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Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, Graziani F, Hobbs FDR, Huck O, Hummers E, Jepsen S, Kravtchenko O, Madianos P, Molina A, Ungan M, Vilaseca J, Windak A, Vinker S. Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe. Eur J Gen Pract 2024; 30:2320120. [PMID: 38511739 PMCID: PMC10962307 DOI: 10.1080/13814788.2024.2320120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing. OBJECTIVES To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD). METHODS The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings. RESULTS Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors. CONCLUSION Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah and the Hebrew University Medical Center, Jerusalem, Israel
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Iain Chapple
- Periodontal Research Group, and Birmingham NIHR Biomedical Research Centre in Inflammation, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Thomas Frese
- Institut für Allgemeinmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy
| | - F. D. Richard Hobbs
- Oxford Primary Care, Radcliffe Primary Care Building, ROQ, University of Oxford, Oxford, UK
| | - Olivier Huck
- Dental Faculty, University of Strasbourg, Strasbourg, France
| | - Eva Hummers
- Department of General Practice and Family Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | | | - Phoebus Madianos
- Department of Periodontology, Faculty of Dentistry, National & Kapodistrian University of Athens, Athens, Greece
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Josep Vilaseca
- Department of Medicine, University of Vic–Central Catalonia University, Vic, Spain
- Primary Health Care Service, Althaia Foundation–Healthcare and University Network, Manresa, Spain
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Wagner SK, Patel PJ, Huemer J, Khalid H, Stuart KV, Chu CJ, Williamson DJ, Struyven RR, Romero-Bascones D, Foster PJ, Khawaja AP, Petzold A, Balaskas K, Cortina-Borja M, Chapple I, Dietrich T, Rahi JS, Denniston AK, Keane PA. Periodontitis and Outer Retinal Thickness: a Cross-Sectional Analysis of the United Kingdom Biobank Cohort. Ophthalmol Sci 2024; 4:100472. [PMID: 38560277 PMCID: PMC10973663 DOI: 10.1016/j.xops.2024.100472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/31/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024]
Abstract
Purpose Periodontitis, a ubiquitous severe gum disease affecting the teeth and surrounding alveolar bone, can heighten systemic inflammation. We investigated the association between very severe periodontitis and early biomarkers of age-related macular degeneration (AMD), in individuals with no eye disease. Design Cross-sectional analysis of the prospective community-based cohort United Kingdom (UK) Biobank. Participants Sixty-seven thousand three hundred eleven UK residents aged 40 to 70 years recruited between 2006 and 2010 underwent retinal imaging. Methods Macular-centered OCT images acquired at the baseline visit were segmented for retinal sublayer thicknesses. Very severe periodontitis was ascertained through a touchscreen questionnaire. Linear mixed effects regression modeled the association between very severe periodontitis and retinal sublayer thicknesses, adjusting for age, sex, ethnicity, socioeconomic status, alcohol consumption, smoking status, diabetes mellitus, hypertension, refractive error, and previous cataract surgery. Main Outcome Measures Photoreceptor layer (PRL) and retinal pigment epithelium-Bruch's membrane (RPE-BM) thicknesses. Results Among 36 897 participants included in the analysis, 1571 (4.3%) reported very severe periodontitis. Affected individuals were older, lived in areas of greater socioeconomic deprivation, and were more likely to be hypertensive, diabetic, and current smokers (all P < 0.001). On average, those with very severe periodontitis were hyperopic (0.05 ± 2.27 diopters) while those unaffected were myopic (-0.29 ± 2.40 diopters, P < 0.001). Following adjusted analysis, very severe periodontitis was associated with thinner PRL (-0.55 μm, 95% confidence interval [CI], -0.97 to -0.12; P = 0.022) but there was no difference in RPE-BM thickness (0.00 μm, 95% CI, -0.12 to 0.13; P = 0.97). The association between PRL thickness and very severe periodontitis was modified by age (P < 0.001). Stratifying individuals by age, thinner PRL was seen among those aged 60 to 69 years with disease (-1.19 μm, 95% CI, -1.85 to -0.53; P < 0.001) but not among those aged < 60 years. Conclusions Among those with no known eye disease, very severe periodontitis is statistically associated with a thinner PRL, consistent with incipient AMD. Optimizing oral hygiene may hold additional relevance for people at risk of degenerative retinal disease. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Siegfried K. Wagner
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Praveen J. Patel
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Josef Huemer
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
| | - Hagar Khalid
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Kelsey V. Stuart
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Colin J. Chu
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Dominic J. Williamson
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, United Kingdom
| | - Robbert R. Struyven
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, United Kingdom
| | - David Romero-Bascones
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Paul J. Foster
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P. Khawaja
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Axel Petzold
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Konstantinos Balaskas
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Mario Cortina-Borja
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Iain Chapple
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- School of Dentistry, Birmingham Community Healthcare NHS Foundation Trust, United Kingdom
| | - Thomas Dietrich
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- School of Dentistry, Birmingham Community Healthcare NHS Foundation Trust, United Kingdom
| | - Jugnoo S. Rahi
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
- Department of Ophthalmology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, United Kingdom
| | - Alastair K. Denniston
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Pearse A. Keane
- Population and Data Sciences, Institute of Ophthalmology, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
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Marruganti C, Gaeta C, Falciani C, Cinotti E, Rubegni P, Alovisi M, Scotti N, Baldi A, Bellan C, Defraia C, Fiorino F, Valensin S, Bellini E, De Rosa A, D'Aiuto F, Grandini S. Are periodontitis and psoriasis associated? A pre-clinical murine model. J Clin Periodontol 2024. [PMID: 38699834 DOI: 10.1111/jcpe.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
AIM To investigate the bidirectional influence between periodontitis and psoriasis, using the respective experimental models of ligature- and imiquimod-induced diseases on murine models. MATERIALS AND METHODS Thirty-two C57/BL6J mice were randomly allocated to four experimental groups: control (P- Pso-), ligature-induced periodontitis (P+ Pso-), imiquimod-induced psoriasis (P- Pso+) and periodontitis and psoriasis (P+ Pso+). Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis (distance between the cemento-enamel junction and alveolar bone crest [CEJ-ABC] and the number of osteoclasts) and psoriasis (epidermal thickness and infiltrate cell [/0.03mm2]) severity as well as systemic inflammation (IL-6, IL-17A, TNF-α) were collected. RESULTS The P+ Pso+ group exhibited the most severe experimental periodontitis and psoriasis, with the highest values of CEJ-ABC, number of osteoclasts, epidermal thickness and infiltrate cells in the dorsal skin, as well as the highest blood cytokine concentration. The P+ Pso- group presented with higher cell infiltrate (/0.03mm2) compared to the control group (p <.05), while the P- Pso+ group showed substantially higher alveolar bone loss (CEJ-ABC) than the control group (p <.05). CONCLUSIONS Experimental periodontitis may initiate and maintain psoriasiform skin inflammation and, vice versa, experimental psoriasis may contribute to the onset of periodontitis. In a combined model of the diseases, we propose a bidirectional association between periodontitis and psoriasis via systemic inflammation.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Falciani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Nicola Scotti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Andrea Baldi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Cristiana Bellan
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Chiara Defraia
- Unit of Anatomical Pathology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology (LAMMB), Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | | | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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4
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Li Y, Wu X, Liu M, Deng K, Tullini A, Zhang X, Shi J, Lai H, Tonetti MS. Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial. J Clin Periodontol 2024. [PMID: 38631679 DOI: 10.1111/jcpe.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
AIM Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment. MATERIALS AND METHODS This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up. RESULTS One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed. CONCLUSIONS The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).
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Affiliation(s)
- Yuan Li
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xinyu Wu
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Min Liu
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ke Deng
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Annamaria Tullini
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Maurizio S Tonetti
- Department of Oral and Maxillofacial Implantology, Shanghai PerioImplant Innovation Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center of Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- European Research Group on Periodontology, Genova, Italy
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Menezes CCD, Barbirato DDS, Fogacci MF, Marañón-Vásquez GA, Carneiro JRI, Maia LC, Barros MCMD. Systemic benefits of periodontal therapy in patients with obesity and periodontitis: a systematic review. Braz Oral Res 2024; 38:e031. [PMID: 38597549 DOI: 10.1590/1807-3107bor-2024.vol38.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/09/2023] [Indexed: 04/11/2024] Open
Abstract
This systematic review aimed to answer the focused question: "What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?". A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1β, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy.
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Affiliation(s)
- Cláudia Callegaro de Menezes
- Universidade Federal do Rio de Janeiro - UFRJ, Dental School, Division of Periodontics, Rio de Janeiro, RJ, Brazil
| | - Davi da Silva Barbirato
- Universidade Federal do Rio de Janeiro - UFRJ, Dental School, Division of Periodontics, Rio de Janeiro, RJ, Brazil
| | - Mariana Fampa Fogacci
- Universidade Federal de Pernambuco - UFPE, Department of Clinical and Preventive Dentistry, Recife, PE, Brazil
| | | | - João Régis Ivar Carneiro
- Universidade Federal do Rio de Janeiro - UFRJ, Clementino Fraga Filho Hospital University, Department of Nutrology/Bariatric Surgery, Rio de Janeiro, RJ, Brazil
| | - Lucianne Copple Maia
- Universidade Federal do Rio de Janeiro - UFRJ, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
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6
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Baima G, Ferrocino I, Del Lupo V, Colonna E, Thumbigere-Math V, Caviglia GP, Franciosa I, Mariani GM, Romandini M, Ribaldone DG, Romano F, Aimetti M. Effect of Periodontitis and Periodontal Therapy on Oral and Gut Microbiota. J Dent Res 2024; 103:359-368. [PMID: 38362600 DOI: 10.1177/00220345231222800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Mounting evidence indicates that periodontitis-related oral bacteria may contribute to gut microbial dysbiosis. This clinical study aimed to explore the oral-gut microbial signatures associated with periodontitis and to longitudinally evaluate the effect of periodontal treatment on the oral and gut microbial composition. Stool and saliva samples from generalized stage III/IV periodontitis patients (n = 47) were collected and analyzed by 16S ribosomal RNA gene amplicon sequencing, before and 3 mo after steps I to II of periodontal therapy. Periodontally healthy matched subjects (n = 47) were used as controls. Principal component analysis was carried out to identify oral-gut microbial profiles between periodontitis patients at baseline and healthy subjects; periodontitis samples were longitudinally compared before and after treatment. β-Diversity of gut microbial profiles of periodontitis patients before treatment significantly differed from healthy controls (P < 0.001). Periodontal therapy was associated with a significant change in gut microbiota (P < 0.001), with post-treatment microbial profiles similar to healthy volunteers. A higher abundance of Bacteroides, Faecalibacterium, Fusobacterium, and Lachnospiraceae was noted in fecal samples of periodontitis patients at baseline compared to healthy controls. In contrast, Lactobacillus was the only genus more abundant in the latter. Additionally, periodontal therapy led to a parallel reduction in the salivary carriage of periodontal pathobionts, as well as gut Bacteroides, Lachnoclostridium, Lachnospiraceae, Oscillospiraceae, and Ruminococcaceae, to levels similar to healthy controls. Collectively, discriminating oral-gut microbial signatures of periodontitis were found. Periodontal treatment both mitigated oral dysbiosis and altered gut microbial composition, signifying potential broader implications for gastrointestinal health and disease.
