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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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2
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AlFatlawi Z, Huang M, Chau DYS, D'Aiuto F. Three dimensional (3D) gingival models in periodontal research: a systematic review. J Mater Sci Mater Med 2023; 34:58. [PMID: 37938480 PMCID: PMC10632299 DOI: 10.1007/s10856-023-06761-z] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
The aim of this study is to systematically appraise the evidence on available full thickness 3D gingival and mucosal models (3D culture in scaffold base system) and their application in periodontal and peri-implant research. This study involved a systematic review of twenty-two studies obtained from searching from five electronic databases: MEDLINE-OVID, EMBASE, EBSCOhost, Web of Science Core Collection and LILACS, as well as a hand search of eligible articles up to September 2022. A total of 2338 studies were initially identified, after removal of duplicates (573), abstracts/title selection (1765), and full text screening (95), twenty-two studies were included, thirty-seven models were identified. Several cellular markers were reported by the studies included. The expression of keratinocytes differentiation markers (K4, K5, K10, K13, K14, K16, K17, K18, K19, involucrin, laminin5), proliferation marker (Ki67, CD90), and vimentin, Type I, II and IV collagen produced by fibroblasts were investigated in thirty models. No quantitative analyses were performed, and results of the review confirmed a substantial level of heterogeneity across experiments. In conclusion, there is currently insufficient evidence to conclude that the available 3D gingival and mucosal models can entirely recapitulate the human gingival tissue/mucosa and provide a useful research tool for periodontal and peri-implant research. This review also highlighted the lack of a standardized protocol to construct and characterize 3D gingival models. A new protocol is proposed for the characterization of in vitro gingival models for future research.
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Affiliation(s)
- Z AlFatlawi
- Periodontology Unit, UCL Eastman Dental Institute, 21 University Street, London, WC1E 6DE, UK
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - M Huang
- Periodontology Unit, UCL Eastman Dental Institute, 21 University Street, London, WC1E 6DE, UK
| | - D Y S Chau
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - F D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute, 21 University Street, London, WC1E 6DE, UK
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3
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Alotaibi FF, Rocchietta I, Buti J, D'Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis. J Clin Periodontol 2023; 50:1487-1519. [PMID: 37495541 DOI: 10.1111/jcpe.13850] [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: 12/07/2022] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
AIM To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. MATERIALS AND METHODS Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. RESULTS Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. CONCLUSIONS VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
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Affiliation(s)
- Faisal F Alotaibi
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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4
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Marruganti C, Suvan JE, D'Aiuto F. Periodontitis and metabolic diseases (diabetes and obesity): Tackling multimorbidity. Periodontol 2000 2023. [PMID: 37845800 DOI: 10.1111/prd.12536] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023]
Abstract
Noncommunicable diseases (NCDs) are multifactorial, long-term, chronic conditions that represent a burden to health-care systems worldwide as they can only be controlled rather than cured; hence, they require long-term care. With the exponential increase in NCDs, the occurrence of individuals presenting with more than one chronic disease is also rapidly rising. "Multimorbidity," defined as the presence of two or more long-term physical or mental disorders, is now considered a worldwide epidemic, affecting around 20% of the adult population. Periodontitis, diabetes, and obesity, all chronic inflammatory diseases, are an example of multimorbidity highly relevant to dental practitioners. Over the last three decades, the three-way relationship among the diseases has been vastly researched and accepted, with important contributions by European researchers. The interplay among periodontitis, diabetes, and obesity is sustained by shared biological mechanisms, such as systemic inflammation, insulin resistance, and metabolic dysfunction, as well as common lifestyle-related risk factors. As such, unhealthy lifestyles were found to generally increase systemic inflammation and insulin resistance and decrease immune function, hence, eventually increasing the risk of NCDs onset and the development of multimorbidity. This narrative review of the evidence supports the need for a paradigm shift from a "single-disease" to a "multiple-disease" framework, characterized by an integrated multidisciplinary approach, which should include lifestyle modification interventions to successfully tackle multimorbid periodontitis and metabolic diseases (diabetes and obesity). A multidisciplinary integrated care pathway in both dental and medical settings should be considered to further tackle the global health challenge of multimorbidity.
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Affiliation(s)
- Crystal Marruganti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Jean E Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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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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6
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Fernandes D, Khambata RS, Massimo G, Ruivo E, Gee LC, Foster J, Goddard A, Curtis M, Barnes MR, Wade WG, Godec T, Orlandi M, D'Aiuto F, Ahluwalia A. Local delivery of nitric oxide prevents endothelial dysfunction in periodontitis. Pharmacol Res 2023; 188:106616. [PMID: 36566926 DOI: 10.1016/j.phrs.2022.106616] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/31/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
AIMS Increased cardiovascular disease risk underlies elevated rates of mortality in individuals with periodontitis. A key characteristic of those with increased cardiovascular risk is endothelial dysfunction, a phenomenon synonymous with deficiencies of bioavailable nitric oxide (NO), and prominently expressed in patients with periodontitis. Also, inorganic nitrate can be reduced to NO in vivo to restore NO levels, leading us to hypothesise that its use may be beneficial in reducing periodontitis-associated endothelial dysfunction. Herein we sought to determine whether inorganic nitrate improves endothelial function in the setting of periodontitis and if so to determine the mechanisms underpinning any responses seen. METHODS AND RESULTS Periodontitis was induced in mice by placement of a ligature for 14 days around the second molar. Treatment in vivo with potassium nitrate, either prior to or following establishment of experimental periodontitis, attenuated endothelial dysfunction, as determined by assessment of acetylcholine-induced relaxation of aortic rings, compared to control (potassium chloride treatment). These beneficial effects were associated with a suppression of vascular wall inflammatory pathways (assessed by quantitative-PCR), increases in the anti-inflammatory cytokine interleukin (IL)-10 and reduced tissue oxidative stress due to attenuation of xanthine oxidoreductase-dependent superoxide generation. In patients with periodontitis, plasma nitrite levels were not associated with endothelial function indicating dysfunction. CONCLUSION Our results suggest that inorganic nitrate protects against, and can partially reverse pre-existing, periodontitis-induced endothelial dysfunction through restoration of nitrite and thus NO levels. This research highlights the potential of dietary nitrate as adjunct therapy to target the associated negative cardiovascular outcomes in patients with periodontitis.
