the use of dental implants for partial and complete edentulous jaw rehabilitation is standard procedure. Both hard and soft tissues must be present in adequate quantity and quality for implant dentistry to produce the best results. Patients with resorbed jaws can receive implant-supported restorations by a variety of reconstructive methods, such as tissue regeneration and the use of vascularized or nonvascularized grafts. How to cite this article: Mondal C, Mohanty R, Rana P, et al. Quality and Success of Bone Graft from Two Different Mandibular Sites Compared for Maxillary Ridge Augmentation: A Systematic Review. J Contemp Dent Pract 2024;25(7):703-710.

From Oral Health to Obstetric Outcomes: A Comprehensive Review of Periodontal Disease and Its Implications for Preeclampsia

Periodontal disease and preeclampsia (PE) are both significant health concerns with implications for maternal and fetal well-being. Emerging evidence suggests a potential association between these two conditions, prompting increased interest in understanding their relationship and clinical implications. This comprehensive review examines the current literature on periodontal disease and PE, focusing on epidemiological evidence, proposed mechanistic pathways, and clinical implications. Epidemiological studies consistently demonstrate an increased risk of PE among pregnant individuals with periodontal disease, independent of traditional risk factors. Proposed mechanisms linking periodontal disease to PE include systemic inflammation, endothelial dysfunction, and immune dysregulation. The implications for research include the need for well-designed prospective studies and randomized controlled trials to elucidate further the mechanisms underlying the association and evaluate the effectiveness of periodontal interventions in preventing PE. Clinicians should be aware of the potential link between periodontal disease and PE and consider screening pregnant individuals for periodontal disease as part of routine prenatal care. Interdisciplinary collaboration between obstetricians and periodontists may be beneficial in managing pregnant individuals with periodontal disease to mitigate the risk of PE. By addressing these research gaps, we can further understand the relationship between oral health and obstetric outcomes and develop evidence-based strategies to improve maternal and fetal health.

Periodontitis and the risk of oral cancer: a meta-analysis of case-control studies

OBJECTIVE

The current studies have yielded inconclusive findings regarding the connection between periodontitis  and oral cancer (OC). Therefore, our goal is to elucidate this relationship.

MATERIALS AND METHODS

We conducted a thorough search of electronic databases (EMBASE, PubMed, Web of Science, and Cochrane Library) up to September 2023. The Newcastle-Ottawa Scale (NOS) was applied to assess study quality. To evaluate potential publication bias, both a funnel plot and Egger's test were employed. Additionally, a sensitivity analysis was conducted to explore the source of heterogeneity when the I2 statistic exceeded 50%.

RESULTS

This systematic review encompassed 16 studies, involving a total of 6,032 OC patients and 7,432 healthy controls. Our meta-analysis, incorporating data from nine studies, revealed a significant correlation between periodontitis and the risk of OC (OR [odds ratio] = 2.94, 95% CI [confidence interval] (2.13, 4.07); five studies, 6,927 participants; low certainty of evidence). Findings also suggested that individuals with more than 15 missing teeth may have a heightened risk of OC (OR = 1.91, 95% CI (1.01, 3.62)). Furthermore, clinical attachment loss (CAL) and decayed, missing, and filled teeth (DMFT) in OC patients were more pronounced compared to the control group (CAL, SMD = 1.94, 95% CI (0.22, 3.66); DMFT, SMD = 0.65, 95% CI (0.12, 1.18)).

CONCLUSION

Periodontitis may serve as a potential risk factor for OC. However, caution is warranted in interpreting these findings due to the substantial level of heterogeneity.

Investigating the Connection between Chronic Periodontitis and Parkinson's Disease: Findings from a Korean National Cohort Study

Recent research suggests a potential relevance between chronic periodontitis (CP) and Parkinson's disease (PD), raising concerns about comorbid PD among elderly CP patients. However, the epidemiologic basis for this association remains unclear. Employing a nested case-control design, this study explored the association between CP and subsequent PD occurrences in Korean adults, leveraging a validated national population-based dataset covering the period from 2002 to 2019. It included 8794 PD patients and 35,176 matched control individuals, established through propensity score matching for age, sex, residential area, and income. Baseline characteristics were compared using standardized differences, and logistic regression was employed to assess the impact of CP histories on PD likelihood while controlling for covariates. We performed a thorough examination of CP events within both 1-year and 2-year intervals preceding the index date, incorporating subgroup analyses. Our analysis revealed no statistically significant association between CP history and PD development overall. However, subgroup analysis revealed a slightly increased likelihood of PD development among CP individuals with a high disease burden (Charlson Comorbidity Index score ≥ 2). In conclusion, although our study did not find a significant overall association between CP history and PD development, the elevated likelihood of PD in subgroups with high disease burden may suggest that comorbidities influence PD probability among certain CP patients. Considering comorbid conditions in PD screening for some individuals with CP may be also important.