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Affiliation(s)
- G Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - I Ferrocino
- Department of Agricultural, Forestry and Food Science, University of Turin, Turin, Italy
| | - V Del Lupo
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - E Colonna
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - V Thumbigere-Math
- Division of Periodontology, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - G P Caviglia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - I Franciosa
- Department of Agricultural, Forestry and Food Science, University of Turin, Turin, Italy
| | - G M Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - M Romandini
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - D G Ribaldone
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - M Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Li L, Hayashi-Okada Y, Falkner KL, Cervi S, Andrusz S, Shimizu Y, Zambon JJ, Kirkwood KL, Schifferle RE, Diaz PI. Randomized Trial to Test a Chemo-Mechanical Antiplaque Regimen as Adjunct to Periodontal Therapy. JDR Clin Trans Res 2024; 9:160-169. [PMID: 37148266 DOI: 10.1177/23800844231167065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP). OBJECTIVES This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics. METHODS This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969. RESULTS In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75). CONCLUSION Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy. KNOWLEDGE TRANSFER STATEMENT This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes.
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Affiliation(s)
- L Li
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - K L Falkner
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - S Cervi
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - S Andrusz
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - J J Zambon
- Department of Periodontics and Endodontics, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - K L Kirkwood
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - R E Schifferle
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Periodontics and Endodontics, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - P I Diaz
- UB Microbiome Center, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
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8
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Dai T, Dai Q. Effect of blood lead levels on periodontitis in American adults: a cross-sectional analysis from the national health and nutrition examination survey. BMC Oral Health 2024; 24:364. [PMID: 38515151 PMCID: PMC10956260 DOI: 10.1186/s12903-024-04068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the impact of blood lead levels on the development and progression of periodontitis. METHODS This study included 8600 participants from the National Nutrition and Health Examination Survey conducted the United States between 2009 and 2014. The exposure variable was the blood lead level, while the outcome variable was periodontitis. To evaluate the relationship between the blood lead level and periodontitis, a multivariate logistic regression model was used. RESULTS A positive association was observed between blood lead levels and the risk of periodontitis in Model 1 (OR = 7.04, 95% CI = 5.95-8.31). After adjusting for age (continuous), sex, ethnicity, and BMI (continuous) in Model 2, the significant association between blood lead levels and periodontitis risk remained evident (OR = 3.06, 95% CI: 2.54-3.70). Consequently, even after comprehensive adjustment for potential confounding factors in Model 3, the robust association between blood lead levels and periodontitis risk persisted (OR = 2.08, 95% CI = 1.67-2.60). When considering the serum lead concentration as a categorical variable and after adjusting for potential confounders in Model 3, we observed that the odds ratios (ORs) of periodontitis in the T2 (0.94 µg/dL-1.60 µg/dL) and T3 (lead ≥ 1.60 µg/dL) groups increased from 1.27 (OR = 1.27, 95% CI: 1.11-1.44) to 1.57 (OR = 1.57, 95% CI: 1.36-1.81) compared to T1 group. Subgroup analysis revealed no effect modifiers. CONCLUSIONS Our main findings suggest that there is no safe range of blood lead levels regarding periodontitis risk and that increasing blood lead levels can significantly increase the prevalence of periodontitis.
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Affiliation(s)
- Tangye Dai
- Nanchang University Affiliated Stomatological Hospital, Jiangxi Province, China.
- Hangzhou stomatological hospital, Hangzhou, Zhejiang, China.
| | - Qun Dai
- Nanchang University Affiliated Stomatological Hospital, Jiangxi Province, China.
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9
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Jin B, Wang P, Liu P, Wang Y, Guo Y, Wang C, Jia Y, Zou R, Dong S, Niu L. Association between periodontitis and endometriosis: a bidirectional Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1271351. [PMID: 38487346 PMCID: PMC10937447 DOI: 10.3389/fendo.2024.1271351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction A potential association between periodontitis and endometriosis has been indicated in previous observational studies. Nevertheless, the causal link between these two disorders has not been clarified. Methods Based on publicly available genome-wide association study (GWAS) summary datasets, we conducted a bidirectional Mendelian randomization (MR) study to investigate the relationship between periodontitis and endometriosis and its subtypes. Single nucleotide polymorphisms (SNPs) strongly associated with candidate exposures at the genome-wide significance level (P < 5 × 10-8) were selected as instrumental variables (IVs). The inverse variance-weighted regression (IVW) was performed to estimate the causal effect of periodontitis on endometriosis. We further conducted two sensitivity analyses, MR-Egger and weighted median, to test the validity of our findings. The main results were replicated via data from the UK Biobank. Finally, a reverse MR analysis was performed to evaluate the possibility of reverse causality. Results The IVW method suggested that periodontitis was positively associated with endometriosis of the pelvic peritoneum (OR = 1.079, 95% CI = 1.016 to 1.146, P = 0.014). No causal association was indicated between periodontitis and other subtypes of endometriosis. In reversed analyses, no causal association between endometriosis or its subtypes and periodontitis was found. Conclusions Our study provided genetic evidence on the causal relationship between periodontitis and endometriosis of the pelvic peritoneum. More studies are necessary to explore the underlying mechanisms.
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Affiliation(s)
- Bilun Jin
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Pengfei Wang
- Centre of Stomatology, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Peiqi Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Yijie Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Yi Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Chenxu Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Yue Jia
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Rui Zou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Shaojie Dong
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Lin Niu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- College of Stomatology, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi’an Jiaotong University, Xi’an, China
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Wu Q, Zhang W, Lu Y, Li H, Yang Y, Geng F, Liu J, Lin L, Pan Y, Li C. Association between periodontitis and inflammatory comorbidities: The common role of innate immune cells, underlying mechanisms and therapeutic targets. Int Immunopharmacol 2024; 128:111558. [PMID: 38266446 DOI: 10.1016/j.intimp.2024.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Periodontitis, which is related to various systemic diseases, is a chronic inflammatory disease caused by periodontal dysbiosis of the microbiota. Multiple factors can influence the interaction of periodontitis and associated inflammatory disorders, among which host immunity is an important contributor to this interaction. Innate immunity can be activated aberrantly because of the systemic inflammation induced by periodontitis. This aberrant activation not only exacerbates periodontal tissue damage but also impairs systemic health, triggering or aggravating inflammatory comorbidities. Therefore, innate immunity is a potential therapeutic target for periodontitis and associated inflammatory comorbidities. This review delineates analogous aberrations of innate immune cells in periodontitis and comorbid conditions such as atherosclerosis, diabetes, obesity, and rheumatoid arthritis. The mechanisms behind these changes in innate immune cells are discussed, including trained immunity and clonal hematopoiesis of indeterminate potential (CHIP), which can mediate the abnormal activation and myeloid-biased differentiation of hematopoietic stem and progenitor cells. Besides, the expansion of myeloid-derived suppressor cells (MDSCs), which have immunosuppressive and osteolytic effects on peripheral tissues, also contributes to the interaction between periodontitis and its inflammatory comorbidities. The potential treatment targets for relieving the risk of both periodontitis and systemic conditions are also elucidated, such as the modulation of innate immunity cells and mediators, the regulation of trained immunity and CHIP, as well as the inhibition of MDSCs' expansion.
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Affiliation(s)
- Qibing Wu
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Weijia Zhang
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yaqiong Lu
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Hongxia Li
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yaru Yang
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Fengxue Geng
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Jinwen Liu
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Li Lin
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yaping Pan
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Chen Li
- Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China; Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.
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11
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Matayoshi S, Tojo F, Suehiro Y, Okuda M, Takagi M, Ochiai M, Kadono M, Mikasa Y, Okawa R, Nomura R, Itoh Y, Itoh N, Nakano K. Effects of mouthwash on periodontal pathogens and glycemic control in patients with type 2 diabetes mellitus. Sci Rep 2024; 14:2777. [PMID: 38307981 PMCID: PMC10837110 DOI: 10.1038/s41598-024-53213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024] Open
Abstract
Periodontitis is known to be associated with type 2 diabetes mellitus (T2DM), and gargling with mouthwash is known to reduce the incidence of periodontitis by inhibiting periodontal pathogens. However, the effects of mouthwash on oral and systemic conditions in patients with T2DM remain unknown. In this study, we investigated the effects of gargling with mouthwash on the number of red complex species, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, and HbA1c levels in patients with T2DM. Patients were instructed to gargle with water for 6 months, followed by gargling with mouthwash containing chlorhexidine gluconate for the subsequent 6 months. At each clinic visit, saliva was collected and bacterial DNA was extracted to detect red complex species using the polymerase chain reaction technique. The HbA1c level was determined using a blood sample. The number of red complex species significantly decreased in younger or male patients who gargled with mouthwash. Furthermore, HbA1c levels significantly decreased in younger patients or patients with higher HbA1c levels who gargled with mouthwash. These results suggest that gargling with mouthwash reduces the number of red complex species and improves the hyperglycemic status in patients with T2DM, especially younger patients.