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Affiliation(s)
- Daniel Fernandes
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Department of Pharmacology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Rayomand S Khambata
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Gianmichele Massimo
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Ernesto Ruivo
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Lorna C Gee
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Julie Foster
- Centre for Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Alison Goddard
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Mike Curtis
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - Michael R Barnes
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - William G Wade
- Centre for Host-Microbiome Interactions, King's College London, London, UK; Forsyth Institute, Cambridge, MA 02142, USA
| | - Thomas Godec
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | | | - Amrita Ahluwalia
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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7
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Luthra S, Orlandi M, Hussain SB, Leira Y, Botelho J, Machado V, Mendes JJ, Marletta D, Harden S, D'Aiuto F. Treatment of periodontitis and C-reactive protein: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 2023; 50:45-60. [PMID: 35946825 PMCID: PMC10087558 DOI: 10.1111/jcpe.13709] [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] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/25/2022] [Accepted: 07/23/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic inflammation is implicated in the onset and progression of several chronic diseases. Periodontitis is a potential trigger of systemic inflammation. PURPOSE To comprehensively appraise all the evidence on the effects of the treatment of periodontitis on systemic inflammation assessed by serum C-reactive protein (CRP) levels. DATA SOURCES Six electronic databases were searched up to 10 February 2022 to identify and select articles in English language only. STUDY SELECTION Twenty-six randomized controlled clinical trials reporting changes amongst 2579 participants about CRP levels at 6 months or more after treatment. DATA EXTRACTION Two reviewers independently extracted data and rated the quality of studies. Meta-analyses were performed using random and fixed effect models. RISK OF BIAS Risk of bias (RoB 2.0 tool) and quality of evidence (GRADEpro GDT tool) analyses were completed. DATA SYNTHESIS Treatment of periodontitis reduced CRP levels by 0.69 mg/L (95% confidence interval: -0.97 to -0.40) after 6 months, but limited evidence was retrieved from studies with longer follow-ups. Similar findings were observed in participants with other co-morbidities in addition to periodontitis. Greatest reductions were observed in participants with concentrations of CRP >3 mg/L at baseline. LIMITATIONS High level of heterogeneity. CONCLUSIONS Treatment of periodontitis reduces serum CRP levels (up to 6 months follow-up) to a degree equivalent to that observed after traditional lifestyle or drug interventions. This evidence supports a causal association between periodontitis and systemic inflammation.
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Affiliation(s)
- Shailly Luthra
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | | | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela and Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
- Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
- Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
| | - José João Mendes
- Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
| | | | - Simon Harden
- Department of Statistical Science, UCL Eastman Dental Institute, London, UK
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8
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Luthra S, Orlandi M, Leira Y, Bokre D, Marletta D, Rotundo R, Harden S, D'Aiuto F. Invasive dental treatment and acute vascular events: A systematic review and meta-analysis. J Clin Periodontol 2022; 49:467-479. [PMID: 35132650 PMCID: PMC9311221 DOI: 10.1111/jcpe.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute infection/inflammation increases the risk of acute vascular events (AVEs). Invasive dental treatments (IDTs) trigger short-term acute inflammation. PURPOSE The aim of this work is to critically appraise the evidence linking IDTs and AVEs. DATA SOURCES Six bibliographical databases were searched up to 31 August 2021. A systematic review following PRISMA guidelines was performed. STUDY SELECTION Intervention and observational studies reporting any AVEs following IDT were included. DATA EXTRACTION Two reviewers independently extracted data and rated the quality of studies. Data were pooled using fixed-effect, inverse variance weights analysis. RISK OF BIAS Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook-Rob 2.0 for randomized controlled trials. DATA SYNTHESIS In 3 out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions, and 327,804 ischaemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92 to 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs: 0.97 to1.10) after treatment. LIMITATIONS A high level of heterogeneity (study designs and time point assessments) was found. CONCLUSION Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment.
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Affiliation(s)
- Shailly Luthra
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK.,Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela and Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.,Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Roberto Rotundo
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Simon Harden
- Department of Statistical Science, UCL Eastman Dental Institute, UCL, London, UK
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9
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Irwandi RA, Kuswandani SO, Harden S, Marletta D, D'Aiuto F. Circulating inflammatory cell profiling and periodontitis: A systematic review and meta-analysis. J Leukoc Biol 2022; 111:1069-1096. [PMID: 35199874 DOI: 10.1002/jlb.5ru1021-524r] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/10/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Inflammation is a key driver of common noncommunicable diseases. Among common triggers of inflammation, chronic gingival inflammation (periodontitis) triggers a consistent humoral host inflammatory response, but little is known on its impact on circulating inflammatory cell profiles. We aimed to systematically appraise all the evidence linking periodontitis and its treatment to circulating inflammatory cell profiles. From 6 databases, 157 studies were eligible for qualitative synthesis and 29 studies for meta-analysis. Our meta-analysis showed that participants with periodontitis exhibited a significant mean increase in circulating CD4+ , CD4+ CD45RO+ , IFNγ-expressing CD4+ and CD8+ T cells, CD19+ CD27+ and CD5+ B cells, CD14+ CD16+ monocytes, and CD16+ neutrophils but decrease in CD8+ T and CD14++ CD16- monocytes. Our qualitative synthesis revealed that peripheral blood neutrophils of patients with periodontitis consistently showed elevated production of reactive oxygen species (ROS) when compared with those of healthy controls. Some evidence suggested that the treatment of periodontitis reversed the exaggerated ROS production, but limited and inconclusive data were found on several circulating inflammatory cell profiling. We conclude that periodontitis and its treatment are associated with minor but consistent alterations in circulating inflammatory cell profiles. These changes could represent key mechanisms explaining the association of periodontitis with other comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis.