Association of Urine (pH < 5.5) with Community Periodontal Index (CPI) and the Number of Remaining Teeth in Korean Adults: A Cross-Sectional Study Using Data from Korea National Health and Nutrition Examination Survey 2016-2018

This study aims to determine the association between UpH (<5.5), Community Periodontal Index (CPI), and the number of remaining teeth-cumulative indicators of oral health-using data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES, 2016-2018), which represents the Korean population. Data from 12,689 adults aged 19 years and older who had periodontal examinations were analyzed. Logistic regression analysis was performed after adjusting for demographic, health, and health-related behavioral factors as covariates to determine the association between UpH, CPI, and the number of remaining teeth. This study found that UpH (<5.5) was associated with CPI and the number of remaining teeth. For UpH (<5.5), the odds ratio for CPI (≥4 mm) was 1.19 times (95% CI: 1.06-1.33). The risk of tooth loss was 1.25 times (95% CI: 1.06-1.48) for those with 0-19 remaining teeth and 1.20 times (95% CI: 1.07-1.34) for those with 20-27 teeth. The results revealed an association between UpH, CPI, and the number of remaining teeth. However, further longitudinal research on UpH and oral status is necessary.

Synthesis of novel metal silica nanoparticles exhibiting antimicrobial potential and applications to combat periodontitis

Periodontitis is a severe form of gum disease caused by bacterial plaque that affects millions of people and has substantial worldwide health and economic implications. However, current clinical antiseptic and antimicrobial drug therapies are insufficient because they frequently have numerous side effects and contribute to widespread bacterial resistance. Recently, nanotechnology has shown promise in the synthesis of novel periodontal therapeutic materials. Nanoparticles are quickly replacing antibiotics in the treatment of bacterial infections, and their potential application in dentistry is immense. The alarming increases in antimicrobial resistance further emphasize the importance of exploring and utilizing nanotechnology in the fight against tooth diseases particularly periodontitis. We developed 16 different combinations of mesoporous silica nanomaterials in this study by ageing, drying, and calcining them with 11 different metals including silver, zinc, copper, gold, palladium, ruthenium, platinum, nickel, cerium, aluminium, and zirconium. The antibacterial properties of metal-doped silica were evaluated using four distinct susceptibility tests. The agar well diffusion antibacterial activity test, which measured the susceptibility of the microbes being tested, as well as the antibacterial efficacy of mesoporous silica with different silica/metal ratios, were among these studies. The growth kinetics experiment was used to investigate the efficacy of various metal-doped silica nanoparticles on microbial growth. To detect growth inhibitory effects, the colony-forming unit assay was used. Finally, MIC and MBC tests were performed to observe the inhibition of microbial biofilm formation. Our findings show that silver- and zinc-doped silica nanoparticles synthesized using the sol-gel method can be effective antimicrobial agents against periodontitis-causing microbes. This study represents the pioneering work reporting the antimicrobial properties of metal-loaded TUD-1 mesoporous silica, which could be useful in the fight against other infectious diseases too.

The associations between dental disease and systemic health

Understanding the relationship between a patient's systemic and oral health is key for clinicians. The aim of this study was to determine if there is an association between specific findings in a dental exam, such as class V carious lesions, and the American Society of Anesthesiologists (ASA) classification as a proxy for systemic health. A retrospective chart review was performed on all patient charts that met inclusion criteria including detailed, complete, and vetted charts obtained over a three-year period in the predoctoral clinic of a United States dental college. Findings recorded at the initial exam included the decayed, missing or filled teeth (DMFT) score, the location of carious lesions and restorations, the presence of periodontal disease, the number of endodontically treated teeth and the number of fractured teeth or restorations. We found no association found between DMFT score and ASA status but did find that ASA I patients had a higher degree of occlusal carious lesions and that ASA III patients were more likely to have interproximal restorations and fractured teeth. We found associations between a greater number of missing teeth and the presence of periodontal disease with worsening ASA status. Our data suggest that ASA classification cannot be used as a reliable predictor for the health of a patient's dentition or the number of cervical caries. However, the data does demonstrate a positive correlation between the number of missing teeth and ASA status, promoting the idea that the number of missing teeth is a crude prognosticator of systemic health. This information can be used by physicians and dentists to help understand the relationships between a patient's dental and systemic health.

Pericardial Effusion in Association With Periodontitis: Case Report and Review of 8 Patients in Literature

Periodontal diseases are well-known background for infective endocarditis. Here, we show that pericardial effusion or pericarditis might have origin also in periodontal diseases. An 86-year-old man with well-controlled hypertension and diabetes mellitus developed asymptomatic increase in pericardial effusion. Two weeks previously, he took oral new quinolone antibiotics for a week because he had painful periodontitis along a dental bridge in the mandibular teeth on the right side and presented cheek swelling. The sputum was positive for Streptococcus species. He was healthy and had a small volume of pericardial effusion for the previous 5 years after drug-eluting coronary stents were inserted at the left anterior descending branch 10 years previously. The differential diagnoses listed for pericardial effusion were infection including tuberculosis, autoimmune diseases, and metastatic malignancy. Thoracic to pelvic computed tomographic scan demonstrated no mass lesions, except for pericardial effusion and a small volume of pleural effusion on the left side. Fluorodeoxyglucose positron emission tomography disclosed many spotty uptakes in the pericardial effusion. The patient denied pericardiocentesis, based on his evaluation of the risk of the procedure. He was thus discharged in several days and followed at outpatient clinic. He underwent dental treatment and pericardial effusion resolved completely in a month. He was healthy in 6 years until the last follow-up at the age of 92 years. We also reviewed 8 patients with pericarditis in association with periodontal diseases in the literature to reveal that periodontal diseases would be the background for developing infective pericarditis and also mediastinitis on some occasions.