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Affiliation(s)
- Saaya Matayoshi
- Joint Research Laboratory of Science for Oral and Systemic Connection, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
| | - Fumikazu Tojo
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yuto Suehiro
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Makoto Okuda
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Misato Takagi
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Marin Ochiai
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Maika Kadono
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yusuke Mikasa
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Rena Okawa
- Joint Research Laboratory of Science for Oral and Systemic Connection, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ryota Nomura
- Department of Pediatric Dentistry, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshito Itoh
- Itoh Internal Medicine Clinic, Osaka, Japan
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Naoto Itoh
- Joint Research Laboratory of Science for Oral and Systemic Connection, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan
- Itoh Internal Medicine Clinic, Osaka, Japan
| | - Kazuhiko Nakano
- Joint Research Laboratory of Science for Oral and Systemic Connection, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
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Abdalla HB, Puhl L, Rivas CA, Wu YC, Rojas P, Trindade-da-Silva CA, Hammock BD, Maddipati KR, Soares MQS, Clemente-Napimoga JT, Kantarci A, Napimoga MH, Van Dyke TE. Modulating the sEH/EETs Axis Restrains Specialized Proresolving Mediator Impairment and Regulates T Cell Imbalance in Experimental Periodontitis. J Immunol 2024; 212:433-445. [PMID: 38117781 PMCID: PMC10866374 DOI: 10.4049/jimmunol.2300650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
Epoxyeicosatrienoic acids (EETs) and other epoxy fatty acids are short-acting lipids involved in resolution of inflammation. Their short half-life, due to its metabolism by soluble epoxide hydrolase (sEH), limits their effects. Specialized proresolving mediators (SPMs) are endogenous regulatory lipids insufficiently synthesized in uncontrolled and chronic inflammation. Using an experimental periodontitis model, we pharmacologically inhibited sEH, examining its impact on T cell activation and systemic SPM production. In humans, we analyzed sEH in the gingival tissue of periodontitis patients. Mice were treated with sEH inhibitor (sEHi) and/or EETs before ligature placement and treated for 14 d. Bone parameters were assessed by microcomputed tomography and methylene blue staining. Blood plasma metabololipidomics were carried out to quantify SPM levels. We also determined T cell activation by reverse transcription-quantitative PCR and flow cytometry in cervical lymph nodes. Human gingival samples were collected to analyze sEH using ELISA and electrophoresis. Data reveal that pharmacological sEHi abrogated bone resorption and preserved bone architecture. Metabololipidomics revealed that sEHi enhances lipoxin A4, lipoxin B4, resolvin E2, and resolvin D6. An increased percentage of regulatory T cells over Th17 was noted in sEHi-treated mice. Lastly, inflamed human gingival tissues presented higher levels and expression of sEH than did healthy gingivae, being positively correlated with periodontitis severity. Our findings indicate that sEHi preserves bone architecture and stimulates SPM production, associated with regulatory actions on T cells favoring resolution of inflammation. Because sEH is enhanced in human gingivae from patients with periodontitis and connected with disease severity, inhibition may prove to be an attractive target for managing osteolytic inflammatory diseases.
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Affiliation(s)
- Henrique B. Abdalla
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
- Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | - Luciano Puhl
- Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | - Carla Alvarez Rivas
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Yu-Chiao Wu
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Paola Rojas
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
| | | | - Bruce D. Hammock
- Department of Entomology and UCD Comprehensive Cancer Center, University of California, Davis, CA, USA
| | | | | | | | - Alpdogan Kantarci
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
| | | | - Thomas E. Van Dyke
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA
- Department of Oral Medicine, Infection, and Immunity, Faculty of Medicine, Harvard University, Boston, MA, USA
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Lipsky MS, Singh T, Zakeri G, Hung M. Oral Health and Older Adults: A Narrative Review. Dent J (Basel) 2024; 12:30. [PMID: 38392234 PMCID: PMC10887726 DOI: 10.3390/dj12020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Oral health's association with general health, morbidity, and mortality in older adults highlights its importance for healthy aging. Poor oral health is not an inevitable consequence of aging, and a proactive, multidisciplinary approach to early recognition and treatment of common pathologies increases the likelihood of maintaining good oral health. Some individuals may not have regular access to a dentist, and opportunities to improve oral health may be lost if health professionals fail to appreciate the importance of oral health on overall well-being and quality of life. The authors of this narrative review examined government websites, the American Dental Association Aging and Dental Health website, and the Healthy People 2030 oral objectives and identified xerostomia, edentulism, caries, periodontitis, and oral cancer as five key topics for the non-dental provider. These conditions are associated with nutritional deficiencies, poorer quality of life, increased risk of disease development and poorer outcomes for cardiovascular disease, diabetes, and other systemic conditions prevalent among older adults. It is important to note that there is a bi-directional dimension to oral health and chronic diseases, underscoring the value of a multidisciplinary approach to maintaining oral health in older adults.
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Affiliation(s)
- Martin S Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- College of Urban and Public Affairs, Portland State University, Portland, OR 97201, USA
| | - Tejasvi Singh
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Golnoush Zakeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA
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Borgnakke WS. Current scientific evidence for why periodontitis should be included in diabetes management. Front Clin Diabetes Healthc 2024; 4:1257087. [PMID: 38274772 PMCID: PMC10809181 DOI: 10.3389/fcdhc.2023.1257087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.
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Affiliation(s)
- Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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15
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Liu Y, Qin H, Li T, Feng C, Han H, Cao Y, Su Y, He H, Yuan C, Sun M, Clarke R, Gan W, Tonetti M, Zong G. Denture use and risk for cardiometabolic disease: observational and Mendelian randomization analyses. Eur J Prev Cardiol 2024; 31:13-20. [PMID: 37697428 PMCID: PMC10767255 DOI: 10.1093/eurjpc/zwad295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/13/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
AIMS Denture use may potentially increase the risk of cardiometabolic diseases (CMDs), but the casual relevance and strength of the associations are currently unknown. METHODS AND RESULTS A total of 495 938 participants from the UK Biobank were included in the observational analyses. Linkage disequilibrium score (LDSC) regression and Mendelian randomization analyses were employed to estimate genetic correlation and the associations between the genetic liability for denture use with coronary artery disease, myocardial infarction, heart failure (HF), any stroke (AS), ischaemic stroke, haemorrhagic stroke, type 2 diabetes (T2D), and related clinical risk factors. In observational analysis, denture use was associated with 14-25% higher risks of various CMDs. The LDSC analysis found that denture use showed a positive genetic correlation with CMDs (rg 0.21-0.38). Genetic liability for denture use was associated with an elevated risk of HF [odds ratio: 1.49 (1.20-1.83)] and T2D [1.11 (1.01-1.24)]. By integrating genetic summary data of denture use with the sum of decayed, missing, and filled tooth surfaces (DMFS), a clinical measure of dental caries obtained from an independent source, genetically determined denture use/DMFS was also associated with an elevated risk of AS [1.21 (1.04-1.40)]. Furthermore, genetically predicted denture use/DMFS was significantly associated with established cardiometabolic risk factors, including HDL cholesterol, triglycerides, waist circumference, waist-to-hip ratio, and height. CONCLUSION Our study supported potential causal associations between the genetic liability for denture use and risks for HF, AS, T2D, and related clinical risk factors. These findings may inform prevention and intervention strategies targeting dental diseases and CMDs.
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Affiliation(s)
- Yunan Liu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Tongtong Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Chengwu Feng
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Han Han
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Yaying Cao
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Yang Su
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Haihao He
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, Zhejiang University School of Public Health, Hangzhou, Zhejiang 310058, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Meng Sun
- NHS Blood and Transplant (NHSBT) Blood Donor Centre, John Radcliffe Hospital, Oxford OX39BQ, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
| | - Wei Gan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Medical Research Council, Population Health Research Unit, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
- Genetics Department, Novo Nordisk Research Centre Oxford, Innovation Building, Old Road Campus, Headington, Oxford OX37LQ, UK
| | - Maurizio Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
- European Research Group on Periodontology, WTC Tower Genoa, Via De Marini, 1-16149 Genoa, Italy
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
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16
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Moon MG, Kang SH, Kim SH, Park SY, Seol YJ, Yoon CH, Lee HJ, Youn TJ, Chae IH, Leira Y, Munoz-Aguilera E, D'Aiuto F. Association between toothbrushing and cardiovascular risk factors: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2015-2017. BMC Oral Health 2024; 24:4. [PMID: 38167045 PMCID: PMC10763411 DOI: 10.1186/s12903-023-03775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Previous studies have suggested that frequent toothbrushing is associated with a lower risk of future cardiovascular events. We sought to investigate further the relationship between toothbrushing, cardiovascular risk factors, and lifestyle behaviours. METHODS We analysed a cross-sectional survey including 13,761 adults aged 30 years or older without a history of cardiovascular diseases from the Korean National Health and Nutritional Examination Survey. Conventional cardiovascular risk factors (blood pressure, lipid profiles, and fasting glucose), and inflammatory markers (high-sensitivity C-reactive protein [hsCRP], and white blood cell counts [WBC]) were investigated in relation to the frequency of toothbrushing. RESULTS The estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk, calculated using the pooled cohort equations was 13.7%, 9.1%, and 7.3% for participants who reported toothbrushing 0-1, 2, and ≥ 3 times a day, respectively. Both conventional risk factors and inflammatory markers were significantly associated with frequent toothbrushing. However, after adjusting potential confounding factors such as age, sex, comorbidities, and lifestyle behaviours, only inflammatory markers were remained as significant factors. CONCLUSIONS Oral hygiene behaviours are closely linked to cardiovascular risk factors. This study suggests that reduced systemic inflammatory burden may explain the benefit of improved oral hygiene in terms of cardiovascular risk.
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Affiliation(s)
- Mi-Gil Moon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Sun-Hwa Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Shin-Young Park
- Program of Clinical Dental Education and Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Pre-doctoral treatment center, Seoul National University Dental Hospital, Seoul, Korea.
| | - Yang-Jo Seol
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Yago Leira
- UCL Eastman Dental Institute, Periodontology Unit, University College London, London, UK
| | - Eva Munoz-Aguilera
- UCL Eastman Dental Institute, Periodontology Unit, University College London, London, UK
| | - Francesco D'Aiuto
- UCL Eastman Dental Institute, Periodontology Unit, University College London, London, UK
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17
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Brun A, Petit C, Huck O, Bouchard P, Carra MC, Gosset M. [Periodontitis : An underestimated risk of cardiovascular diseases]. Med Sci (Paris) 2024; 40:35-41. [PMID: 38299901 DOI: 10.1051/medsci/2023193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Epidemiological studies have identified periodontitis as a contributing factor to cardiovascular risk. Periodontitis is a chronic inflammatory disease that affects the tissues supporting the teeth. Although the nature of the association between periodontitis and cardiovascular disease (CVD) remains to be defined, the low-grade systemic inflammation and chronic bacteremia associated with periodontitis appear to be involved in the development of atherosclerosis and associated cardiovascular pathologies. Periodontal treatment has been shown to improve cardiovascular health parameters. A bidirectional preventive approach, involving the management of both periodontitis and cardiovascular risk factors, could lead to a reduction in morbidity and mortality related to cardiovascular disease.