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Affiliation(s)
- Rizky A Irwandi
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Sandra O Kuswandani
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom.,Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Simon Harden
- Department of Statistical Science, University College London, London, United Kingdom
| | - Debora Marletta
- Cruciform Hub, University College London, London, United Kingdom
| | - Francesco D'Aiuto
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
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10
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Eames I, D'Aiuto F, Shahreza S, Javanmardi Y, Balachandran R, Hyde M, Ng YL, Gulabivala K, Watson S, Davies H, Szita N, Khajeh J, Suvan J, Moeendarbary E. Removal and dispersal of biofluid films by powered medical devices: Modeling infectious agent spreading in dentistry. iScience 2021; 24:103344. [PMID: 34825134 PMCID: PMC8603215 DOI: 10.1016/j.isci.2021.103344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/27/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Medical procedures can disperse infectious agents and spread disease. Particularly, dental procedures may pose a high risk of disease transmission as they use high-powered instruments operating within the oral cavity that may contain infectious microbiota or viruses. Here we assess the ability of powered dental devices in removing the biofluid films and identified mechanical, hydrodynamic, and aerodynamic forces as the main underlying mechanisms of removal and dispersal processes. Our results indicate that potentially infectious agents can be removed and dispersed immediately after dental instrument engagement with the adherent biofluid film, while the degree of their dispersal is rapidly depleted owing to the removal of the source and dilution by the coolant water. We found that droplets created by high-speed drill interactions typically travel ballistically, while aerosol-laden air tends to flow as a current over surfaces. Our mechanistic investigation offers plausible routes for reducing the spread of infection during invasive medical procedures. Mechanical, hydrodynamic, and aerodynamic forces drive removal/dispersal processes The air-rotor has the highest ability to remove and disperse infectious agents The aerosol cloud flows as a current and continuously settles Manipulating rheological properties of the fluids can suppress aerosol generation
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Affiliation(s)
- Ian Eames
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Francesco D'Aiuto
- Unit of Periodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Somayeh Shahreza
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Yousef Javanmardi
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | | | - Martin Hyde
- TSI, 30 Millbank, Westminster, London, SW1P 4WP, UK
| | - Yuan-Ling Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Kishor Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Sara Watson
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Hywel Davies
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Nicolas Szita
- Department of Biochemical Engineering, University College London, Bernard Katz Building, Gower Street, London WC1E 6BT, UK
| | - Janette Khajeh
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, University College London, London, WC1X 8LT, UK
| | - Emad Moeendarbary
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
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11
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Orlandi M, Muñoz Aguilera E, Marletta D, Petrie A, Suvan J, D'Aiuto F. Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:314-327. [PMID: 34791686 DOI: 10.1111/jcpe.13554] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
AIM To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life. MATERIALS AND METHODS Systematic electronic searches were conducted to identify randomized controlled trials with minimum 6-month follow-up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable. RESULTS Meta-analyses confirmed reductions of high-sensitivity C-reactive protein (hs-CRP) [0.56 mg/L, 95% confidence interval (CI) (-0.88, -0.25), p < .001]; interleukin (IL)-6 [0.48 pg/ml, 95% CI (-0.88, -0.08), p = .020], and plasma glucose [1.33 mmol/l, 95% CI (-2.41, -0.24), p = .016], and increase of flow-mediated dilation (FMD) [0.31%, 95% CI (0.07, 0.55), p = .012] and diastolic blood pressure [0.29 mmHg, 95% CI (0.10, 0.49), p = .003] 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed [0.77 risk ratio, 95% CI (0.60, 0.98), p = .036]. Limited evidence was reported on quality-of-life (QoL) outcomes in the included studies. CONCLUSIONS Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | | | | | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
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12
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Pinto RD, Monaco A, Ortu E, Czesnikiewicz-Guzik M, Aguilera EM, Giannoni M, D'Aiuto F, Guzik TJ, Ferri C, Pietropaoli D. Access to dental care and blood pressure profiles in adults with high socioeconomic status. J Periodontol 2021; 93:1060-1071. [PMID: 34726790 PMCID: PMC9542004 DOI: 10.1002/jper.21-0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
Background Reduced access to dental care may increase cardiovascular risk; however, socioeconomic factors are believed to confound the associations. We hypothesized that the relation persists despite economic wellness and high education, with reduced access to dental care affecting cardiovascular risk at least in part through its effect on blood pressure (BP), possibly mediated by systemic inflammation. Methods We first assessed the sociodemographic and clinical characteristics related to last dental visit timing (≤ or >6 months; self‐reported) using national representative cross‐sectional data. Then, the association of last dental visit timing with clinic BP was selectively investigated in highly educated, high income participants, further matched for residual demographic and clinical confounders using propensity score matching (PSM). The mediating effect of systemic inflammation was formally tested. Machine learning was implemented to investigate the added value of dental visits in predicting high BP over the variables included in the Framingham Hypertension Risk Score among individuals without an established diagnosis of hypertension. Results Of 27,725 participants included in the population analysis, 46% attended a dental visit ≤6 months. In the PSM cohort (n = 2350), last dental visit attendance >6 months was consistently associated with 2 mmHg higher systolic BP (P = 0.001) and with 23 to 35% higher odds of high/uncontrolled BP compared with attendance ≤6 months. Inflammation mildly mediated the association. Access to dental care improved the prediction of high BP by 2%. Conclusions Dental care use impacts on BP profiles independent of socioeconomic confounders, possibly through systemic inflammation. Regular dental visits may contribute to preventive medicine.
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Affiliation(s)
- Rita Del Pinto
- Unit of Internal Medicine and Nephrology - Center for Hypertension and Cardiovascular Prevention - San Salvatore Hospital - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy.,Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Annalisa Monaco
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Eleonora Ortu
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK.,Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Eva Muñoz Aguilera
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Mario Giannoni
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Internal and Agricultural Medicine, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Claudio Ferri
- Unit of Internal Medicine and Nephrology - Center for Hypertension and Cardiovascular Prevention - San Salvatore Hospital - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy.,Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Davide Pietropaoli
- Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy.,Center for Oral Diseases, Prevention and Translational Research - San Salvatore Hospital, Dental Clinic - University of L'Aquila, Department of Life, Health and Environmental Sciences, L'Aquila, Italy
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13
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Hussain SB, Leira Y, Zehra SA, Botelho J, Machado V, Ciurtin C, D'Aiuto F, Orlandi M. Periodontitis and Systemic Lupus Erythematosus: A systematic review and meta-analysis. J Periodontal Res 2021; 57:1-10. [PMID: 34608627 DOI: 10.1111/jre.12936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/11/2021] [Revised: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
This systematic review and meta-analysis evaluated the association between periodontitis (PD) and systemic lupus erythematosus (SLE). A systematic search was conducted through the following electronic databases: Cochrane Library, MEDLINE, EMBASE, Scopus, LILACS, CINAHL and SIGLE (System for Information on Grey Literature in Europe) for relevant publications up to September 2020 with no language restriction. The association between PD and SLE was assessed by the prevalence of PD in SLE patients (both sex and females only) as the primary outcome. Secondary outcomes included differences in common gingival parameters including probing pocket depth (PPD), clinical attachment level (CAL), disease activity index (SLEDAI) scores of SLE patients with or without PD. A total of 1183 citations and 22 full text articles were screened. Eighteen articles were included in the qualitative synthesis, and 13 in the quantitative analysis. SLE diagnosis was associated with greater odds of PD (OR = 1.33, 95% Confidence Interval [CI]: 1.20-1.48), but these were non-significant when examined in females (OR = 3.20, 95%CI: 0.85-12.02). Patients with SLE exhibited no differences in PPD (SMD: -0.09 mm, 95%CI: -0.45-0.27) and CAL (SMD: 0.05 mm, 95%CI: -0.30-0.40) when compared with systemically healthy controls. PD diagnosis was, however, associated with higher SLEDAI scores in patients suffering from SLE (SMD: 0.68, 95% CI: 0.03-1.32). PD and SLE are both inflammatory diseases and their association could be bi-directional. This review suggested that the patients with SLE have greater odds of suffering with PD. Further investigations are required to assess the association between PD and SLE.