Factors Associated with Periodontitis in Younger Individuals: A Scoping Review

Periodontitis is a disease that affects many young adults, and if left untreated, it can have lasting and permanent effects on an individual's oral health. The purpose of this scoping review was to review the recent literature to identify factors that place young individuals at risk of stage II or III periodontitis. Using the PRISMA guidelines for scoping reviews, three databases were systematically searched for peer-reviewed human studies published in English that investigated risk factors associated with stage II and/or III periodontitis in individuals less than 40 years of age. This review excluded abstracts, literature reviews, including narrative, scoping, and systematic reviews and meta-analyses, conference proceedings, letters to the editor, and editorials. The authors then extracted data from the relevant studies using a predefined form to summarize the aims, design, results, risk factors examined, and the type and severity of periodontitis. Among a total of 2676 articles screened, only three articles met the review's inclusion criteria. Of these articles, one was a longitudinal case-control study and two were cross-sectional studies. Identified risk factors associated with stage II or III periodontitis included self-reported bleeding when brushing, low bone mineral density, being overweight, and smoking in young adults. Of note, only three studies met the inclusion criteria, suggesting a gap in the research literature.

Heavy metals in drinking water and periodontitis: evidence from the national oral health survey from China

BACKGROUND

Periodontitis has become an increasingly important public health issue, coupled with a high economic burden for prevention and treatment. Exposure to essential trace heavy metals has been associated with various diseases; however, the relationships between essential trace heavy metals and periodontitis remain inconclusive.

OBJECTIVES

To investigate the association between essential trace heavy metals in tap water and periodontitis in a nationally representative sample in China.

METHODS

We conducted a nationwide study including 1348 participants from the Fourth National Oral Health Survey in the 2015-2016 period. The trace heavy metals concentration was measured in the local pipeline terminal tap water. Periodontitis was diagnosed according to the classification scheme proposed at the 2018 world workshop on the classification of periodontal and peri-implant diseases and conditions. We used weighted multivariable logistic regression to estimate the association between essential trace heavy metals and the risk of periodontitis. We additionally used spline analysis to explore the possible nonlinear dose-response associations.

RESULTS

Periodontitis patients were exposed to higher concentrations of essential trace heavy metals. In adjusted models, for 1 SD increase in the concentration of iron, manganese, and copper in tap water, the risk of periodontitis increased by 30% (OR: 1.30, 95%CI: 1.12-1.50), 20% (OR: 1.20, 95%CI: 1.03-1.41), and 20% (OR: 1.20, 95%CI: 1.04-1.39), respectively. Stratified analyses demonstrated that the associations between essential trace heavy metals and periodontitis were higher in females, elders, and rural residents. Spline analysis revealed nonlinear exposure-response relationships between periodontitis and exposure to iron, manganese, and copper in tap water.

CONCLUSIONS

Exposures to essential trace heavy metals in drinking water were associated with greater odds of periodontitis. Given the growing burden of periodontitis, our study sheds light on tailored public health policies for improving drinking water standards to alleviate periodontitis impairment.

Effects of Periodontitis on Major Organ Systems

This review focuses on the fact that oral disorders are not merely localized to the mouth; in a broader sense, they also have a more significant impact on systemic health. In this review, we tried to bring to the notice various complications of periodontitis on the body's major organ systems. It has also been suggested that there is a potential connection between periodontitis and certain systemic disorders. Reviewing this fascinating topic is necessary. The objective is to create a thorough body of knowledge on the subject that is simple to access, alert medical professionals to the connection between dental health and systemic health, and highlight the necessity of a more thorough incorporation of medical and dental training. Periodontitis is a probable risk factor for various problems connected to the cardiovascular, pulmonary, endocrine, musculoskeletal, central nervous, and reproductive systems. It is a continual likely source of infection. Oral health affects overall health, and if extensive healthcare is ever accomplished, dental health should never be considered a distinct, remote, and lower significant part of health wholly disconnected from quality of life. One should never underestimate oral disorders as being acute and always curable. People should take utmost care and take the condition seriously to prevent significant complications.