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Affiliation(s)
- Adrian Brun
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Henri Mondor (AP-HP), service de médecine bucco-dentaire, Créteil, France
| | - Catherine Petit
- Laboratoire de nanomédecine régénérative, Inserm UMR 1260, CRBS, 1 rue Eugène Boeckel, 67000 Strasbourg, France - Département de parodontologie, faculté de chirurgie dentaire Robert Frank, Strasbourg, France - Hôpitaux universitaires de Strasbourg, pôle de médecine et chirurgie bucco-dentaire, Strasbourg, France
| | - Olivier Huck
- Laboratoire de nanomédecine régénérative, Inserm UMR 1260, CRBS, 1 rue Eugène Boeckel, 67000 Strasbourg, France - Département de parodontologie, faculté de chirurgie dentaire Robert Frank, Strasbourg, France - Hôpitaux universitaires de Strasbourg, pôle de médecine et chirurgie bucco-dentaire, Strasbourg, France
| | - Philippe Bouchard
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Rothschild (AP-HP), service d'odontologie, 5 rue Santerre 75012 Paris
| | - Maria Clotilde Carra
- Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Rothschild (AP-HP), service d'odontologie, 5 rue Santerre 75012 Paris - Epidemiology and Statistics Research Centre, Inserm UMR1153, Paris, France
| | - Marjolaine Gosset
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Charles Foix (AP-HP), service de médecine bucco-dentaire, Ivry/Seine, France
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18
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Cusi K, Ekhlaspour L, Fleming TK, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Napoli N, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Verduzco-Gutierrez M, Younossi ZM, Gabbay RA. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S52-S76. [PMID: 38078591 PMCID: PMC10725809 DOI: 10.2337/dc24-s004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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19
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Lu H, Sun J, Sun J. Identification of potential crosstalk genes and mechanisms between periodontitis and diabetic nephropathy through bioinformatic analysis. Medicine (Baltimore) 2023; 102:e36802. [PMID: 38206700 PMCID: PMC10754619 DOI: 10.1097/md.0000000000036802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Periodontitis and diabetic nephropathy are significant public health concerns globally and are closely related with each other. This study aimed to identify potential crosstalk genes, pathways, and mechanisms associated with the interaction between periodontitis and diabetic nephropathy. Expression profiles of periodontitis and diabetic nephropathy were retrieved from the Gene expression omnibus gene expression omnibus database, and differentially expressed genes (DEGs) were screened, followed by identification of co-expressed differential genes. Gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using R software. A protein-protein interaction network was constructed via STRING website, and key crosstalk genes were selected using Cytoscape. Subsequent gene ontology and KEGG analyses were conducted for the key genes, and a validation dataset was obtained from the gene expression omnibus database for differential gene validation. The TRRUST website was employed to identify transcription factors (TFs) associated with the key crosstalk genes between periodontitis and diabetic nephropathy, followed by differential analysis of TFs. A total of 17 crosstalk genes were obtained. Among them, SAMSN1, BCL2A1, interleukin-19, IL1B, RGS1, CXCL3, CCR1, CXCR4, CXCL1, and PTGS2 were identified as key crosstalk genes between periodontitis and diabetic nephropathy. Additionally, 16 key TFs were discovered. This bioinformatic analysis revealed potential crosstalk genes between periodontitis and diabetic nephropathy. The identified key genes participate in signaling pathways, including cytokine signaling and chemokine signaling transduction, which might collectively influence these 2 diseases. These genes may serve as potential biomarkers guiding future research in this field.
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Affiliation(s)
- Huijuan Lu
- Department of Nephrology, First People’s Hospital of Linping District, Hangzhou, China
| | - Jia Sun
- Department of Nephrology, First People’s Hospital of Linping District, Hangzhou, China
| | - Jieqiong Sun
- Department of Nephrology, First People’s Hospital of Linping District, Hangzhou, China
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20
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Xu K, Ma S, Gu J, Liu Q, He Z, Li Y, Jia S, Ji Z, Tay F, Zhang T, Niu L. Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES. Clin Oral Investig 2023; 28:37. [PMID: 38148418 DOI: 10.1007/s00784-023-05471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health. MATERIALS AND METHODS Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5-1 year, 1-2 years, 2-5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment. CONCLUSIONS Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality. CLINICAL RELEVANCE This study highlights the potential benefits of regular dental visits in maintaining general health.
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Affiliation(s)
- Kehui Xu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Sai Ma
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Junting Gu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Qing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Zikang He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yuanyuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
- Department of General Dentistry, Chenggong Hospital Affiliated to Medical School of Xiamen University, Xiamen, 361000, Fujian, China
| | - Shuailin Jia
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453003, Hena, China
| | - Zhaohua Ji
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, the Fourth Military Medical University, Xi'an, 710032, China
| | - Franklin Tay
- The Graduate School, Augusta University, Augusta, GA, 30912, USA
| | - Tong Zhang
- Department of Stomatology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Lina Niu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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21
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Joseph P, Prabhakar P, Holtfreter B, Pink C, Suvan J, Kocher T, Pitchika V. Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions. Clin Oral Investig 2023; 28:21. [PMID: 38147183 PMCID: PMC10751251 DOI: 10.1007/s00784-023-05392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up. MATERIALS AND METHODS A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities. RESULTS The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group. CONCLUSION Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions. TRIAL REGISTRATION This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO.
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Affiliation(s)
- Prabhakar Joseph
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Priya Prabhakar
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
- Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany
| | - Jeanie Suvan
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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22
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Gupta U, Dey P. The oral microbial odyssey influencing chronic metabolic disease. Arch Physiol Biochem 2023:1-17. [PMID: 38145405 DOI: 10.1080/13813455.2023.2296346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Since the oral cavity is the gateway to the gut, oral microbes likely hold the potential to influence metabolic disease by affecting the gut microbiota. METHOD A thorough review of literature has been performed to link the alterations in oral microbiota with chronic metabolic disease by influencing the gut microbiota. RESULT A strong correlation exists between abnormalities in oral microbiota and several systemic disorders, such as cardiovascular disease, diabetes, and obesity, which likely initially manifest as oral diseases. Ensuring adequate oral hygiene practices and cultivating diverse oral microflora are crucial for the preservation of general well-being. Oral bacteria have the ability to establish and endure in the gastrointestinal tract, leading to the development of prolonged inflammation and activation of the immune system. Oral microbe-associated prophylactic strategies could be beneficial in mitigating metabolic diseases. CONCLUSION Oral microbiota can have a profound impact on the gut microbiota and influence the pathogenesis of metabolic diseases.
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Affiliation(s)
- Upasana Gupta
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
| | - Priyankar Dey
- Department of Biotechnology, Thapar Institute of Engineering & Technology, Patiala, Punjab, India
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23
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Serón C, Olivero P, Flores N, Cruzat B, Ahumada F, Gueyffier F, Marchant I. Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care. Front Public Health 2023; 11:1270557. [PMID: 38192555 PMCID: PMC10771979 DOI: 10.3389/fpubh.2023.1270557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.
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Affiliation(s)
- Constanza Serón
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Pablo Olivero
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Laboratorio de Estructura y Función Celular, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Nicolás Flores
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Benjamín Cruzat
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Francisca Ahumada
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - François Gueyffier
- Laboratoire de biologie et biométrie évolutive – équipe modélisation des effets thérapeutiques, Université Claude Bernard Lyon, Lyon, France
| | - Ivanny Marchant
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
- Clinical Studies Unit, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
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Altamura S, Pietropaoli D, Lombardi F, Del Pinto R, Ferri C. An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease. Biomedicines 2023; 11:3033. [PMID: 38002033 PMCID: PMC10669155 DOI: 10.3390/biomedicines11113033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as "the gut-kidney axis" through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.
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Affiliation(s)
- Serena Altamura
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- PhD School in Medicine and Public Health, Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
| | - Davide Pietropaoli
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Center of Oral Diseases, Prevention and Translational Research—Dental Clinic, 67100 L’Aquila, Italy
| | - Francesca Lombardi
- Laboratory of Immunology and Immunopathology, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Rita Del Pinto
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.A.); (D.P.); (C.F.)
- Oral Diseases and Systemic Interactions Study Group (ODISSY Group), 67100 L’Aquila, Italy
- Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100 L’Aquila, Italy
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Listl S, Baltussen R, Carrasco-Labra A, Carrer F, Lavis J. Evidence-Informed Oral Health Policy Making: Opportunities and Challenges. J Dent Res 2023; 102:1293-1302. [PMID: 37585875 PMCID: PMC10604434 DOI: 10.1177/00220345231187828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Despite a clear need for improvement in oral health systems, progress in oral health systems transformation has been slow. Substantial gaps persist in leveraging evidence and stakeholder values for collective problem solving. To truly enable evidence-informed oral health policy making, substantial "know-how" and "know-do" gaps still need to be overcome. However, there is a unique opportunity for the oral health community to learn and evolve from previous successes and failures in evidence-informed health policy making. As stated by the Global Commission on Evidence to Address Societal Challenges, COVID-19 has created a once-in-a-generation focus on evidence, which has fast-tracked collaboration among decision makers, researchers, and evidence intermediaries. In addition, this has led to a growing recognition of the need to formalize and strengthen evidence-support systems. This article provides an overview of recent advancements in evidence-informed health policy making, including normative goals and a health systems taxonomy, the role of evidence-support and evidence-implementation systems to improve context-specific decision-making processes, the evolution of learning health systems, and the important role of citizen deliberations. The article also highlights opportunities for evidence-informed policy making to drive change in oral health systems. All in all, strengthening capacities for evidence-informed health policy making is critical to enable and enact improvements in oral health systems.
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Affiliation(s)
- S. Listl
- Radboud University Medical Center, Radboud Institute of Health Sciences (RIHS), Department of Dentistry - Quality and Safety of Oral Healthcare, Nijmegen, the Netherlands
| | - R. Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A. Carrasco-Labra
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F.C. Carrer
- Department of Community Dentistry, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - J.N. Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Chien WC, Fu E, Chung CH, Cheng CM, Tu HP, Lee WC, Chen WL, Shih KC. Type 2 Diabetes Mellitus and Periodontitis: Bidirectional Association in Population-based 15-year Retrospective Cohorts. J Clin Endocrinol Metab 2023; 108:e1289-e1297. [PMID: 37224522 DOI: 10.1210/clinem/dgad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE A two-way relationship between periodontitis and diabetes has been proposed. However, bidirectional epidemiological observation is limited and inconsistent. OBJECTIVE Using the National Health Insurance Research Database of Taiwan (covering over 99% of the entire population), we aimed to estimate the development of diabetes in periodontitis patients or that of periodontitis in patients with type 2 diabetes mellitus (T2DM), respectively. METHODS A total of 11 011 patients with severe periodontitis were recruited from 2000 to 2015. After matching by age, sex, and index date, 11 011 patients with mild periodontitis and 11 011 non-periodontitis controls were registered. Additionally, 157 798 patients with T2DM and 157 798 non-T2DM controls were enrolled, in whom the development of periodontitis was traced. Cox proportional hazards model was performed. RESULTS Periodontitis patients tended to have a statistically high risk for T2DM. The adjusted hazard ratio was 1.94 (95% CI, 1.49-2.63, P < .01) and 1.72 (95% CI, 1.24-2.52, P < .01) for severe and mild periodontitis groups, respectively. The patients with severe periodontitis had a higher risk of having T2DM relative to those with mild periodontitis (1.17 [95% CI, 1.04-1.26, P < .001]). Conversely, the risk of periodontitis increased significantly in patients with T2DM (1.99 [95% CI, 1.42-2.48, P < .01]). However, high risk was observed for the outcome of severe periodontitis (2.08 [95% CI, 1.50-2.66, P < .001]), but not for mild periodontitis (0.97 [95% CI, 0.38-1.57, P = .462]). CONCLUSION We suggest that the bidirectional association is between T2DM and severe but not mild periodontitis.