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Affiliation(s)
- Syed Basit Hussain
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Yago Leira
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Syeda Ambreen Zehra
- Department of Dental Physical Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - João Botelho
- Periodontology Department, Egas Moniz-Cooperativa de Ensino Superior, Almada, Portugal.,Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz, Almada, Portugal
| | - Vanessa Machado
- Periodontology Department, Egas Moniz-Cooperativa de Ensino Superior, Almada, Portugal.,Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz, Almada, Portugal
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospital, London, United Kingdom
| | - Francesco D'Aiuto
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Marco Orlandi
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
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14
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Del Pinto R, Landi L, Grassi G, Sforza NM, Cairo F, Citterio F, Paolantoni G, D'Aiuto F, Ferri C, Monaco A, Pietropaoli D. Hypertension and Periodontitis: A Joint Report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP). High Blood Press Cardiovasc Prev 2021; 28:427-438. [PMID: 34562228 PMCID: PMC8484186 DOI: 10.1007/s40292-021-00466-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.
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Affiliation(s)
- Rita Del Pinto
- Unit of Internal Medicine and Nephrology, Department of Life, Health and Environmental Sciences, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Luca Landi
- Private Practice, Via della Balduina, 114, 00136, Rome, Italy.
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | | | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | | | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Claudio Ferri
- Unit of Internal Medicine and Nephrology, Department of Life, Health and Environmental Sciences, Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
| | - Annalisa Monaco
- Unit of Oral Diseases, Department of Life, Health and Environmental Sciences, Prevention and Translational Research, Dental Clinic, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Davide Pietropaoli
- Unit of Oral Diseases, Department of Life, Health and Environmental Sciences, Prevention and Translational Research, Dental Clinic, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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15
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Serban S, Chapple ILC, D'Aiuto F, Douglas GVA, Pavitt S. Letter to the Editor: "Methodological Gaps in Studying the Oral-Systemic Disease Connection". J Dent Res 2021; 100:1299. [PMID: 34151634 DOI: 10.1177/00220345211024215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Serban
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - I L C Chapple
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - F D'Aiuto
- Eastman Dental Institute, University College London, London, UK
| | - G V A Douglas
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - S Pavitt
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
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16
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Orlandi M, Masi S, Bhowruth D, Leira Y, Georgiopoulos G, Yellon D, Hingorani A, Chiesa ST, Hausenloy DJ, Deanfield J, D'Aiuto F. Remote Ischemic Preconditioning Protects Against Endothelial Dysfunction in a Human Model of Systemic Inflammation: A Randomized Clinical Trial. Arterioscler Thromb Vasc Biol 2021; 41:e417-e426. [PMID: 34107730 DOI: 10.1161/atvbaha.121.316388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom
| | - Stefano Masi
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom.,Internal Medicine Unit, University of Pisa, Italy (S.M.)
| | - Devina Bhowruth
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom.,Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela and Medical-Surgical Dentistry Research Group (Y.L.), Health Research Institute of Santiago de Compostela, Spain.,Clinical Neurosciences Research Laboratory (Y.L.), Health Research Institute of Santiago de Compostela, Spain
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom (G.G.)
| | - Derek Yellon
- The Hatter Cardiovascular Institute (D.Y., D.J.H.), University College London, United Kingdom
| | - Aroon Hingorani
- Institute of Cardiovascular Science (A.H.), University College London, United Kingdom
| | - Scott T Chiesa
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute (D.Y., D.J.H.), University College London, United Kingdom.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.).,National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.).,Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.).,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.)
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (S.M., D.B., S.T.C., J.D.), University College London, United Kingdom
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital (M.O., Y.L., F.D.), University College London, United Kingdom
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17
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Muñoz Aguilera E, Leira Y, Miró Catalina Q, Orlandi M, Czesnikiewicz-Guzik M, Guzik TJ, Hingorani AD, Nart J, D'Aiuto F. Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population-based surveys. J Intern Med 2021; 289:532-546. [PMID: 32969093 DOI: 10.1111/joim.13180] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 06/04/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association. METHODS This cross-sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI-3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C-reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis. RESULTS Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0-1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0-1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1-2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0-1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001). CONCLUSIONS These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.
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Affiliation(s)
- E Muñoz Aguilera
- From the, Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Y Leira
- From the, Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.,Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Q Miró Catalina
- Department of Statistics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - M Orlandi
- From the, Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - M Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK.,Department of Experimental Dentistry and Dental Prophylaxis, Jagiellonian University, Krakow, Poland
| | - T J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Internal and Agricultural Medicine, Jagiellonian University, Krakow, Poland
| | - A D Hingorani
- Genetic Epidemiology, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - J Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - F D'Aiuto
- From the, Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
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18
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Muñoz Aguilera E, Suvan J, Orlandi M, Miró Catalina Q, Nart J, D'Aiuto F. Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy Individuals: Results From a Nested Case-Control Study. Hypertension 2021; 77:1765-1774. [PMID: 33775115 DOI: 10.1161/hypertensionaha.120.16790] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Eva Muñoz Aguilera
- From the Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, United Kingdom (E.M.A., J.S., M.O., F.D.).,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain (E.M.A., Q.M.C., J.N.)
| | - Jean Suvan
- From the Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, United Kingdom (E.M.A., J.S., M.O., F.D.)
| | - Marco Orlandi
- From the Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, United Kingdom (E.M.A., J.S., M.O., F.D.)
| | - Queralt Miró Catalina
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain (E.M.A., Q.M.C., J.N.)
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain (E.M.A., Q.M.C., J.N.)
| | - Francesco D'Aiuto
- From the Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, United Kingdom (E.M.A., J.S., M.O., F.D.)