Optimization of In Situ Gel-Forming Chlorhexidine-Encapsulated Polymeric Nanoparticles Using Design of Experiment for Periodontitis

Periodontitis is a chronic inflammatory disease of the gums caused by pathogenic microorganisms damaging and destroying periodontal tissues. Chlorhexidine digluconate (CHX) is a commonly used antimicrobial agent for the treatment of periodontitis. However, it has many drawbacks, such as toxicity due to the high dosage required, low prolonged release, and low adhesion in the periodontal pocket. The objective of this study was to develop and optimize CHX-encapsulated polymeric nanoparticles (NPs) loaded into in situ gel-forming (ISGF) using design of experiment (DoE) to improve the treatment of periodontitis and overcome these limitations. CHX-NPs were optimized from 0.046%w/v chitosan, 0.05%w/w gelatin, and 0.25%w/w CHX. After that, the optimized of CHX-NPs was loaded into a thermosensitive ISGF, which was a mixture of 15%w/v Poloxamer 407 and 1% hydroxypropyl methylcellulose (HPMC). The optimized CHX-NPs, loaded into ISGF, was evaluated by measuring gelling temperature and time, pH, viscosity, compatibility, in vitro drug release, antibacterial activity, cytotoxicity, and stability. The results showed that the size, PDI, and zeta potential of optimized CHX-NPs were 53.07±10.17 nm, 0.36±0.02, and 27.63±4.16 mV, respectively. Moreover, the optimized ISGF loading CHX-NPs showed a gelling temperature at 34.3±1.2°C within 120.00±17.32 s with a pH value of 4.06. The viscosity of the formulations at 4°C was 54.33±0.99 cP. The DSC and FTIR showed no interaction between ingredients. The optimal formulations showed a prolonged release of up to 7 days while providing potential antibacterial activity and were safe for normal gingival fibroblast cells. Moreover, the formulations had high stability at 4°C and 25°C for 3 months. In conclusion, the study achieved the successful development of ISGF loading CHX-NPs formulations for effectiveness use in periodontal treatment.

Estimation and Co-Relation of the Neutrophil Count and Neutrophil Chemotaxis in Patients With Gingivitis, Chronic Periodontitis, and Localized Aggressive Periodontitis Compared With Healthy Controls

INTRODUCTION

Neutrophils are the most plentiful WBCs found in human blood. They are the first cells to respond to wounds and foreign invaders in the human body. They help the body fight infections. The neutrophil count may be used to check for infections, inflammation, or any other underlying conditions. The lower the neutrophil count, the higher the infection risk. Chemotaxis is the ability of the body cells to move in a specific direction as a response to a chemical stimulus. Neutrophil chemotaxis, a feature of the innate immune response, is the directed migration of neutrophils from one site in the body to another to provide effector functions. The present study was aimed at estimating and co-relating the neutrophil count and neutrophil chemotaxis in patients who had gingivitis, chronic periodontitis, and localized aggressive periodontitis, and in healthy participants.

METHODS

Eighty participants (40 males and 40 females), aged 20-50 years, were included in the study and divided into four groups: Group I: control group with healthy periodontium; Group II: participants with gingivitis; Group III: participants with periodontitis; and Group IV: participants with localized aggressive periodontitis. Blood samples were collected for hematological analysis to evaluate the neutrophil counts and neutrophil chemotaxis.

RESULTS

The mean value of neutrophil count (%) was highest in Group IV (72.535) followed by Group III (71.29), Group II (62.13), and least in Group I (58.15). This difference is statistically significant (p < 0.001). On intergroup comparison, a statistically significant difference was noted between all the groups except between Group I and Group II, and between Group III and Group IV. The mean value of neutrophil count and neutrophil chemotaxis assay were found to be statistically significant in all four groups.

CONCLUSION

This study shows a positive correlation between neutrophils and periodontal diseases which could be beneficial for further studies.

A Systematic Review and Meta-Analysis on the Efficacy of Locally Delivered Adjunctive Curcumin (Curcuma longa L.) in the Treatment of Periodontitis

This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; p = 0.03; 95% CI -0.54 to -0.11; I2 = 62.3%), and for PPD (-0.47 mm; p = 0.024; 95% CI -0.88 to -0.06; I2 = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.

Salivary Biomarkers in Periodontitis Post Scaling and Root Planing

OBJECTIVES

This study was conducted to evaluate the levels of salivary uric acid and arginase in patients with periodontitis, generalized gingivitis, and in healthy individuals. Then, the effects of non-surgical periodontal therapy on levels of salivary arginase and uric acid were also investigated.

METHODS

A total of 60 subjects were divided into three groups based on periodontal health: group I comprised 20 healthy individuals; group II comprised 20 subjects who had generalized gingivitis; group III comprised 20 subjects who had generalized periodontitis. On day 0, the clinical examination of periodontal status was recorded, following which saliva samples were collected. Group II and group III subjects underwent non-surgical periodontal therapy. These patients were recalled on day 30 to collect saliva samples. The periodontal parameters were reassessed on day 90, and saliva samples were collected for analysis of salivary arginase and uric acid levels.

