Oral manifestations in hypertensive patients: A clinical study

Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM)

OBJECTIVE

The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions.

METHOD

One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM.

RESULTS

The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10.

CONCLUSION

Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.

Oral Findings in Hemodialyzed Patients Diagnosed with Diabetes Mellitus and/or Hypertension-A Systematic Review

Chronic kidney disease is classified as a civilization disease and is being diagnosed in an increasing number of patients. Hypertension and diabetes mellitus often coexist in hemodialyzed patients. The aim of the present study was to identify publications on the oral cavity status of multimorbid hemodialyzed adult patients additionally diagnosed with hypertension and/or diabetes mellitus, published between 2012 and 2022 to establish evidence of the impact of hypertension and diabetes mellitus on the oral status of hemodialyzed patients. Scopus and Web of Science databases were searched. Eight articles were included in the review. In total, 3 articles discussed oral hygiene in hemodialyzed patients, 4 discussed periodontal status, 3 discussed mucosa condition and saliva parameters, and 3 discussed the problem of Candidiasis infections. The conclusions were as follows: there is still a limited number of publications discussing the oral status of hemodialyzed patients diagnosed with hypertension; involved articles have proven that coexisting diseases can influence the oral cavity status of hemodialyzed patients and cause periodontal disorders, lower hygiene status, saliva parameters and make the risk of Candida infections higher.

The Relationship between Oral Health-Related Quality of Life and Body Mass Index in an Older Population from Southern Italy: The Salus in Apulia Study

BACKGROUND

The assessment of oral health-related quality of life (OHRQoL) evaluated the impact of an individual's oral health on the patient's physical and psychosocial status. We evaluated the association between subjective OHRQoL, measured with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and unfavorable body mass index (BMI) (i.e., too high or too low) in a large population-based study on older adults from Southern Italy. Moreover, we assessed which of the seven OHIP-14 domains was the most strongly associated with an unfavorable BMI.

METHODS

We used data on a subpopulation of the Salus in Apulia Study, including 216 older adults. BMI < 18.4 kg/m2 and >30 kg/m2 were classified as unfavorable, while values between 18.5 and 30 kg/m2 were classified as ideal.

RESULTS

A higher OHIP-14 total score increased the risk of an unfavorable BMI (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.15). In the model adjusted for age, sex, education, hypertension, carbohydrate consumption, and alcohol consumption, this finding was confirmed with a higher OHIP-14 total score increasing the risk of an unfavorable BMI (OR: 1.10, 95% CI: 1.01-1.22), and higher age linked to a decreased risk of an unfavorable BMI (OR: 0.89, 95% CI: 0.82-0.97). In a random forest regression model, the most important predictive domains/sub-scales of OHIP-14 in the mean decrease in the Gini coefficient for unfavorable BMI were, in order of decreasing importance, physical pain, functional limitation, psychological discomfort, physical disability, social disability, psychological disability, and handicap.

CONCLUSIONS

In older age, negative OHRQoL, particularly linked to the physical pain domain, increased the risk of being underweight or overweight and obesity.

Relationship of obstructive sleep apnea with periodontal condition and its local and systemic risk factors

OBJECTIVE

Obstructive sleep apnea (OSA) and periodontitis share risk factors, such as age, obesity, stress, and cardiovascular events, which have a bidirectional cause-effect relationship through systemic inflammation. Our objective was to determine the relationship between OSA and the periodontal condition and its associated local and systemic risk factors.

MATERIAL AND METHODS

This was an observational case-control study involving 60 patients. Local oral risk factors and the systemic condition of each patient were evaluated. All patients underwent polysomnography for the diagnosis of OSA. Chi-squared, one-way ANOVA, and Bonferroni's tests were performed.

RESULTS

A higher percentage of patients with periodontitis had severe OSA (66.66%); however, no statistically significant association was found between the two pathologies (p = 0.290). In terms of systemic risk factors, an association was found between arterial hypertension and severe OSA (p = 0.038), and in terms of local factors, an association was found between the use of removable prostheses and severe OSA (p = 0.0273).