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19
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Leira Y, Fragkiskos D, Orlandi M, Suvan J, Nibali L, Tonetti MS, Belibasakis GN, Bostanci N, D'Aiuto F. Severe Periodontitis and Biomarkers of Bacterial Burden. Results From a Case-Control and Intervention Clinical Trial. Front Oral Health 2021; 2:615579. [PMID: 35047991 PMCID: PMC8757820 DOI: 10.3389/froh.2021.615579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background and aims: Periodontitis is an inflammatory-infectious disease. Identifying markers of systemic exposure of periodontitis might be of interest to study its interaction with other conditions. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) is upregulated during bacterial infections. Our aim was therefore to investigate whether periodontitis and its treatment are associated with bacterial endotoxin and sTREM-1. Methods: Fifty patients with severe periodontitis and 50 age-matched controls were included in a case-control study (all never smokers). A secondary analysis of a previously published intervention study was performed, in which included 69 patients with severe periodontitis were randomized to receive either intensive (IPT) or control periodontal therapy (CPT) and monitored over 6 months. Serum levels of bacterial endotoxin and sTREM-1 were determined at one time point (case-control study) and at baseline, 1 day, 1 and 6 months after periodontal treatment (intervention study). Results: Severe periodontitis was associated with elevated circulating endotoxin levels when cases (22.9 ± 2.2 EU/ml) were compared to controls (3.6 ± 0.5 EU/ml, p < 0.001) and with sTREM-1 levels (1302.6 ± 47.8 vs. 870.6 ± 62.0 pg/ml, p < 0.001). A positive correlation was observed between sTREM-1 and endotoxin levels (r = 0.4, p < 0.001). At 6 months after treatment, IPT significantly decreased serum levels of sTREM-1 compared to CPT (adjusted mean difference of 500.2 pg/ml, 95% CI: 18.9–981.4; p = 0.042). No substantial differences were noted in endotoxin levels at any time point after treatment between groups. Conclusions: Severe periodontitis is linked to increased circulating endotoxin and sTREM-1 levels and following IPT a reduction in sTREM-1 levels is observed.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Center, University College London, London, United Kingdom
- Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Dimitrios Fragkiskos
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Center, University College London, London, United Kingdom
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Center, University College London, London, United Kingdom
| | - Jeanie Suvan
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Center, University College London, London, United Kingdom
| | - Luigi Nibali
- Periodontology Unit, Center for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Maurizio S. Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, Prince Philip Dental Hospital, University of Hong Kong, Hong Kong, China
- European Research Group on Periodontology, Genova, Italy
| | - Georgios N. Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Nagihan Bostanci
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Center, University College London, London, United Kingdom
- *Correspondence: Francesco D'Aiuto
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West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent 2021; 106:103562. [PMID: 33573801 DOI: 10.1016/j.jdent.2020.103562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.
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Affiliation(s)
- Nicola West
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK.
| | - Nick Claydon
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Francesco D'Aiuto
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Nikos Donos
- Periodontology, Institute of Dentistry, Barts and The London School of Medicine & Dentistry, Queen Mary University, Turner Street, London E1 2AD, UK.
| | - Mark Ide
- Periodontology, Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE1 9RT, UK.
| | - Ian Needleman
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA.
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21
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Suvan J, Masi S, Harrington Z, Santini E, Raggi F, D'Aiuto F, Solini A. Effect of Treatment of Periodontitis on Incretin Axis in Obese and Nonobese Individuals: A Cohort Study. J Clin Endocrinol Metab 2021; 106:e74-e82. [PMID: 33084864 DOI: 10.1210/clinem/dgaa757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/23/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Periodontitis confers an increased risk of developing type 2 diabetes and, in patients with obesity, it might interfere with the incretin axis. The effect of periodontal treatment on glucoregulatory hormones remains unknown. OBJECTIVE To evaluate the effect of periodontal treatment on incretin axis in obese and lean nondiabetic individuals. SETTING King's College Dental Hospital and Institute, London, UK. PARTICIPANTS AND METHODS The metabolic profile of obese and normal-body-mass-index individuals affected by periodontitis was studied at baseline, 2, and 6 months after intensive periodontal treatment, by measuring plasma insulin, glucagon, glucagon-like peptide-1(GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) and markers of systemic inflammation and oxidative stress. MAIN OUTCOME MEASURE(S) Circulating levels of incretins and inflammatory markers. RESULTS At baseline, periodontal parameters were worse for obese than nonobese; this was accompanied by higher levels of circulating high-sensitivity C-reactive protein (hs-CRP), insulin, and GLP-1. The response to periodontal treatment was less favorable in the obese group, without significant variations of hs-CRP or malondialdehyde. Glucoregulatory hormones changed differently after treatment: while insulin and glucagon did not vary at 2 and 6 months, GLP-1 and GIP significantly increased at 6 months in both groups. In particular, GLP-1 increased more rapidly in obese participants, while the increase of GIP followed similar trends across visits in both groups. CONCLUSIONS Nonsurgical treatment of periodontitis is associated with increased GLP-1 and GIP levels in nonobese and obese patients; changes in GLP-1 were more rapid in obese participants. This might have positive implications for the metabolic risk of these individuals.
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Affiliation(s)
- Jeanie Suvan
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zoe Harrington
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
| | | | - Francesco Raggi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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22
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Botelho J, Machado V, Hussain SB, Zehra SA, Proença L, Orlandi M, Mendes JJ, D'Aiuto F. Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis. Exp Hematol 2020; 93:1-13. [PMID: 33068648 DOI: 10.1016/j.exphem.2020.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/01/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022]
Abstract
Periodontitis is a chronic inflammatory disease with local and systemic implications. Evidence suggests consistent hematologic changes associated with periodontitis. Our aim was to critically appraise the available evidence on hemogram, leukogram, and thrombogram alterations in otherwise healthy patients suffering from periodontitis when compared with controls. For this systematic review (SR), we searched MEDLINE, Web of Science, EMBASE, and the Cochrane Library (CENTRAL) for studies published up to June 2020. Both observational and interventional studies with baseline standard hematologic levels were included. Outcomes of interest were baseline hemogram, leukogram, and thrombogram values and the impact of periodontitis treatment on these outcomes. Upon risk of bias assessment, data extraction and both qualitative and quantitative (standardized mean differences) analyses were performed. Random-effects meta-analyses were performed to provide pooled estimates. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed (PROSPERO Reg. No. CRD42020164531). A total of 45 studies, eight intervention and 37 case-control studies, were identified after the final search of 3,012 titles. Following quality assessment, 43 articles were deemed to have low risk of bias, and two articles moderate risk. Meta-analyses confirmed that periodontitis was associated with both white and red cell lineages. Severe chronic periodontitis was associated with greater white blood cell counts (mean difference [MD] = 0.53, 95% confidence interval [CI]: 0.26-0.79) when compared with controls. Periodontitis was associated with a larger number of neutrophils (MD = 7.16%, 95% CI: 5.96-8.37) and lower mean platelet volume (MD = 0.30 fL, 95% CI: 0.49 to -0.10) compared with healthy participants. Nonsurgical periodontal treatment was associated with a decrease in white blood cell (WBC) levels (MD = 0.28 109/L, 95% CI: -0.47 to -0.08) in patients with chronic periodontitis. Periodontitis is associated with hematologic changes (Strength of Recommendation Taxonomy [SORT] A recommendation). Higher WBC levels, higher neutrophil levels, higher erythrocyte sedimentation rate, and lower mean platelet volumes are the most common blood count findings. The association between periodontitis and WBC could be causal in nature. Further assessment to determine whether periodontitis causes changes in circulating blood cells and to identify the molecular mechanisms underlying these associations is warranted.