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Affiliation(s)
- Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Earl Fu
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City 23142, Taiwan, ROC
- Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Chia-Mao Cheng
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City 23142, Taiwan, ROC
| | - Hsiao-Pei Tu
- Department of Oral Hygiene, Hsin-Sheng Junior College of Medical Care and Management, Taoyuan City 32544, Taiwan, ROC
| | - Wei-Cheng Lee
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Wei-Liang Chen
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Kuang-Chung Shih
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- Division of Endocrinology & Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, ROC
- Division of Endocrinology & Metabolism, Cheng Hsin General Hospital, Taipei 11220, Taiwan, ROC
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Neves VCM, Satie Okajima L, Elbahtety E, Joseph S, Daly J, Menon A, Fan D, Volkyte A, Mainas G, Fung K, Dhami P, Pelegrine AA, Sharpe P, Nibali L, Ide M. Repurposing Metformin for periodontal disease management as a form of oral-systemic preventive medicine. J Transl Med 2023; 21:655. [PMID: 37814261 PMCID: PMC10563330 DOI: 10.1186/s12967-023-04456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/19/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Despite the improvements in treatment over the last decades, periodontal disease (PD) affects millions of people around the world and the only treatment available is based on controlling microbial load. Diabetes is known to increase the risk of PD establishment and progression, and recently, glucose metabolism modulation by pharmaceutical or dietarian means has been emphasised as a significant modulator of non-communicable disease development. METHODS The impact of pharmaceutically controlling glucose metabolism in non-diabetic animals and humans (REBEC, UTN code: U1111-1276-1942) was investigated by repurposing Metformin, as a mean to manage periodontal disease and its associated systemic risk factors. RESULTS We found that glucose metabolism control via use of Metformin aimed at PD management resulted in significant prevention of bone loss during induced periodontal disease and age-related bone loss in vivo. Metformin also influenced the bacterial species present in the oral environment and impacted the metabolic epithelial and stromal responses to bacterial dysbiosis at a single cell level. Systemically, Metformin controlled blood glucose levels and age-related weight gain when used long-term. Translationally, our pilot randomized control trial indicated that systemic Metformin was safe to use in non-diabetic patients and affected the periodontal tissues. During the medication window, patients showed stable levels of systemic blood glucose, lower circulating hsCRP and lower insulin levels after periodontal treatment when compared to placebo. Finally, patients treated with Metformin had improved periodontal parameters when compared to placebo treated patients. CONCLUSION This is the first study to demonstrate that systemic interventions using Metformin in non-diabetic individuals aimed at PD prevention have oral-systemic effects constituting a possible novel form of preventive medicine for oral-systemic disease management.
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Affiliation(s)
- Vitor C M Neves
- Centre for Craniofacial and Regenerative Biology, FoDOCS, King's College London, London, UK.
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK.
| | - Luciana Satie Okajima
- Department of Periodontology and Implantology, School of Dentistry, São Leopoldo Mandic, Campinas, Brazil
| | - Eyad Elbahtety
- Centre for Craniofacial and Regenerative Biology, FoDOCS, King's College London, London, UK
| | - Susan Joseph
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK
| | - James Daly
- Centre for Craniofacial and Regenerative Biology, FoDOCS, King's College London, London, UK
| | - Athul Menon
- NIHR BRC Genomics Research Platform, Guy's and St Thomas' NHS Foundation Trust, King's College London School of Medicine, London, UK
| | - Di Fan
- Centre for Craniofacial and Regenerative Biology, FoDOCS, King's College London, London, UK
| | - Ayste Volkyte
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK
| | - Giuseppe Mainas
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK
| | - Kathy Fung
- NIHR BRC Genomics Research Platform, Guy's and St Thomas' NHS Foundation Trust, King's College London School of Medicine, London, UK
| | - Pawan Dhami
- NIHR BRC Genomics Research Platform, Guy's and St Thomas' NHS Foundation Trust, King's College London School of Medicine, London, UK
| | - Andre A Pelegrine
- Department of Periodontology and Implantology, School of Dentistry, São Leopoldo Mandic, Campinas, Brazil
| | - Paul Sharpe
- Centre for Craniofacial and Regenerative Biology, FoDOCS, King's College London, London, UK
- Institute of Animal Physiology and Genetics, Brno, Czech Republic
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK
| | - Mark Ide
- Periodontology Unit, Centre for Host-Microbiome Interactions, FoDOCS, King's College London, London, UK
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28
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Pu R, Fu M, Yang G, Jiang Z. The association of work physical activity and recreational physical activity with periodontitis in the NHANES (2009-2014). J Periodontol 2023; 94:1220-1230. [PMID: 37074222 DOI: 10.1002/jper.23-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between different types and intensity of physical activities (PA) and periodontitis in a nationally representative sample of adults in the United States. METHODS The data of periodontal condition and PA of 10,714 individuals were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014 and the Global Physical Activity Questionnaire (GPAQ). The association between the prevalence of periodontitis and two PAs (work PA and recreational PA) was respectively analyzed and adjusted by uni- and multi-variable logistic regression models. The odd ratios (ORs), adjusted odd ratios (ORad ), and 95% confidence interval (95% CI) were calculated as the main outcome indicators. RESULTS After adjusted by age, sex, race, poverty-income ratio (PIR), diabetes, smoking status, alcohol use, and floss frequency, moderate and vigorous work PAs were significantly correlated with higher odds of periodontitis (ORad = 1.22, 95% CI = 1.02-1.46; ORad = 1.40, 95% CI = 1.04-1.89, respectively) while moderate and vigorous recreational PAs were correlated with lower odds of periodontitis (ORad = 0.81, 95% CI = 0.69-0.95; ORad = 0.55, 95% CI = 0.43-0.71, respectively). CONCLUSIONS Work PAs and recreational PAs have opposite associations on the prevalence of developing periodontitis and their aggravating or protective associations enhance with the increase of intensity.
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Affiliation(s)
- Rui Pu
- The Affiliated Hospital of Stomatology, School of Stomatology, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mengdie Fu
- The Affiliated Hospital of Stomatology, School of Stomatology, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoli Yang
- The Affiliated Hospital of Stomatology, School of Stomatology, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiwei Jiang
- The Affiliated Hospital of Stomatology, School of Stomatology, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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He I, Poirier B, Jensen E, Kaur S, Hedges J, Jesudason S, Jamieson L, Sethi S. Demystifying the connection between periodontal disease and chronic kidney disease - An umbrella review. J Periodontal Res 2023; 58:874-892. [PMID: 37477165 DOI: 10.1111/jre.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
Chronic kidney disease (CKD) and poor oral health are inter-related and their significant impact on each other is well established in the literature. Many systematic reviews and meta-analyses have demonstrated a strong relationship between CKD and periodontitis, where periodontal treatment has shown potential in improving CKD outcomes. However, the quality of the studies and heterogeneity of the results show variation. The aim of this umbrella review was to review the quality of the current systematic reviews on the relationship between CKD and oral health with an emphasis on periodontal disease and to generate clinically relevant guidelines to maintain periodontal health in patients with CKD. This umbrella review was conducted and reported in alignment with the Joanna Briggs Institute and the PRISMA 2020 guidelines. The review protocol was established prior to commencing the review and registered on JBI and PROSPERO (CRD42022335209). Search strings were established for PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Dentistry & Oral Science Source up to April 2022. All systematic reviews and meta-analyses that considered the relationship between CKD and periodontitis or periodontal treatment were included. Of 371 studies identified through the systematic search, 18 systematic reviews met the inclusion criteria. Ten studies assessed the relationship between oral health status and CKD with a focus on periodontitis and CKD, five reviewed the impact of periodontal treatment on CKD outcomes, two included both relationship and effectiveness of periodontal treatment and one qualitatively reviewed oral health-related quality of life in patients with kidney failure. Findings indicate there is a bidirectional relationship between CKD and periodontal disease. In view of the heterogeneity of the existing literature on CKD and periodontal disease, specific recommendations for the management of periodontitis among patients with CKD are proposed for medical professionals, dental professionals, and aged care workers based on the evidence collated in this review.
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Affiliation(s)
- Isaac He
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Emilija Jensen
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sushil Kaur
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Hessain D, Dalsgaard EM, Norman K, Sandbæk A, Andersen A. Oral health and type 2 diabetes in a socioeconomic perspective. Prim Care Diabetes 2023; 17:466-472. [PMID: 37500424 DOI: 10.1016/j.pcd.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS This study aimed to examine the association between type 2 diabetes and poor self-rated oral health, and to investigate whether such association is modified by socioeconomic position. METHODS We conducted a cross-sectional study, including a population aged 18-75 years with self-reported type 2 diabetes (N = 41,884) and a sex-, age- and municipality-matched reference population from the Health in Central Denmark survey (2020). Multivariable logistic regression was used, and effect modification of indicators of socioeconomic position was examined. RESULTS Oral health was rated as poor in 37.0% of the population with type 2 diabetes and in 23.8% of the reference population without diabetes. Individuals with diabetes had higher risk of poor oral health (adjusted odds ratio (OR) 1.46 (95% CI: 1.39; 1.53)) than references. Interaction was seen between type 2 diabetes and highest attained education (p < 0.001). Stratified analyses showed higher risk of poor oral health in people with type 2 diabetes across all educational levels. CONCLUSIONS People with type 2 diabetes were more likely to rate their oral health as poor than the reference population. Low education strengthened the association between diabetes and poor oral health.
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Affiliation(s)
- Dunia Hessain
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Else-Marie Dalsgaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Kasper Norman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Annelli Sandbæk
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
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Lei F, Ni J, Hu JL, Guo DN, Fan J. Different doses of vitamin D supplementation to nonsurgical treatment for vitamin-D-insufficient patients with diabetic periodontitis and the effect on gingival BMP-2 levels. Kaohsiung J Med Sci 2023; 39:1030-1037. [PMID: 37395326 DOI: 10.1002/kjm2.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Epidemiological data show people with diabetes mellitus (DM) have three-fold increase in risk of periodontitis. A vitamin D insufficiency can affect the progression of DM and periodontitis. This study evaluated the effects of different-dose vitamin D supplementation to nonsurgical periodontal therapy for vitamin-D-insufficient diabetic patients coexisting with periodontitis and changes of gingival bone morphogenetic protein-2 (BMP-2) levels. The study included 30 vitamin-D-insufficient patients receiving nonsurgical treatment followed by administration of 25,000 international units (IU) vitamin D3 per week (the low-VD group) and 30 patients receiving 50,000 UI vitamin D per week (the high-VD group). The decreases of probing pocket depth, clinical attachment loss, bleeding index, and periodontal plaque index values of patients after the six-month supplementation of 50,000 UI vitamin D3 per week to nonsurgical treatment were more significant than those after the six-month supplementation of 25,000 UI vitamin D3 per week to nonsurgical treatment. It was found that 50,000 IU per week vitamin D supplementation for 6 months could lead to a better glycemic control for vitamin-D-insufficient diabetic patients coexisting with periodontitis after nonsurgical periodontal therapy. Increased levels of serum 25(OH) vitamin D3 and gingival BMP-2 were found in both low- and high-dose VD groups, and the high-dose VD group exhibited higher levels than the low-dose VD group. Vitamin D supplementation in large doses for 6 months tended to improve the treatment of periodontitis and increase gingival BMP-2 levels in diabetic patients coexisting with periodontitis who were vitamin D deficient.