CONCLUSION

In the general population, patients with periodontitis showed a higher prevalence of severe OSA. Obesity and hypothyroidism were the most prevalent systemic findings in patients with OSA and periodontitis. Arterial hypertension and osteoarthritis were found to be associated with severe OSA. The local risk factors associated with periodontitis and severe OSA were removable partial dentures and misfit resins.

CLINICAL RELEVANCE

To study the factors that can facilitate the progression of OSA and periodontitis, physicians and dentists should be advised to provide comprehensive care for patients with both pathologies.

Risk factors associated with xerostomia and reduced salivary flow in hypertensive patients

OBJECTIVE

The aim of this study was to evaluate the risk factors associated with xerostomia and hyposalivation in a group of hypertensive patients.

SUBJECTS AND METHODS

A cross-sectional study was conducted. Hypertensive patients belonged to two healthcare centers were included. Xerostomia was assessed by asking a question and using the Xerostomia Inventory. Unstimulated salivary flow was collected. Different epidemiological variables were analyzed such as age, sex, habits, diseases, drugs, and blood pressure.

RESULTS

221 individuals were included. Xerostomia was reported in 51.13% of patients. Patients with xerostomia suffered more from osteoarthritis and diaphragmatic hernia. These patients took more anticoagulants (acenocoumarol), antiarrhythmics (amiodarone), analgesics (paracetamol) and epilepsy drugs (pregabalin) and less platelet aggregation inhibitors and angiotensin II receptor blockers (losartan). Unstimulated flow was reduced in 37.56% of patients. Patients suffering hyposalivation presented more diseases such as anxiety, infectious or parasitic diseases, hepatitis C, diaphragmatic hernia, and osteoarthritis. These patients took more repaglinide, thiazides, anti-inflammatories, anti-rheumatics, glucosamine, diazepam, and selective beta-2-adrenoreceptor agonists and less combinations of candesartan and diuretics.

CONCLUSIONS

Xerostomia and hyposalivation are frequent in hypertensive patients. It is advisable to take into consideration the comorbidities and the drugs they receive, since they can increase the risk of these salivary disorders.

Awareness and knowledge of oral manifestations in cardiovascular diseases among the general public

Cardiovascular diseases (CVDs) are disorders affecting the heart and blood vessels. Periodontal problems, bleeding gums, dry mouth, and gingival hyperplasia are common oral manifestations seen in cardiovascular-related problems. To assess the extent of awareness and knowledge, the general public has toward the oral manifestation related to that of CVDs. A questionnaire was distributed among the general public in relation to that of the extent of awareness and knowledge of oral manifestations with regard to CVD. A total of 161 responses were collected from the survey. The collected data were compiled and analyzed by the SPSS software; the Pearson Chi-square test was done where P < 0.05 was considered statistically significant. The study showed that 65.22% of the population is aware of the types of CVD. About 59.63% of the population do not know that periodontal problems lead to cardiovascular problems. About 39.75% have vague knowledge about the maintenance of poor oral health causing cardiovascular problems. The study concluded that the general public is not much aware of the oral manifestations related to that of CVDs.

Association between antihypertensive drugs and the elderly's oral health- related quality of life: Results of Amirkola cohort study

Background:

Prerequisite for achieving the goals of the registration program is the existence of valid and accurate data, and the usability of this data is possible if they are coded correctly. This study assets the quality of pathological data of the population-based cancer registration centers based on ICD-O-3.

Methods:

This applied study was performed descriptively and retrospectively. The study population included 20129 pathology reports sent to the population-based cancer registration center of Mazandaran Province during 2018-2020. A total of 2015 out of, 2050 samples of the received reports were examined according to stratified random sampling method. A researcher checklist was made to collect the data, and STATA 13 and Cohen's Kappa agreement coefficient were used to analyze the data.