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Affiliation(s)
- João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal; Evidence-Based Hub, CRU, CiiEM, IUEM, Almada, Portugal.
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal; Evidence-Based Hub, CRU, CiiEM, IUEM, Almada, Portugal
| | - Syed Basit Hussain
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
| | | | - Luís Proença
- Quantitative Methods for Health Research, CiiEM, IUEM, Monte de Caparica, Portugal
| | - Marco Orlandi
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
| | | | - Francesco D'Aiuto
- Periodontology Unit, University College London Eastman Dental Institute, London, UK
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23
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Pietropaoli D, Monaco A, D'Aiuto F, Muñoz Aguilera E, Ortu E, Giannoni M, Czesnikiewicz-Guzik M, Guzik TJ, Ferri C, Del Pinto R. Active gingival inflammation is linked to hypertension. J Hypertens 2020; 38:2018-2027. [PMID: 32890278 DOI: 10.1097/hjh.0000000000002514] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear. METHODS Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning. RESULTS Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power. CONCLUSION Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.
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Affiliation(s)
- Davide Pietropaoli
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Annalisa Monaco
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eva Muñoz Aguilera
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eleonora Ortu
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Mario Giannoni
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Rita Del Pinto
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
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24
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Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Barbosa Ribeiro A, Orlandi M, Guzik TJ, Hingorani AD, Nart J, D'Aiuto F. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res 2020; 116:28-39. [PMID: 31549149 DOI: 10.1093/cvr/cvz201] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [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: 05/30/2019] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10-1.35] and severe PD (OR = 1.49; 95% CI: 1.09-2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85-3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88-6.11] and DBP (2.03 mmHg; 95% CI: 1.25-2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.
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Affiliation(s)
- Eva Muñoz Aguilera
- Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK.,Department of Periodontology, Faculty of Dentistry, Universitat Internacional de Catalonia, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Jean Suvan
- Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK
| | - Jacopo Buti
- Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow G12 8QQ, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK.,Department of Experimental Dentistry and Dental Prophylaxis, Jagiellonian University, Krakow, Poland.,Department of Internal and Agricultural Medicine, Jagiellonian University, Krakow, Poland
| | - Aline Barbosa Ribeiro
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow G12 8QQ, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK.,Department of Physiology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Orlandi
- Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK
| | - Tomasz J Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow G12 8QQ, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK.,Department of Experimental Dentistry and Dental Prophylaxis, Jagiellonian University, Krakow, Poland.,Department of Internal and Agricultural Medicine, Jagiellonian University, Krakow, Poland
| | - Aroon D Hingorani
- Genetic Epidemiology, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - Jose Nart
- Department of Periodontology, Faculty of Dentistry, Universitat Internacional de Catalonia, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, University College London Eastman Dental Institute, London WC1X 8LD, UK
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25
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Abstract
Cardiovascular diseases are the worldwide leading cause of mortality. Cardiovascular diseases are noncommunicable conditions with a complex pathogenesis, and their clinical manifestations include major cardiovascular events such as myocardial infarction and stroke. Epidemiologic evidence suggests a consistent association between periodontitis and increased risk of cardiovascular diseases. Some evidence supports a beneficial effect of the treatment of periodontitis on both surrogate and hard cardiovascular outcomes. This narrative review has been conducted as an update of the most recent evidence on the effects of periodontitis treatment on cardiovascular outcomes since the last commissioned review of the European Federation of Periodontology-American Academy of Periodontology World Workshop in 2012. Newer evidence originating from published randomized controlled trials confirms a positive effect of periodontal treatment on surrogate measures of cardiovascular diseases, whereas there have been no randomized controlled trials investigating the effect of periodontal treatment on the incidence of cardiovascular disease events such as myocardial infarction and stroke. In conclusion, there is sufficient evidence from observational and experimental studies on surrogate cardiovascular measures to justify the design and conduct of appropriately powered randomized controlled trials investigating the effect of effective periodontal interventions on cardiovascular disease outcomes (ie, myocardial infarction and stroke) with adequate control of traditional cardiovascular risk factors.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | - 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
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26
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Affiliation(s)
- Stefano Masi
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, Level 2, Nomura House, 1 St Martins Le Grand, London, UK.,Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco D'Aiuto
- UCL Eastman Dental Institute, Periodontology Unit, University College London, UK
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, Level 2, Nomura House, 1 St Martins Le Grand, London, UK
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27
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Leira Y, Iglesias-Rey R, Gómez-Lado N, Aguiar P, Sobrino T, D'Aiuto F, Castillo J, Blanco J, Campos F. Periodontitis and vascular inflammatory biomarkers: an experimental in vivo study in rats. Odontology 2020; 108:202-212. [PMID: 31583485 PMCID: PMC7066291 DOI: 10.1007/s10266-019-00461-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022]
Abstract
The objective of this preclinical in vivo study was to determine changes in vascular inflammatory biomarkers in systemic circulation after injection of lipopolysaccharide (LPS) from Porphyromonas gingivalis (Pg) in rats. Experimental periodontitis was induced by injections of Pg-LPS. Gingival soft and hard tissues changes were analysed by means of magnetic resonance imaging and micro computed tomography. Serum levels of interleukin (IL)-6, IL-10, pentraxin (PTX) 3, and soluble fragment of tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) were determined at baseline and 24 h, 7, 14, and 21 days after periodontal induction. Significant periodontal inflammation and alveolar bone loss were evident at the end of periodontal induction. Experimental periodontitis posed an acute systemic inflammatory response with increased serum levels of IL-6 and PTX3 at 24 h post-induction, followed by a significant overexpression of sTWEAK at 7 days. This inflammatory state was maintained until the end of the experiment (21 days). As expected, IL-10 serum levels were significantly lower during the follow-up compared to baseline concentrations. In the present animal model, experimental periodontitis is associated with increased systemic inflammation. Further studies are needed to confirm whether PTX3 and sTWEAK could be useful biomarkers to investigate potential mechanisms underlying the relationship between periodontitis and atherosclerotic vascular diseases.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK.
| | - Ramón Iglesias-Rey
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesa da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Noemí Gómez-Lado
- Molecular Imaging Group, Clinical University Hospital, Faculty of Medicine, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Aguiar
- Molecular Imaging Group, Clinical University Hospital, Faculty of Medicine, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesa da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesa da Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesa da Choupana s/n, 15706, Santiago de Compostela, Spain.