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Affiliation(s)
- Fei Lei
- Department of Stomatology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jing Ni
- Clinical Medicine, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jin-Long Hu
- Department of Stomatology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Dan-Ni Guo
- Department of Stomatology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jing Fan
- Department of Stomatology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
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Liao WZ, Zhou ZY, Lin ZK, Xie SJ, Zheng YF, Wang JT, Zheng JH, Chen HK, Chen WS, Guo XG. Coffee consumption and periodontitis: a Mendelian Randomization study. Genes Nutr 2023; 18:13. [PMID: 37689663 PMCID: PMC10492363 DOI: 10.1186/s12263-023-00732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Coffee is one of the most consumed beverages in the world, coffee consumption has been growing in the United States over the past 20 years. Periodontitis is defined by the pathologic loss of the periodontal ligament and destruction of the connective tissue attachment and alveolar bone loss and is related to different systemic diseases and conditions. However, the causality has remained unclarified, thus we regarded discovering the causal relationship between coffee consumption and the liability to periodontitis as the objective of the study. METHODS Coffee consumption was subdivided into binary coffee consumption and continuous coffee consumption to refine the study design. Genetic instruments were stretched from the MRC-IEU's (MRC Integrative Epidemiology Unit) output from the GWAS pipeline using phesant-derived variables based on the UK Biobank, the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) project, and the joint meta-analysis of a recent GWAS. The IVW (Inverse Variance Weighted) was regarded as the primary method to estimate the causality, a scatter plot revealed the intuitive result, and tests for stability were also carried out. RESULTS An effect of continuous coffee consumption on the risk of periodontitis was found, with per SD of coffee consumed increases, the risk of periodontitis rises by 1.04% (Odds Ratio of IVW is 1.0104), while the effect of binary coffee consumption on periodontitis did not meet the requirement of indicating a strong causal association, neither were the reverse causality analyses. CONCLUSIONS The study indicated the causality of continuous coffee consumption to the risk of periodontitis with a relatively small scale of effect estimate and no strong evidence for an effect of binary coffee-consuming behavior on periodontitis. There was also no intensive evidence suggesting reverse causality.
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Affiliation(s)
- Wan-Zhe Liao
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Nanshan College of Guangzhou Medical University, Guangzhou, 511436, China
| | - Zhi-Yi Zhou
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | | | - Shuo-Jia Xie
- Department of Clinical Medicine, The Nanshan College of Guangzhou Medical University, Guangzhou, 511436, China
| | - Ya-Fang Zheng
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Jun-Tao Wang
- Department of Clinical Medicine, The Fourth Clinical School of Nanchang University, Nanchang, 330031, China
| | - Jun-Huang Zheng
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Nanshan College of Guangzhou Medical University, Guangzhou, 511436, China
| | - Hao-Kai Chen
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Wu-Shu Chen
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Department of Clinical Medicine, The Nanshan College of Guangzhou Medical University, Guangzhou, 511436, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
- Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, China.
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Papayannopoulos V. NET histones inflame periodontitis. J Exp Med 2023; 220:e20230783. [PMID: 37552469 PMCID: PMC10407781 DOI: 10.1084/jem.20230783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Microbial dysbiosis triggers inflammatory periodontitis. In this issue of JEM, Kim et al. (2023. J. Exp. Med.https://doi.org/10.1084/jem.20221751) demonstrate that neutrophil extracellular trap histones are the major mediators fueling the pathogenic Th17 inflammation that promotes gum and bone loss in periodontitis.
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Fan Z, Chen R, Yin W, Xie X, Wang S, Hao C. Effects of AIM2 and IFI16 on Infectious Diseases and Inflammation. Viral Immunol 2023; 36:438-448. [PMID: 37585649 DOI: 10.1089/vim.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Both absent in melanoma 2 (AIM2) and interferon-inducible protein 16 (IFI16) are intracellular innate immune receptors that recognize double-stranded DNA released during pathogenic infection, leading to the assembly of the inflammasome. The assembly of the inflammasome results in the secretion of bioactive interleukin (IL)-1β and IL-18 and induces cell death through an inflammatory process called pyroptosis. Although the AIM2 inflammasome is generally harmful in the context of some aseptic inflammatory illnesses, it plays a protective role in infectious diseases. During inflammatory processes, there is competition between IFI16 and AIM2. In this review, we explore the impacts of IFI16 and AIM2 in infectious disease and aseptic inflammation, respectively, and how they compete.
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Affiliation(s)
- Zhen Fan
- Department of Stomatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, P.R. China
| | - Rui Chen
- Department of Stomatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, P.R. China
| | - Wen Yin
- Department of Stomatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, P.R. China
| | - Xiaomei Xie
- Department of Stomatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, P.R. China
| | - Shan Wang
- Department of Oral Pathology, School of Stomatology, Hainan Medical University, Haikou, P.R. China
- Department of Stomatology, The Second Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
| | - Chunbo Hao
- Department of Stomatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, P.R. China
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Oliveira VB, Costa FWG, Haas AN, Júnior RMM, Rêgo RO. Effect of subgingival periodontal therapy on glycaemic control in type 2 diabetes patients: Meta-analysis and meta-regression of 6-month follow-up randomized clinical trials. J Clin Periodontol 2023; 50:1123-1137. [PMID: 37257917 DOI: 10.1111/jcpe.13830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/05/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Periodontitis worsens the hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Subgingival instrumentation, with or without surgical access, is the gold-standard treatment for periodontitis. The aim was to summarize the evidence on the effect of subgingival instrumentation (with or without open flap) on the reduction of glycosylated haemoglobin (HbA1c). METHODS Nine electronic databases were searched up to 15 February 2023. Twelve randomized controlled trials with at least 6 months of follow-up were included. Studies using systemic or local-delivery antimicrobial therapies were excluded. Meta-analyses were performed using the random-effects model. The sources of heterogeneity were assessed by applying linear meta-regression. Risk of bias was assessed by RoB 2, and certainty of evidence by GRADE. RESULTS Eleven studies were included in the quantitative analyses (1374 patients). Subgingival instrumentation resulted in 0.29% lower HbA1c (95% confidence interval: 0.10-0.47; p = .03) compared with non-active treatment. DISCUSSION None of the 12 studies were assessed as having low risk of bias. The percentage of females and the time of diabetes diagnosis significantly explained the high level of heterogeneity. Subgingival periodontal therapy results in a significant and clinically relevant improvement in glycaemic control over 6 months in patients with T2DM and periodontitis. The grade of evidence was moderate.
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Affiliation(s)
- Victor Bento Oliveira
- Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Fábio Wildson Gurgel Costa
- Department of Clinical Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Alex Nogueira Haas
- Department of Conservative Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rodrigo Otávio Rêgo
- Department of Clinical Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
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Marruganti C, Romandini M, Gaeta C, Cagidiaco EF, Discepoli N, Parrini S, Graziani F, Grandini S. Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study. J Clin Periodontol 2023; 50:1089-1100. [PMID: 37013691 DOI: 10.1111/jcpe.13813] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
AIM To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy. METHODS A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] ≥4 mm with bleeding on probing, and no sites with PPD ≥ 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders. RESULTS Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p < .01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p < .05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p < .01). Subjects with a combination of 'unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD≥6 mm (MD = 1.51; 95% CI: 0.23-2.80; p < .05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p < .05) at re-evaluation. CONCLUSIONS Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mario Romandini
- Faculty of Odontology, University Complutense, Madrid, Spain
| | - Carlo Gaeta
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Nicola Discepoli
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Parrini
- Unit of Oral Surgery, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Shen MT, Shahin B, Chen Z, Adami GR. Unexpected lower level of oral periodontal pathogens in patients with high numbers of systemic diseases. PeerJ 2023; 11:e15502. [PMID: 37465146 PMCID: PMC10351517 DOI: 10.7717/peerj.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023] Open
Abstract
Background Periodontal disease is associated with systemic conditions such as diabetes, arthritis, and cardiovascular disease, all diseases with large inflammatory components. Some, but not all, reports show periopathogens Porphyromonas gingivialis and Tannerella forsythia at higher levels orally in people with one of these chronic diseases and in people with more severe cases. These oral pathogens are thought to be positively associated with systemic inflammatory diseases through induction of oral inflammation that works to distort systemic inflammation or by directly inducing inflammation at distal sites in the body. This study aimed to determine if, among patients with severe periodontal disease, those with multi-morbidity (or many chronic diseases) showed higher levels of periodontal pathogens. Methods A total of 201 adult subjects, including 84 with severe periodontal disease were recruited between 1/2017 and 6/2019 at a city dental clinic. Electronic charts supplied self-reported diseases and conditions which informed a morbidity index based on the number of chronic diseases and conditions present. Salivary composition was determined by 16S rRNA gene sequencing. Results As expected, patients with severe periodontal disease showed higher levels of periodontal pathogens in their saliva. Also, those with severe periodontal disease showed higher levels of multiple chronic diseases (multimorbidity). An examination of the 84 patients with severe periodontal disease revealed some subjects despite being of advanced age were free or nearly free of systemic disease. Surprisingly, the salivary microbiota of the least healthy of these 84 subjects, defined here as those with maximal multimorbidity, showed significantly lower relative numbers of periodontal pathogens, including Porphyromonas gingivalis and Tannerella Forsythia, after controlling for active caries, tobacco usage, age, and gender. Analysis of a control group with none to moderate periodontal disease revealed no association of multimorbidity or numbers of medications used and specific oral bacteria, indicating the importance of severe periodontal disease as a variable of interest. Conclusion The hypothesis that periodontal disease patients with higher levels of multimorbidity would have higher levels of oral periodontal pathogens is false. Multimorbidity is associated with a reduced relative number of periodontal pathogens Porphyromonas gingivalis and Tannerella forsythia.