Results:

Among the 2015 reports of pathology, 1114 (55.3%) pathology reports were related to government centers, (42.9%) 865 cases were registered with their topographic code, morphology and behavior. Based on the registration of the exact topographic code, the kappa coefficient and the total agreement were 0.266 and 27.70%, respectively. Kappa coefficient in all received reports and reports with topographic code was 0.346 and 0.906, respectively. In the reports with topographic code, the most reports of cancers were related to cancers of the gastrointestinal organs (97.6%) 246.

Conclusion:

The accuracy of the codes given in the pathology centers in terms of topographic, morphological, behavioral and grade codes based on the percentage of agreement with the coding was above average, which were higher in governmental centers and also in some cancers.

Risk Factors of Oropharyngeal Candidiasis in COVID-19 Patients: A Case-control Study

Background: With the emergence and spread of coronavirus disease 2019 (COVID-19) globally, health care systems have faced the biggest challenge in recent decades. Objectives: The present study aimed to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients. Methods: The total number of confirmed COVID-19 patients was 218 (105 cases with OPC and 113 controls without OPC). The questionnaire used in this study consisted of demographic data, treatment strategy, clinical and laboratory data, and underlying diseases collected from the onset of clinical OPC until the end of hospitalization. Results: Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of the cases (58.1%) and controls (58.4%) were males. Increasing age (P = 0.03) and hospitalization length (P = 0.016) were significantly associated with OPC in COVID-19 patients. Diabetes (P = 0.003), solid tumor (P = 0.019), and hypertension (P = 0.000) were the most common underlying conditions. The use of dentures (P = 0.003) and poor oral hygiene (P = 0.000) were related to OPC in the case group. Therapy with chloroquine (P = 0.012), IVIG (P = 0.001), diuretics (P = 0.000), and corticosteroid pulse therapy (P = 0.000) were significantly associated with developing OPC in case patients. Conclusions: Old age, hospitalization length, poor oral hygiene, corticosteroids use, diabetes, solid tumor, and hypertension may predispose COVID-19 patients to develop OPC.

The Evaluation of Medical Conditions in Patients Admitted to the Oral Diagnosis Clinic

Background/Aim: The aim of this study is to set forth the current systemic diseases of the patients admitted to the oral diagnosis clinic of the Faculty of Dentistry Sütçü İmam University, and the prevalence of these diseases.

Material and Methods: This study will be conducted by retrospective evaluation of anamneses in the tooth information management system of patients admitted to the oral diagnosis clinic of the Faculty of Dentistry, Sütçü İmam University for dental treatment. The anamneses taken from the patients before their treatments will be obtained from digital medium.

Results: Out of 4077 patients included in the study, 2554 were female, and 1523 were male. Of them, 25.6% had systemic diseases. The mean age of the patients was 35.24%+12.3. It was found that cardiovascular diseases were more common than the other systemic diseases. The most common cardiovascular disease was found to be hypertension (7.5%), while the most common endocrine system disease was diabetes mellitus (7.5%).

Conclusions: Dental practitioners must keep themselves up-to-date as they encounter patients with systemic diseases. They must pay attention while taking anamneses from patients. Therefore, they may apply medical consultation to prevent probable complications when necessary.

The oral health status, behaviours and knowledge of patients with cardiovascular disease in Sydney Australia: a cross-sectional survey

BACKGROUND

Periodontal disease is a risk factor for atherosclerotic cardiovascular disease and it is recommended internationally that patients with cardiovascular disease should engage in preventative oral health practices and attend regular dental care visits. This study aimed to explore the oral health status, behaviours and knowledge of patients with cardiovascular disease.

METHODS

A cross-sectional questionnaire containing 31 items was administered to patients with cardiovascular disease from cardiac rehabilitation and outpatient clinics in Sydney Australia in 2016-2017.

RESULTS

Of the 318 patients surveyed, 81.1% reported having at least one oral health problem. Over a third (41.2%) of participants had not seen a dentist in the preceding 12 months and 10.7% had received any oral healthcare information in the cardiac setting. Those with valvular conditions were more likely to have received information compared to those with other cardiovascular conditions (40.6% versus 7.4%, p < 0.001). Only half of the participants had adequate oral health knowledge.