RESULTS

Group II and group III showed improvement in clinical parameters following non-surgical periodontal therapy on the 90th day. The MGI score, PPD, and CAL showed improvement. On day 0, at baseline, salivary arginase levels in group III and group II were higher than those in healthy subjects, whereas on day 0, salivary uric acid levels in group III and group II were lower than those in healthy subjects. Both on day 0 and day 90, the salivary arginase level showed a positive correlation with the periodontal parameters, whereas the salivary uric acid level was positively correlated with the periodontal parameters on day 90.

CONCLUSION

the level of salivary arginase was a pro-inflammatory marker and a raised level of salivary uric acid was an anti-inflammatory marker following periodontal therapy, suggesting their pivotal role in assessing periodontal status and evaluation of treatment outcome.

Association between periodontitis and COVID-19 severity in a tertiary hospital: A retrospective cohort study

Introduction

Periodontitis is a chronic inflammatory disease caused by biofilm accumulation resulting in loss of periodontal attachment which could be linked to systemic implications. Coronavirus disease of 2019 (COVID-19) is a disease caused by SARS-CoV-2 that triggers damage to the lungs and other organs. COVID-19 and periodontitis share similar risk factors such as smoking, obesity, old age, and diabetes mellitus. Studies noted that periodontitis along with some systemic diseases has increased mortality. Thus, this study aims to examine the association of periodontitis with COVID-19 outcomes.

Methods

This observational study included periodontitis group and non-periodontitis group for COVID-19 outcome assessment. Inclusion criteria were applied to select adults (≥18 years old) who showed at least one dental visit, and were isolated or admitted due to a COVID-19 complication (i.e. in-ward, ICU, or death). Exclusion criteria were patients with no active dental records. The periodontal status was examined from posterior bitewings and panoramic radiographs. The primary outcome assessed was COVID-19 complications versus no admission.

Results and discussion

This study was the first of its kind as a retrospective cohort study to assess the association between periodontitis and COVID-19 severity in Riyadh, Saudi Arabia. Our findings revealed that periodontitis is statistically associated with COVID-19 severity. Periodontitis patients were three times more likely to have COVID-19 complications (p = 0.025). Diabetes (p = 0.004) and hypertension (p = 0.016) patients were 3.5 times more likely to have COVID-19 complications.

Conclusion

Understanding the potential association between periodontitis and COVID-19 through systemic inflammation might be a pathway to achieve high quality medical care.

Inclusion of gerodontology in dental curriculum: An urgent case for India

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

Purification, crystallization and crystallographic analysis of the PorX response regulator associated with the type IX secretion system

Pathogenic bacteria utilize specialized macromolecular secretion systems to transport virulence factors across membrane(s) and manipulate their infected host. To date, 11 secretion systems have been identified, including the type IX secretion system (T9SS) associated with human, avian and farmed-fish diseases. As a bacterial secretion system, the T9SS also facilitates gliding motility and the degradation of different macromolecules by the secretion of metabolic enzymes in nonpathogenic bacteria. PorX is a highly conserved protein that regulates the transcription of essential T9SS components and additionally mediates the function of T9SS via direct interaction with PorL, the rotary motor protein of the T9SS. PorX is also a member of a two-component system regulatory cascade, where it serves as the response regulator that relays a signal transduced from a conserved sensor histidine kinase, PorY, to a designated sigma factor. Here, the recombinant expression and purification of PorX homologous proteins from the pathogenic bacterium Porphyromonas gingivalis and the nonpathogenic bacterium Flavobacterium johnsoniae are reported. A bioinformatical characterization of the different domains comprising the PorX protein is also provided, and the crystallization and X-ray analysis of PorX from F. johnsoniae are reported.

Risk of dementia according to the severity of chronic periodontitis in Korea: a nationwide retrospective cohort study

OBJECTIVES

We investigated the risk of dementia in older adults with chronic periodontitis according to the severity of periodontitis.

METHODS

Data on patients with chronic periodontitis were extracted from the National Health Insurance Service-Senior cohort database from 2002 to 2014. Among 52,728 subjects eligible for inclusion, 11,953 subjects had newly diagnosed mild chronic periodontitis (MCP), and 40,775 subjects had newly diagnosed severe chronic periodontitis (SCP). Two 1:1 propensity score matched cohorts were created with 8,624 patients each in the MCP and SCP groups. To analyze the risk of dementia, a Cox proportional-hazard model was used to calculate hazard ratios with 95% confidence intervals (CIs).

RESULTS

In the Kaplan-Meier curve, the disease-free probability was significantly lower in the SCP group than in the MCP group (p for log-rank=0.001). In the multivariable-adjusted model, the HR for the occurrence of dementia in the SCP group compared to the MCP group was 1.15 (95% CI, 1.04 to 1.27; p=0.009). A subgroup analysis revealed a significant association between dementia and the severity of periodontitis, especially in subjects who were male, aged ≥70 years, and had comorbidities.

CONCLUSIONS

Reducing the severity of chronic periodontitis can help to reduce the risk of dementia. Therefore, it is necessary to aggressively conduct early dementia-prevention programs for males under the age of 70 that include dental health to prevent the progression of periodontitis from mild to severe.