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28
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Suvan J, Harrington Z, Petrie A, Patel K, Darbar U, Donos N, D'Aiuto F. Obesity as predictive factor of periodontal therapy clinical outcomes: A cohort study. J Clin Periodontol 2020; 47:594-601. [DOI: 10.1111/jcpe.13261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/29/2019] [Accepted: 01/04/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Jean Suvan
- Unit of Periodontology UCL Eastman Dental Institute London UK
| | | | - Aviva Petrie
- Unit of Biostatistics UCL Eastman Dental Institute London UK
| | - Kalpesh Patel
- Unit of Periodontology UCL Eastman Dental Institute London UK
| | - Ulpee Darbar
- Unit of Periodontology UCL Eastman Dental Institute London UK
| | - Nikos Donos
- Centre for Oral Clinical Research Barts and The London School of Medicine and Dentistry QMUL London UK
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29
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Hussain SB, Botelho J, Machado V, Zehra SA, Mendes JJ, Ciurtin C, Orlandi M, D'Aiuto F. Is there a bidirectional association between rheumatoid arthritis and periodontitis? A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:414-422. [PMID: 32113837 DOI: 10.1016/j.semarthrit.2020.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 10/24/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several lines of evidence suggest a bi-directional association between Rheumatoid Arthritis (RA) and Periodontitis (PD). Our aim was to systematically appraise the evidence on the association between RA and PD in terms of clinical and laboratory outcomes. METHODS An electronic search of several databases (PubMed, EMBASE, MEDLINE, LILACS, CINHL, Scopus, Web of Science, The Cochrane Library, OpenGrey and Google Scholar) was conducted up to March 2019 (PROSPERO CRD42018107817) by two independent reviewers. Observational studies included in the review were quality-appraised using the Newcastle-Ottawa Scale (NOS) tool. Random effects models were used for quantitative analyses. RESULTS A total of 8 case-control studies were identified after the final search of 1491 titles. Following quality assessment, 2 studies were excluded due to the high risk of bias, while the remaining 6 were further analysed. Meta-analyses revealed no substantial effect of RA on the Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) of patients with PD when compared to controls but high degree of study heterogeneity was found. To the contrary, PD was associated with substantially worse RA disease activity as assessed by an increase in the DAS28 score of 0.74 (0.25-1.24, 95%CI, p < 0.001). CONCLUSION There is consistent evidence suggesting that PD is associated with worse RA clinical activity as assessed by DAS28 scores whereas, RA patients do not have worsen PD clinical outcomes.
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Affiliation(s)
- Syed Basit Hussain
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK.
| | - João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Syeda Ambreen Zehra
- Department of Dental Physical Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - José João Mendes
- Periodontology Department, Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Centre, Egas Moniz, Almada, Portugal
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospital, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute 256 Gray's Inn Road, London WC1X 8LD, UK
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Moreno Sancho F, Leira Y, Orlandi M, Buti J, Giannobile WV, D'Aiuto F. Cell-Based Therapies for Alveolar Bone and Periodontal Regeneration: Concise Review. Stem Cells Transl Med 2019; 8:1286-1295. [PMID: 31692298 PMCID: PMC6877771 DOI: 10.1002/sctm.19-0183] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
Current regenerative strategies for alveolar bone and periodontal tissues are effective and well adopted. These are mainly based on the use of a combination of synthetic/natural scaffolds and bioactive agents, obviating the incorporation of cells. However, there are some inherent limitations associated with traditional techniques, and we hypothesized that the use of cell-based therapies as part of comprehensive regenerative protocols may help overcome these hurdles to enhance clinical outcomes. We conducted a systematic review of human controlled clinical trials investigating the clinical and/or histological effect of the use of cell-based therapies for alveolar bone and periodontal regeneration and explored the translational potential of the different cell-based strategies identified in the included trials. A total of 16 studies (11 randomized controlled trials, 5 controlled clinical trials) were included for data synthesis and qualitative analysis with meta-analyses performed when appropriate. The results suggest a clinical benefit from the use of cell therapy. Improved outcomes were shown for alveolar ridge preservation, lateral ridge augmentation, and periodontal regeneration. However, there was insufficient evidence to identify best-performing treatment modalities amongst the different cell-based techniques. In light of the clinical and histological outcomes, we identify extraction socket and challenging lateral and vertical bone defects requiring bone block grafts as strong candidates for the adjuvant application of mesenchymal stem cells. Given the complexity, invasiveness, and costs associated with techniques that include "substantial manipulation" of tissues and cells, their additional clinical benefit when compared with "minimal manipulation" must be elucidated in future trials. Stem Cells Translational Medicine 2019;8:1286&1295.