CONCLUSIONS

Despite a high incidence of reported oral health problems, many patients lacked knowledge about oral health, were not receiving oral health information from cardiac care providers and had difficulty accessing dental services. Further research is needed to develop oral health strategies in this area.

Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college - A cross sectional study

To assess the oral findings of patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to outpatient department of a dental college. Methods: Patients coming to dental Out Patient Department (OPD) were screened using STOP questionnaire and were categorized into high (n=130) and no risk (n=130) OSA groups. BANG (body mass index, age, neck circumference and gender) was recorded for both the OSA risk group patients. Following this oral and general examination was performed using predetermined criteria for temporomandibular disorder (TMD), Angle’s Class of Malocclusion, maxillary arch constriction, facial profile, Mallampati score for uvula, tongue size, depth of palatal vault and periodontitis. Chi-squared statistics was applied to know the significant difference among the two groups. Multivariate logistic regression model was run by including the significant variables. Results: 94 females and 166 males were present in the study with a mean age of 43.67±11.89 in both the risk groups. All the variables except Angle’s class of malocclusion and periodontitis showed significant difference among high and no risk OSA groups. Logistic regression confirmed that neck circumference, Class 3 or 4 Mallampati score, large tongue and deep palatal vault were commonly observed among high risk OSA group and were independent risk factors for developing high risk of OSA. Conclusion: Neck circumference>40cm, large tongue, Class 3 or 4 Mallampati score and deep palatal vault were found to be independent predictors of developing high risk of OSA. Dentist can play a vital role in screening such patients as he comes in close vicinity of oral cavity and thus can refer the patients to sleep physician to promote interdisciplinary approach.

An epidemiological survey in hospital setup in Lucknow district: A cross-sectional study

Introduction:

Oral cancer is the sixth most common form of cancer reported globally which includes lip, tongue, mouth, and throat. Developing countries face several challenges to identify and remove potential risk factors. Chewing tobacco/pan masala is considered to be the most potential risk factor for oral precancerous lesions and oral cancer.

Objective:

To study the clinical-epidemiological profile of oral cancer cases and potential risk factor associated with it.

Materials and Methods:

This is cross-sectional study which includes all major tertiary hospital in Lucknow district. Five hundred and eight cases of oral cancer reported in all major tertiary hospitals in Lucknow district during 2013–2016.

Study Variable:

Clinicoepidemiological characteristics of oral cancer cases.

Statistical Analysis:

percentages, proportions.

Results:

Out of 508 cases, majority of the subjects included in the study belonged to 18–75 years age group. Reported cases of oral cancer in males were higher as compared to females. Most of the subjects belonged to lower middle and upper lower socioeconomic group. It was found that 199 (39.2%) subjects consumed smokeless tobacco. Buccal mucosa was the common site of oral cancer being present in 50.4% of the subjects. Histopathologically, 256 cases of buccal mucosa, 17 cases of lip, 33 cases of alveolar region, 16 cases of mandible region, 156 cases of tongue region, 7 cases of gingival buccal sulcus region, and 23 cases of palate were diagnosed as oral squamous cell carcinoma.

Conclusion:

In the present study, the most affected site was buccal mucosa (50.4%), tongue (30.7%), and other diagnosis was <10%.

STRUCTURAL CHARACTERISTICS AND ANTIHYPERTENSIVE EFFECTS OF ANGIOTENSIN-I-CONVERTING ENZYME INHIBITORY PEPTIDES IN THE RENIN-ANGIOTENSIN AND KALLIKREIN KININ SYSTEMS

BACKGROUND

The commercially available synthetic angiotensin-I-converting enzyme (ACE) inhibitors are known to exert negative side effects which have driven many research groups globally to discover the novel ACE inhibitors.