Periodontal Disease in Patients with Psoriasis: A Systematic Review

Psoriasis is a chronic, inflammatory, and recurrent skin disease. As with periodontitis, the development and progression of lesions depend on immunological, genetic, and environmental factors. This systematic review was designed to answer the question: "Is there a relationship between psoriasis and periodontal disease?". Following the inclusion and exclusion criteria, sixteen studies were included in this systematic review (according to PRISMA statement guidelines). Based on the meta-analysis, psoriasis patients showed a more than two-fold increase in the odds of periodontal disease. Almost one-third of these patients suffered from periodontitis of varying severity. Despite the heterogeneity of the included studies, psoriasis is associated with a higher risk of periodontitis, and especially with advanced progression.

A retrospective study comparing oral health in cancer patients and healthy people

The purpose of this study was to investigate the relationship between oral and dental health in cancer patients and control group, which was conducted in Tabriz Shahid Gazi hospital. A researchers-made and validated questionnaire including oral and dental health criteria, was filled by the cancer patients (201 cases) and healthy controls (199 cases). Then, the results of the study were analyzed by SPSS software, and reported as Odds ratios (95 % confidence intervals) in tow groups. The results indicate that comparison of filled tooth, tooth extraction, dental caries, and gingival problems including bleeding, gum surgery and inflammation in cancer and controls were significantly meaningful. However, the comparison between the two groups was not significant in terms of the type of the tooth (natural or denture) and the number of daily toothbrushes, but they were considered as risk factors due to statistical results. Environmental factors, and especially oral hygiene, can play an important role in the incidence of different cancers. Among these, the type of oral microorganisms, and their overgrowth and released antigens should be studied further in the emergence of different kinds of cancer in humans.

The Role of Epigenetic and Biological Biomarkers in the Diagnosis of Periodontal Disease: A Systematic Review Approach

The aim of this systemic review was to collate and analyze existing data from published literature sources to identify the current understanding of the role of epigenetic and biological biomarkers in periodontal disease and diagnostics. A comprehensive searching strategy was undertaken in Embase, Medline, The Dentistry and Oral Sciences and CINAHL databases. Grey literature searching strategies were also employed. Articles published in the English language between 2017−2020 were included. A total of 1014 studies were returned of which 15 studies were included. All included articles were cross-sectional, case−control studies. Relevant data were extracted according to various demographic and methodological factors including cohort size, oral biofluid sampled, number of examiners, smoking status and reported outcomes. A measure of the biomarker levels and corresponding significance were documented where possible. This review identified that exRNA has the greatest diagnostic potential, with four biomarkers (SPRR1A, lnc-TET3-2:1, FAM25A, CRCT1) displaying sensitivity of >71% and specificity of 100% in the assessed samples (p < 0.001) for gingivitis. This work also identifies the need for a unified approach to future research to draw meaningful comparison. Further investigations are warranted to definitively validate exRNA data and for the development of an exRNA-specific point-of-care diagnostic test.

Longitudinal follow-up study of the association between statin use and chronic periodontitis using national health screening cohort of Korean population

Since a potential link between statins and the risk of adverse chronic periodontitis (CP) has been raised, we aimed to validate the association between statin use and the incidence of CP using nationwide cohort data. This longitudinal follow-up study included 169,381 patients prescribed statins who were matched with an equal number of controls using propensity scores from the Korean National Health Insurance Service-Health Screening Cohort database (2002–2015). A Cox proportional hazard model was used to assess the occurrence of CP following statin use after adjusting for multiple covariates. The occurrence of CP was significantly higher in patients who had long-term use (1–3 years, 3–5 years, or > 5 years) than with short-term use (≤ 1 year) of statins. After adjustment, statin users exhibited an occurrence of CP 1.32-fold higher (95% confidence interval 1.30–1.33) than that of the matched nonusers (incidence: 25.0 and 22.0 per 100 person-years, respectively). Subgroup analyses supported the adverse impact of statins on CP independent of age and gender. Statin user odds ratios for developing CP were higher compared to those of nonusers. This was consistent in individuals aged > 40 years in both genders, especially with long-term use.

Evaluation of the association between periodontitis and risk of Parkinson's disease: a nationwide retrospective cohort study

The objective of this study was to examine the association between periodontitis and risk of incident Parkinson's disease using large-scale cohort data on the entire population of South Korea. Health checkup data from 6,856,180 participants aged 40 and older were provided by the National Health Insurance Service of South Korea between January 1, 2009, and December 31, 2009, and the data were followed until December 31, 2017. The hazard ratio (HR) of Parkinson's disease and 95% confidence interval (CI) were estimated using a Cox proportional hazards model adjusted for potential confounders. The incidence probability of Parkinson's disease was positively correlated with the presence of periodontitis. The HR of Parkinson's disease for the participants without the need of further dentist visits was 0.96 (95% CI 0.921-1.002); the HR of Parkinson's disease increased to 1.142 (95% CI 1.094-1.193) for the individuals who needed further dentist visits. Compared to individuals without periodontitis and without metabolic syndrome, the HR of incident Parkinson's disease gradually increased for individuals with periodontitis, with metabolic syndrome, and with both periodontitis and metabolic syndrome. People with periodontitis and metabolic syndrome had the highest HR of incident Parkinson's disease, at 1.167 (95% CI 1.118-1.219). In conclusion, a weak association between periodontitis and Parkinson's disease was suggested after adjusting for confounding factors from the population-based large-scale cohort of the entire South Korean population.