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Affiliation(s)
- Michael T Shen
- Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
| | - Betti Shahin
- Restorative Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America
- Biostatistics Shared Resource Core, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL, United States of America
| | - Guy R Adami
- Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL, United States of America
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Allalou A, Peng J, Robinson GA, Marruganti C, D’Aiuto F, Butler G, Jury EC, Ciurtin C. Impact of puberty, sex determinants and chronic inflammation on cardiovascular risk in young people. Front Cardiovasc Med 2023; 10:1191119. [PMID: 37441710 PMCID: PMC10333528 DOI: 10.3389/fcvm.2023.1191119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Worrying trends of increased cardiovascular disease (CVD) risk in children, adolescents and young people in the Modern Era have channelled research and public health strategies to tackle this growing epidemic. However, there are still controversies related to the dynamic of the impact of sex, age and puberty on this risk and on cardiovascular health outcomes later in life. In this comprehensive review of current literature, we examine the relationship between puberty, sex determinants and various traditional CVD-risk factors, as well as subclinical atherosclerosis in young people in general population. In addition, we evaluate the role of chronic inflammation, sex hormone therapy and health-risk behaviours on augmenting traditional CVD-risk factors and health outcomes, ultimately aiming to determine whether tailored management strategies for this age group are justified.
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Affiliation(s)
- Amal Allalou
- University College London Medical School, University College London, London, United Kingdom
| | - Junjie Peng
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - George A. Robinson
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Crystal Marruganti
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Francesco D’Aiuto
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Gary Butler
- Department of Paediatric Endocrinology, University College London Hospital, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
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Rodrigues JVS, Cláudio MM, Franciscon JPS, Rosa RAC, Cirelli T, de Molon RS, Figueredo CMS, Garcia VG, Theodoro LH. The Effect of Non-Surgical Periodontal Treatment on Patients with Combined Refractory Arterial Hypertension and Stage III, Grade B Periodontitis: A Preliminary Prospective Clinical Study. J Clin Med 2023; 12:4277. [PMID: 37445313 DOI: 10.3390/jcm12134277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
We sought to evaluate the effects of non-surgical periodontal treatment (NSPT) on periodontal clinical parameters, systemic blood pressure (BP), and plasma levels of systemic inflammation markers in patients with combined refractory arterial hypertension (RAH) and stage III grade B periodontitis. Twenty-seven participants with RAH and periodontitis received NSPT. The analyzed clinical parameters were probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI). An assessment was performed for systemic BP, complete blood count, coagulogram, creatinine measurement, C-reactive protein (CRP), glycated hemoglobin, cholesterol, glutamic oxaloacetic transaminase, glutamate pyruvic transaminase, waist-hip ratio, and body mass index. In the follow-up period, twenty-two patients were evaluated at baseline and after 90 and 180 days. The data were submitted for statistical analysis (α = 0.05%). As expected, the clinical results showed a significant improvement in the percentages of PI, BOP, PD, and CAL, which were statistically significant at 90 and 180 days (p < 0.0001). Importantly, NSPT significantly reduced the blood level of CRP (p < 0.02). However, no significant reduction in BP parameters was noted in the evaluated follow-up periods. NSPT, despite the benefits in periodontal clinical parameters, reduced the plasma level of CRP but not the BP in patients with combined RAH and periodontitis.
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Affiliation(s)
- João Victor Soares Rodrigues
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
- Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba 16015-050, SP, Brazil
| | - Marina Módulo Cláudio
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
| | - João Paulo Soares Franciscon
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
| | - Rossana Abud Cabrera Rosa
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
| | - Thamiris Cirelli
- Department of Dentistry, University Center of Associated School-UNIFAE, São João da Boa Vista 13870-377, SP, Brazil
| | - Rafael Scaf de Molon
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
| | - Carlos Marcelo S Figueredo
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4111, Australia
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, OF Odontologi, OF Orala sjukdomar, 171 77 Stockholm, Sweden
| | - Valdir Gouveia Garcia
- Latin American Institute of Dental Research and Education (ILAPEO), Curitiba 80710-150, PR, Brazil
| | - Leticia Helena Theodoro
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil
- Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba 16015-050, SP, Brazil
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Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
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Chapman LS, Vinall-Collier K, Siddle HJ, Mustufvi Z, Mankia K, Serban S. 'It surprised me a lot that there is a link': a qualitative study of the acceptability of periodontal treatment for individuals at risk of rheumatoid arthritis. RMD Open 2023; 9:rmdopen-2023-003099. [PMID: 37156573 PMCID: PMC10174022 DOI: 10.1136/rmdopen-2023-003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Current evidence suggests that periodontal disease could be a causal risk factor for rheumatoid arthritis (RA) onset and progression. Earlier periodontal intervention in individuals at risk of RA could provide a unique opportunity to prevent or delay the onset of RA. This study aimed to explore the acceptability of periodontal treatment as a measure to potentially prevent RA among at-risk individuals and healthcare professionals. METHODS Semistructured interviews were conducted with anti-CCP positive at-risk individuals (CCP+ at risk) and a range of healthcare professionals. At-risk participant data were analysed using reflexive thematic analysis; subsequent coding of healthcare professional data was deductive, based on a preidentified set of constructs. RESULTS Nineteen CCP+ at-risk and 11 healthcare professionals participated. Three themes (six subthemes) were identified: (1) understanding risk (knowledge of shared at-risk factors; information and communication); (2) oral health perceptions and experiences (personal challenges and opportunities for dental intervention and oral health maintenance; external barriers) and (3) oral health treatment and maintenance (making oral health changes with the aim of preventing RA; acceptability of participation in periodontal research). CONCLUSIONS Periodontal disease is common in individuals at risk of RA, but the impact of poor oral health may not be well understood. Oral health information should be tailored to the individual. CCP+ at-risk participants and healthcare professionals identified seeking dental treatment can be hindered by dental phobia, treatment costs or inability to access dentists. While CCP+ at-risk individuals may be reluctant to take preventive medications, a clinical trial involving preventive periodontal treatment is potentially acceptable.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Karen Vinall-Collier
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Zhain Mustufvi
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - K Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Stefan Serban
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
- Public Health Directorate, NHS England North West Region, Manchester, UK
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Nagy FT, Gheorghita D, Dharmarajan L, Braunitzer G, Achim A, Ruzsa Z, Antal MÁ. Oral Health of Patients Undergoing Percutaneous Coronary Intervention-A Possible Link between Periodontal Disease and In-Stent Restenosis. J Pers Med 2023; 13:jpm13050760. [PMID: 37240930 DOI: 10.3390/jpm13050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: There is a well-documented association between coronary artery disease (CHD) and periodontal disease (PD) mediated by common inflammatory pathways. This association, however, has not been investigated extensively in the special context of in-stent restenosis. This study aimed to investigate the periodontal status of patients undergoing percutaneous coronary intervention (PCI) for restenotic lesions. Methods and Results: We enrolled 90 patients undergoing percutaneous coronary intervention and 90 age- and gender-matched healthy controls in the present study. All subjects received a full-mouth examination by a periodontist. Plaque index, periodontal status, and tooth loss were determined. The periodontal state was significantly worse (p < 0.0001) in the PCI group, and each periodontal stage increased the odds of belonging to the PCI group. This effect of PD was independent of diabetes mellitus, another strong risk factor for CAD. The PCI group was further divided into two subgroups: PCI for restenotic lesions (n = 39) and PCI for de novo lesions (n = 51). Baseline clinical and procedural characteristics were comparable between the two PCI subgroups. A significant (p < 0.001) association was found between the PCI subgroup and the severity of periodontal disease, with the incidence of severe PD reaching 64.1%. Conclusions: Patients undergoing PCI for in-stent restenosis exhibit more severe forms of periodontal disease not only as compared to healthy controls but also as compared to patients stented for de novo lesions. The potential causality between PD and restenosis must be studied in larger prospective studies.
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Affiliation(s)
- Ferenc Tamás Nagy
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Dorottya Gheorghita
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
| | | | | | - Alexandru Achim
- "Nicolae Stancioiu" Heart Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Márk Ádám Antal
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
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Pigeaud KE, Rietveld ML, Witvliet AF, Hogervorst JMA, Zhang C, Forouzanfar T, Bravenboer N, Schoenmaker T, de Vries TJ. The Effect of Sclerostin and Monoclonal Sclerostin Antibody Romosozumab on Osteogenesis and Osteoclastogenesis Mediated by Periodontal Ligament Fibroblasts. Int J Mol Sci 2023; 24:ijms24087574. [PMID: 37108735 PMCID: PMC10145870 DOI: 10.3390/ijms24087574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Sclerostin is a bone formation inhibitor produced by osteocytes. Although sclerostin is mainly expressed in osteocytes, it was also reported in periodontal ligament (PDL) fibroblasts, which are cells that play a role in both osteogenesis and osteoclastogenesis. Here, we assess the role of sclerostin and its clinically used inhibitor, romosozumab, in both processes. For osteogenesis assays, human PDL fibroblasts were cultured under control or mineralizing conditions with increasing concentrations of sclerostin or romosozumab. For analyzing osteogenic capacity and alkaline phosphatase (ALP) activity, alizarin red staining for mineral deposition and qPCR of osteogenic markers were performed. Osteoclast formation was investigated in the presence of sclerostin or romosozumab and, in PDLs, in the presence of fibroblasts co-cultured with peripheral blood mononuclear cells (PBMCs). PDL-PBMC co-cultures stimulated with sclerostin did not affect osteoclast formation. In contrast, the addition of romosozumab slightly reduced the osteoclast formation in PDL-PBMC co-cultures at high concentrations. Neither sclerostin nor romosozumab affected the osteogenic capacity of PDL fibroblasts. qPCR analysis showed that the mineralization medium upregulated the relative expression of osteogenic markers, but this expression was barely affected when romosozumab was added to the cultures. In order to account for the limited effects of sclerostin or romosozumab, we finally compared the expression of SOST and its receptors LRP-4, -5, and -6 to the expression in osteocyte rich-bone. The expression of SOST, LRP-4, and LRP-5 was higher in osteocytes compared to in PDL cells. The limited interaction of sclerostin or romosozumab with PDL fibroblasts may relate to the primary biological function of the periodontal ligament: to primarily resist bone formation and bone degradation to the benefit of an intact ligament that is indented by every chew movement.