METHOD

Literature search was performed within the PubMed, ScienceDirect.com and Google Scholar.

RESULTS

The presence of proline at the C-terminal tripeptide of ACE inhibitor can competitively inhibit the ACE activity. The effects of other amino acids are less studied leading to difficulties in predicting potent peptide sequences. The broad specificity of the enzyme may be due to the dual active sites observed on the somatic ACE. The inhibitors may not necessarily competitively inhibit the enzyme which explains why some reported inhibitors do not have the common ACE inhibitor characteristics. Finally, the in vivo assay has to be carried out before the peptides as the antihypertensive agents can be claimed. The peptides must be absorbed into circulation without being degraded, which will affect their bioavailability and potency. Thus, peptides with strong in vitro IC50 values do not necessarily have the same effect in vivo and vice versa.

CONCLUSION

The relationship between peptide amino acid sequence and inhibitory activity, in vivo studies of the active peptides and bioavailability must be studied before the peptides as antihypertensive agents can be claimed.

Madagascine Induces Vasodilatation via Activation of AMPK

Madagascine (3-isopentenyloxyemodin) can be chemically synthesized or purified from several Rhamnus species, and it is found to have more potent biological activities than the parent compound emodin. The aim of this study is to characterize the vasodilatory effect of madagascine on vasoconstriction and sphingosylphosphorylcholine induced vasospasm in ex vivo and reveal the potential mechanisms in vitro. The effects of madagascine on vasoconstriction of rat mesenteric resistance arteries (MRAs) induced by K⁺, methoxamine, and endothelin-1 were, respectively, studied. The cholesterol-enriched porcine coronary vascular smooth muscle (VSM) strips were used to investigate the effects of madagascine on abnormal constriction induced by sphingosylphosphorylcholine (SPC) which has a pivotal role in vasospasm. The vasodilatory effect was induced by madagascine (0.3-100 μM) in isolated rat MRAs and the vasodilatory effect was blocked by NO synthase inhibitor L-NAME and AMPK inhibitor compound C. Madagascine (10 μM) also significantly relaxed the abnormal constriction in porcine VSM induced by SPC and the effect was abolished by compound C. Madagascine significantly increased the phosphorylation of endothelial nitric oxide synthase (eNOS) in endothelial cells while decreasing the phosphorylation of myosin phosphatase target subunit 1 (MYPT1) in VSM cells. Madagascine-induced vasodilatation was abrogated using small interfering RNA knockdown of AMPK. In summary, madagascine exerted vasodilatation through activating AMPK, leading to the activation of eNOS in endothelium and inhibition of ROCK/MYPT1 in VSM. This study suggests the potential value of madagascine in amelioration of vasospasm related cardiovascular diseases.

Association between periodontitis and arterial hypertension: A systematic review and meta-analysis

BACKGROUND

Several studies have shown that periodontal diseases are associated with hypertension (HT). However, heterogeneity among populations, diagnosis criteria, and shared risk factors represent some difficulties in terms of interpretation. Therefore, the aim of this study was to determine the magnitude of the association between periodontal diseases and HT.

METHODS AND RESULTS

A systematic review and meta-analysis, including studies published up to June 2016, have been performed. Sixteen studies assessing the association between periodontal diseases and HT have been included. The meta-analysis considering all included studies (moderate to severe periodontitis) showed that the presence of HT was associated with the presence of periodontal diseases (OR, 1.50; 95% CI, 1.27-1.78). To reduce potential bias, a stratified analysis has been performed illustrating the impact of inclusion criteria and adjustments on the magnitude of the association. Interestingly, when only studies with secure diagnosis of severe periodontitis and HT were considered, an OR=1.64 (95% CI, 1.23-2.19) has been measured.

CONCLUSIONS

Periodontal diseases are associated with a higher risk of HT especially for severe periodontitis. However, no conclusions could be made regarding the causative involvement of periodontal diseases mainly due to the reduced number of available prospective studies and remaining questions regarding underlying biological mechanisms.