Periodontal diseases and its association with disease activity in ankylosing spondylitis/SpA: A systematic review

A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of the soft and hard connective tissue. There is evidence of increased levels of tumor necrosis factor-alpha and various interleukins in both patients of AS and periodontitis. This study aimed to conduct a systematic review exploring the relationship between AS and PD. We searched MEDLINE - Embase databases (from their inception till October 2019) using appropriate combinations of the following search items with limits '(English, Human)': Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, rheumatic disease and periodontitis, PD, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL). This search was supplemented by the manual search of bibliographies of the selected articles and conference proceedings of the European League against Rheumatism. Only the reviews and observational studies of cross-sectional, cohort, or case-control type on adult patients with AS were selected. Data were extracted from a predesigned PROforma. A total of 984 articles were identified, and 12 were selected for a detailed appraisal. All the identified studies were of the case-control type. The prevalence of periodontitis ranged from 38% to 88% in patients with AS and 26% to 71% in the control group. Of the 12 studies, 2 showed significant changes in PI, 2 showed altered PPD, 3 showed significantly increased CAL, and 2 showed increased BOP. In 7 studies, periodontitis was seen in a significant number of patients with AS (p<0.05). All the studies reported that the prevalence of PD in patients with AS was higher than that in patients without AS. Our systematic review found an association between AS and PD. Patients with AS show a higher prevalence of periodontitis and poor oral hygiene than the healthy controls.

Effectiveness of Antimicrobial Photodynamic Therapy in the Treatment of Periodontitis: A Systematic Review and Meta-Analysis of In Vivo Human Randomized Controlled Clinical Trials

This systematic review and meta-analysis evaluated antimicrobial photodynamic therapy (aPDT) efficacy in periodontitis. The review protocol was conducted in accordance with PRISMA statements, Cochrane Collaboration recommendations and is registered in PROSPERO (CRD 42020161516). Electronic and hand search strategies were undertaken to gather data on in vivo human RCTs followed by qualitative analysis. Differences in probing pocket depth (PPD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in random effects model at three and six months. Heterogeneity was analyzed, using Q and I² tests. Publication bias was assessed by visual examination of the funnel plot symmetry. Sixty percent of 31 eligible studies showed a high risk of bias. Meta-analysis on 18 studies showed no additional benefit in split mouth studies in terms of PPD reduction (SMD 0.166; 95% CI −0.278 to 0.611; P = 0.463) and CAL gain (SMD 0.092; 95% CI −0.013 to 0.198; P = 0.088). Similar findings noted for parallel group studies; PPD reduction (SMD 0.076; 95% CI −0.420 to 0.573; P = 0.763) and CAL gain (SMD 0.056; 95% CI −0.408 to 0.552; P = 0.745). Sensitivity analysis minimized heterogeneity for both outcome variables; however, intergroup differences were not statistically significant. Future research should aim for well-designed RCTs in order to determine the effectiveness of aPDT.

Gemella haemolysans inhibits the growth of the periodontal pathogen Porphyromonas gingivalis

The oral microbiome plays an important role in the human microbial community and in maintaining the health of an individual. Imbalances in the oral microbiome may contribute to oral and systemic diseases. The progression of periodontal disease is closely related to the growth of bacteria, such as Porphyromonas gingivalis, in the oral cavity. However, the pathogen growth mechanism specific to periodontal disease remains unknown. This study aimed to identify bacteria associated with periodontal health by focusing on hemolytic bacteria. Unstimulated saliva samples were collected from ten periodontitis patients and five healthy subjects to detect and identify the presence of hemolytic bacteria. The saliva of healthy subjects contained a higher proportion of G. haemolysans than saliva samples from patients with periodontitis. Growth inhibition assays indicated that the protein components contained in the culture supernatant of G. haemolysans directly suppressed the growth of P. gingivalis. This study shows that the presence of G. haemolysans in saliva is associated with periodontal health and that it inhibits the growth of P. gingivalis in vitro.

Responses of canine periodontal ligament cells to bubaline blood derived platelet rich fibrin in vitro

Platelet-rich fibrin (PRF) promotes wound healing by providing the release of growth factors. Here, the influence of Thai and Murrah bubaline blood derived PRF on canine periodontal ligament cells (cPDLs) was investigated. PRF was prepared from Thai and Murrah buffaloes with single centrifugation. Results demonstrated that Thai bubaline blood derived PRF exhibited fiber-mesh like morphology and contained more platelet entrapment than Murrah bubaline blood derived PRF. Both bubaline PRFs were able to degrade in vitro under condition with trypsin. Thai but not Murrah bubaline blood derived PRF promoted cPDLs proliferation in serum free and 2% serum culture conditions. Correspondingly, the significant upregulation of KI67 mRNA expression was observed in those cells treated with Thai bubaline blood derived PRF. However, both Thai and Murrah bubaline blood derived PRF accelerated cell migration in an in vitro wound healing assay and facilitated cell spreading. Further, cPDLs cultured in osteogenic induction medium supplemented with Thai bubaline blood derived PRF exhibited the increased mineral deposition in vitro. Frozen Thai bubaline blood derived PRF also promoted cell proliferation, KI67 mRNA expression, cell migration, and cell spreading in cPDLs. Taken these evidence together, bubaline blood derived PRF could provide potential benefits for canine periodontal tissue healing.