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Affiliation(s)
- Karina E Pigeaud
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Melanie L Rietveld
- Amsterdam University College, University of Amsterdam and Vrije Universiteit, Science Park 113, 1098 XG Amsterdam, The Netherlands
| | - Aster F Witvliet
- Amsterdam University College, University of Amsterdam and Vrije Universiteit, Science Park 113, 1098 XG Amsterdam, The Netherlands
| | - Jolanda M A Hogervorst
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 LA Amsterdam, The Netherlands
| | - Chen Zhang
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 LA Amsterdam, The Netherlands
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Tim Forouzanfar
- Oral Pathology and 3D Innovation Lab, Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 LA Amsterdam, The Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ton Schoenmaker
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Teun J de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
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Rengo C, Valletta A, Liccardo D, Spagnuolo G, Corbi G, De Luca F, Lauria MR, Perrotta A, Rengo G, Ferrara N, Rengo S, Valletta R, Cannavo A. Healthy aging: when periodontal health matters. JGG 2023. [DOI: 10.36150/2499-6564-n580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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45
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Marruganti C, Baima G, Aimetti M, Grandini S, Sanz M, Romandini M. Periodontitis and low cognitive performance: A population-based study. J Clin Periodontol 2023; 50:418-429. [PMID: 36644802 DOI: 10.1111/jcpe.13779] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
AIM To study the epidemiological association between periodontitis and low cognitive performance among older adults, within a representative sample of the U.S. POPULATION MATERIALS AND METHODS Data from 2086 older adults (≥60 years old), representative of 77.1 million people, were retrieved from the NHANES 2011-2014 database. Periodontitis cases were identified and classified according to the AAP/CDC criteria (mild, moderate, and severe). Cognitive function was assessed through the Consortium to Establish a Registry for Alzheimer's disease (CERAD), the animal fluency test (AFT), the digit symbol substitution test (DSST), and the global cognition score. The lowest non-survey weighted quartile for each cognitive test was defined as low cognitive performance. Simple and multiple regression analyses were performed. RESULTS Moderate and severe periodontitis were significantly associated with a low DSST performance (OR = 1.66 and OR = 2.97, respectively). Each millimetre increase in mean CAL was associated with a lower AFT (OR = 1.44), DSST (OR = 1.86), and global cognition (OR = 1.50) performance. CONCLUSIONS The findings of the present study suggest the existence of an independent association between periodontitis and low cognitive performance among older adults (≥60 years old).
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
- University of Turin, Polytechnic of Turin, Turin, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
- University of Turin, Polytechnic of Turin, Turin, Italy
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mariano Sanz
- Faculty of Odontology, University Complutense, Madrid, Spain
| | - Mario Romandini
- Faculty of Odontology, University Complutense, Madrid, Spain
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Graziani F, Gennai S, Marruganti C, Peric M, Ghiadoni L, Marhl U, Petrini M. Acute-phase response following one-stage full-mouth versus quadrant non-surgical periodontal treatment in subjects with comorbid type 2 diabetes: A randomized clinical trial. J Clin Periodontol 2023; 50:487-499. [PMID: 36517997 DOI: 10.1111/jcpe.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
AIM To compare the level of inflammatory markers and endothelial function 24 h (Day 1) and 90 days (Day 90) after conventional quadrant-wise scaling and root planing (Q-SRP) versus one-stage full-mouth SRP (FM-SRP) in patients affected by type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Patients affected by periodontitis and T2DM were randomly allocated to receive FM-SRP or Q-SRP and followed up at Day 1 and Day 90. Serum samples, vital signs, and flow-mediated dilation (FMD) parameters were collected at baseline, Day 1, and Day 90. Periodontal variables were collected at baseline and Day 90. The primary outcome was the C-reactive protein (CRP) concentration at Day 1 after periodontal treatment. Student's t-test for independent samples was used for between-group comparisons (Mann-Whitney U test for non-normal data), while analysis of variance with post hoc Tukey tests (Kruskal-Wallis and Dunn tests for non-normal data) were used for intra-group comparisons. RESULTS Forty subjects were included in the study. FM-SRP produced a significant increase in CRP and a significant reduction in FMD at Day 1 compared to Q-SRP (p < .05). The absolute change in HbA1c (mmol/mol) from baseline to Day 90 was significantly improved in the Q-SRP (ΔHbA1c = -1.59 [SD = 1.20]) compared to the FM-SRP group (ΔHbA1c = -0.8 [SD = 0.95]) (p = .04). CONCLUSIONS FM-SRP triggers a robust acute-phase response at 24 h after treatment compared to Q-SRP. Such systemic acute perturbations may offset the beneficial systemic effects of periodontal treatment in terms of HbA1c reduction and improvement in endothelial function in T2DM subjects.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
- Unit of Periodontology, Endodontology and Restorative dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marina Peric
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Urska Marhl
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Morena Petrini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Department of Medical, Oral and Biotechnological Science, University of Chieti, Chieti, Italy
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Ye Y, Xu X, Mao B, Tang X, Cui S, Zhao J, Zhang Q. Evaluation of heat-inactivated Limosilactobacillus fermentum CCFM1139 and its supernatant for the relief of experimental periodontitis in rats. Food Funct 2023; 14:2847-2856. [PMID: 36880339 DOI: 10.1039/d2fo02938c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Periodontitis is a chronic inflammatory disease induced by subgingival microbial dysbiosis, characterised by inflammation of the soft tissues of the periodontium and progressive loss of alveolar bone. Limosilactobacillus fermentum CCFM1139 is a probiotic with the potential to relieve periodontitis in vitro and in vivo. Due to the cost of active strain in production applications, we considered the effectiveness of bacterial components and metabolites in alleviating experimental periodontitis. Therefore, this study investigated the effect of heat-inactivated Limosilactobacillus fermentum CCFM1139 and its supernatant in the development of experimental periodontitis through animal experiments. The results showed that active, heat-inactivated Limosilactobacillus fermentum CCFM1139 and its supernatant all significantly reduced IL-1β levels in gingival tissue and serum (p < 0.05). Micro-computed tomography (micro CT) analysis showed that the active and heat-inactivated Limosilactobacillus fermentum CCFM1139 reduced alveolar bone loss in rats with periodontitis by 25.6% and 15.9% respectively (p < 0.05), with no change in percentage of bone volume (p > 0.05). In histomorphometric analysis, active Limosilactobacillus fermentum CCFM1139 showed better results in reducing alveolar bone loss and reducing inflammatory cell recruitment at the second molar. In addition, there was no significant difference in the number of tartrate-resistant acid phosphatase (TRAP) positive cells after in all experimental groups (p > 0.05). Therefore, heat-inactivated Limosilactobacillus fermentum CCFM1139 or its supernatant also have the ability to relieve periodontitis, and their alleviating effect may focus on the regulation of inflammatory response.
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Affiliation(s)
- Yuhan Ye
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
| | - Xianyin Xu
- Department of Stomatology, Wuxi Children's Hospital, Wuxi, Jiangsu 214023, P. R. China
| | - Bingyong Mao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
| | - Xin Tang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
| | - Shumao Cui
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
| | - Qiuxiang Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, P. R. China.
- State Key Laboratory of Dairy Biotechnology, Shanghai Engineering Research Center of Dairy Biotechnology, Dairy Research Institute, Bright Dairy & Food Co., Ltd, Shanghai 200436, China
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Ruan Q, Guan P, Qi W, Li J, Xi M, Xiao L, Zhong S, Ma D, Ni J. Porphyromonas gingivalis regulates atherosclerosis through an immune pathway. Front Immunol 2023; 14:1103592. [PMID: 36999040 PMCID: PMC10043234 DOI: 10.3389/fimmu.2023.1103592] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
Atherosclerosis (AS) is a chronic inflammatory disease, involving a pathological process of endothelial dysfunction, lipid deposition, plaque rupture, and arterial occlusion, and is one of the leading causes of death in the world population. The progression of AS is closely associated with several inflammatory diseases, among which periodontitis has been shown to increase the risk of AS. Porphyromonas gingivalis (P. gingivalis), presenting in large numbers in subgingival plaque biofilms, is the “dominant flora” in periodontitis, and its multiple virulence factors are important in stimulating host immunity. Therefore, it is significant to elucidate the potential mechanism and association between P. gingivalis and AS to prevent and treat AS. By summarizing the existing studies, we found that P. gingivalis promotes the progression of AS through multiple immune pathways. P. gingivalis can escape host immune clearance and, in various forms, circulate with blood and lymph and colonize arterial vessel walls, directly inducing local inflammation in blood vessels. It also induces the production of systemic inflammatory mediators and autoimmune antibodies, disrupts the serum lipid profile, and thus promotes the progression of AS. In this paper, we summarize the recent evidence (including clinical studies and animal studies) on the correlation between P. gingivalis and AS, and describe the specific immune mechanisms by which P. gingivalis promotes AS progression from three aspects (immune escape, blood circulation, and lymphatic circulation), providing new insights into the prevention and treatment of AS by suppressing periodontal pathogenic bacteria.
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Affiliation(s)
- Qijun Ruan
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Peng Guan
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Weijuan Qi
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Jiatong Li
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Mengying Xi
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Limin Xiao
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Sulan Zhong
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Dandan Ma
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
- *Correspondence: Dandan Ma, ; Jia Ni,
| | - Jia Ni
- Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
- *Correspondence: Dandan Ma, ; Jia Ni,
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Yuzefpolskaya M, Bohn B, Ladanyi A, Khoruts A, Colombo PC, Demmer RT. Oral and gut microbiome alterations in heart failure: Epidemiology, pathogenesis and response to advanced heart failure therapies. J Heart Lung Transplant 2023; 42:291-300. [PMID: 36586790 DOI: 10.1016/j.healun.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/18/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Despite significant advances in therapies, heart failure (HF) remains a progressive disease that, once advanced, is associated with significant death and disability. Cardiac replacement therapies with left ventricular assist device (LVAD) and heart transplantation (HT) are the only treatment options for advanced HF, while lifesaving they can also be lifespan limiting due to the associated complications. Systemic inflammation is mechanistically important in HF pathophysiology and progression. However, directly targeting inflammation in HF has not been beneficial thus far. These failed attempts at therapeutics might be related to our limited understanding of the factors that cause inflammation in HF, and, therefore, to our inability to investigate these triggers in interventional studies. Observational studies have consistently demonstrated associations between alterations in the digestive (gut and oral) microbiome, inflammation and HF risk and progression. Additionally, recent data indicate that these microbial perturbations persist following LVAD and HT, along with residual inflammation and oxidative stress. Furthermore, there is rising recognition of the critical contribution of the microbiome to the metabolism of immunosuppressive drugs after HT. Cumulatively, these findings might posit a mechanistic link between microbiome alterations, systemic inflammation, and adverse outcomes in HF patients before and after cardiac replacement therapies. This review (1) provides an update on available data linking changes in digestive tract microbiota, inflammation, and oxidative stress, to HF pathogenesis and progression; (2) describes evolution of these relationships following LVAD and HT; and (3) outlines present and future intervention strategies that can manipulate the microbiome and possibly modify HF disease trajectory.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York City, New York.
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Annamaria Ladanyi
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York City, New York
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine University of Minnesota, Minneapolis, Minnesota
| | - Paolo C Colombo
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York City, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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50
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Corbella S, Calciolari E, Donos N, Alberti A, Ercal P, Francetti L. Laser treatments as an adjunct to non-surgical periodontal therapy in subjects with periodontitis and type 2 diabetes mellitus: a systematic review and meta-analysis. Clin Oral Investig 2023. [PMID: 36849595 DOI: 10.1007/s00784-023-04873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/22/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence. MATERIALS AND METHODS Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control. RESULTS Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence. CONCLUSION Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.
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