Is antimicrobial photodynamic therapy an effective treatment modality for aggressive periodontitis? A systematic review of in vivo human randomized controlled clinical trials

BACKGROUND

Limitations of scaling and root planing (SRP) have directed research to utilize additional therapies to enhance conventional techniques. The present systematic review was conducted to evaluate and present a comprehensive overview on effectiveness of antimicrobial photodynamic therapy (aPDT) in the management of aggressive periodontitis (AgP).

METHODOLOGY

The PRISMA statement guidelines and Cochrane Collaboration recommendations were followed to conduct this systematic review. The review protocol is registered in PROSPERO (CRD 42019143316). A structured electronic and manual search strategy was implied to gather the relevant published data on in vivo human RCTs from their earliest records until 31st October 2019. Relevant data was extracted from the eligible studies, analysed and impartially appraised for its quality.

RESULTS

Eleven papers met the eligibility criteria and included in this review. The data on standardized study protocol, ideal photosensitizer (PS) dye-wavelength combination, optimal parameters was inconclusive and a high risk of bias in majority of the studies noted, which are fundamental in establishing a standardized and replicable protocol.

CONCLUSION

Ultimately researchers should conduct well-designed and robust RCTs performed by trained clinicians in order to determine the effectiveness of aPDT, if any, after acknowledging the drawbacks highlighted in this systematic review.

The Influence of Diet on Oxidative Stress and Inflammation Induced by Bacterial Biofilms in the Human Oral Cavity

The article is a concise compendium of knowledge on the etiology of pathogenic microorganisms of all complexes causing oral diseases. The influence of particular components of the diet and the role of oxidative stress in periodontal diseases were described. The study investigated the bacteriostatic effect of the diet of adults in in vivo and in vitro tests on the formation of bacterial biofilms living in the subgingival plaque, causing diseases called periodontitis. If left untreated, periodontitis can damage the gums and alveolar bones. Anaerobic bacteria, called periopathogens or periodontopathogens, play a key role in the etiopathogenesis of periodontitis. The most important periopathogens of the oral microbiota are bacteria of all complexes, including the red complex. The obtained results suggest the possibility of using a specific diet in the prevention and treatment of periodontal diseases-already treated as a disease of civilization. The quoted article is an innovative compilation of knowledge on this subject and it can be a valuable source of knowledge for professional hygienists, dentists, peridontologists, dentistry students and anyone who cares about proper oral hygiene. The obtained results suggest the possibility of using this type of diet in the prophylaxis of the oral cavity in order to avoid periodontitis.

Quantitative Detection of Periodontopathogenic Bacteria in Atherosclerotic Plaques from Coronary Arteries by Real-Time PCR

Objectives:

Epidemiologic studies have suggested periodontitis as a risk factor for Coronary Artery Diseas (CAD). Detection of periopathogens in atheromatous plaque provides some evidence for the causal relationship between these two conditions. The aim of this study was to determine the presence and quantity of periopathogens in coronary atherosclerotic plaques in patients undergoing Coronary Artery Bypass Graft (CABG) surgery.

Methods:

20 patients who were candidates for endarterectomy were enrolled in this study for the periodontal examination. Subgingival and coronary atherosclerotic plaque samples were then collected. Thereafter, quantitative detection of Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivali (P.g), and all bacteria detected by Real-Time PCR (RT-PCR) were measured. The correlation analysis was also used to evaluate the relationship between quantities of periopathogens in atherosclerotic and subgingival plaque samples.

Results:

A.a was detected in 13 patients (65%) with subgingival plaques and 4 patients (20%) with atherosclerotic plaques. In addition, P.g was found in 15 patients (75%) with subgingival and 10 patients (50%) with atherosclerotic plaques. A.a represented means of 2.7% and 10.04% of detected bacteria in both atherosclerotic and subgingival plaque samples, respectively. The mean of quantity of P.g was 10.85% and 12.87% of the detected bacteria obtained from atherosclerotic and subginigival samples, respectively. Correlation analysis showed a significant correlation between the quantities of A.a in the atherosclerotic and subgingival plaques, but such a significant relationship was not found for P.g.

Conclusion:

This study confirmed the detection of A.a and P.g in atheromatous plaque. The quantitative data suggested that periopathogens comprise a significant proportion of atherosclerotic plaque microbiome, which may consequently contribute to the development of CAD.