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Affiliation(s)
| | - Yago Leira
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom.,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Orlandi
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, College of Engineering and Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Francesco D'Aiuto
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
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Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, Nosalski R, Pelka P, Nowakowski D, Wilk G, Mikolajczyk TP, Schramm-Luc A, Furtak A, Matusik P, Koziol J, Drozdz M, Munoz-Aguilera E, Tomaszewski M, Evangelou E, Caulfield M, Grodzicki T, D'Aiuto F, Guzik TJ. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur Heart J 2019; 40:3459-3470. [PMID: 31504461 PMCID: PMC6837161 DOI: 10.1093/eurheartj/ehz646] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/25/2019] [Accepted: 08/21/2019] [Indexed: 01/07/2023] Open
Abstract
AIMS Inflammation is an important driver of hypertension. Periodontitis is a chronic inflammatory disease, which could provide a mechanism for pro-hypertensive immune activation, but evidence of a causal relationship in humans is scarce. We aimed to investigate the nature of the association between periodontitis and hypertension. METHODS AND RESULTS We performed a two-sample Mendelian randomization analysis in the ∼750 000 UK-Biobank/International Consortium of Blood Pressure-Genome-Wide Association Studies participants using single nucleotide polymorphisms (SNPs) in SIGLEC5, DEFA1A3, MTND1P5, and LOC107984137 loci GWAS-linked to periodontitis, to ascertain their effect on blood pressure (BP) estimates. This demonstrated a significant relationship between periodontitis-linked SNPs and BP phenotypes. We then performed a randomized intervention trial on the effects of treatment of periodontitis on BP. One hundred and one hypertensive patients with moderate/severe periodontitis were randomized to intensive periodontal treatment (IPT; sub- and supragingival scaling/chlorhexidine; n = 50) or control periodontal treatment (CPT; supragingival scaling; n = 51) with mean ambulatory 24-h (ABPM) systolic BP (SBP) as primary outcome. Intensive periodontal treatment improved periodontal status at 2 months, compared to CPT. This was accompanied by a substantial reduction in mean SBP in IPT compared to the CPT (mean difference of -11.1 mmHg; 95% CI 6.5-15.8; P < 0.001). Systolic BP reduction was correlated to periodontal status improvement. Diastolic BP and endothelial function (flow-mediated dilatation) were also improved by IPT. These cardiovascular changes were accompanied by reductions in circulating IFN-γ and IL-6 as well as activated (CD38+) and immunosenescent (CD57+CD28null) CD8+T cells, previously implicated in hypertension. CONCLUSION A causal relationship between periodontitis and BP was observed providing proof of concept for development of clinical trial in a large cohort of hypertensive patients. ClinicalTrials.gov: NCT02131922.
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Affiliation(s)
- Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Osmenda
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Mateusz Siedlinski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Richard Nosalski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Piotr Pelka
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Daniel Nowakowski
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Wilk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Tomasz P Mikolajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Agata Schramm-Luc
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Aneta Furtak
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Pawel Matusik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Joanna Koziol
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | | | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Mark Caulfield
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-107 Krakow, Poland
| | | | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Rotundo R, Genzano L, Patel D, D'Aiuto F, Nieri M. Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial. J Clin Periodontol 2019; 46:1013-1023. [PMID: 31292987 DOI: 10.1111/jcpe.13168] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 03/09/2019] [Revised: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the superiority of coronally advanced flaps (CAFs) when used in combination with a xenogeneic collagen matrix (CMX) for root coverage of multiple adjacent gingival recessions. MATERIALS AND METHODS Participants with at least 2 upper adjacent teeth exhibiting gingival recession depth ≥2 mm were recruited and randomized to CAF with (test) or without (control) CMX, respectively. Mean and complete root coverage, amount of keratinized tissue (KTw), gingival thickness (GThick) and patient-reported outcomes (PROMs) were recorded at baseline, 3, 6 and 12 months. RESULTS Twenty-four patients providing 61 gingival recessions were analysed. After 1 year, gingival recession depth decreased from 2.3 ± 0.7 to 0.3 ± 0.4 mm in the CAF + CMX group (2.0 ± 0.8 mm meanRC) and from 2.6 ± 1.0 to 0.6 ± 0.3 mm in the control group (2.0 ± 1.1 mm meanRC). No difference was observed between the two groups (p = 0.2023). Nineteen (63%) of the test and 16 (52%) of control defects showed complete root coverage (p = 0.4919). GThick greatly increased in the test group (0.5 mm; 0.2-0.8 mm, 95% CI; p = 0.0057). No difference between the two groups was observed for KTw (p = 0.5668) and PROMs. CONCLUSION At 1 year, CAF + CMX provided similar root coverage to CAF alone, but a significant increase in gingival thickness.
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Affiliation(s)
- Roberto Rotundo
- Honorary Associate Professor in Periodontology, UCL Eastman Dental Institute, London, UK
| | | | - Divya Patel
- Specialist Trainee, UCL Eastman Dental Institute, London, UK
| | - Francesco D'Aiuto
- Chair and Honorary Consultant in Periodontology, UCL Eastman Dental Institute, London, UK
| | - Michele Nieri
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Habbab KM, D'Aiuto F, Habbab MA, Porter SR. Molecular markers relevant to myocardial injury following dental extraction in patients with or without coronary artery disease. BDJ Open 2019; 5:9. [PMID: 31240112 PMCID: PMC6586777 DOI: 10.1038/s41405-019-0018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives The aim of this study was to characterize biological changes following dental extractions in patients with and without coronary artery disease (CAD). Materials and methods Forty-five patients (36 males and 9 females) referred for dental extraction underwent treatment and provided blood samples before, immediately after, and 24 h after the procedure. A broad array of biomarkers was employed to assess myocardial injury (highly sensitive troponin T, hs-TnT), bacterial burden (LPS endotoxin activity), and systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, and TNF-α). Results Dental extraction in patients with and without CAD was associated with rises in hs-TnT (p = 0.013), hs-CRP (p < 0.001), fibrinogen (p = 0.005), endotoxin activity (p < 0.001), IFN-γ (p < 0.001), IL-6 (p < 0.001), IL-8 (p = 0.011), and IL-12 (p < 0.001) at 24 h compared with immediately post procedure. Changes in systemic inflammation and endotoxin activity were more evident in those with hs-TnT rise. Conclusions Simple dental extractions may cause mild increase in hs-TnT, indicating minor myocardial injury in both patients with and without CAD. Acute systemic inflammation and endotoxemia could represent a possible link between invasive dental treatment and increased risk of acute cardiovascular events. These findings indicate that invasive dental treatment (as simple as a single dental extraction) may impact negatively on clinical outcomes in dental patients, especially those with CAD.
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Affiliation(s)
- K M Habbab
- 1UCL Eastman Dental Institute, London, England UK.,2Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - F D'Aiuto
- 1UCL Eastman Dental Institute, London, England UK
| | - M A Habbab
- 2Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - S R Porter
- 1UCL Eastman Dental Institute, London, England UK
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Leira Y, Ameijeira P, Domínguez C, López‐Arias E, Ávila‐Gómez P, Pérez‐Mato M, Sobrino T, Campos F, D'Aiuto F, Leira R, Blanco J. Periodontal inflammation is related to increased serum calcitonin gene‐related peptide levels in patients with chronic migraine. J Periodontol 2019; 90:1088-1095. [DOI: 10.1002/jper.19-0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Yago Leira
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Medical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Pablo Ameijeira
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Clara Domínguez
- Department of NeurologyHeadache UnitUniversity Clinical HospitalUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Esteban López‐Arias
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Paulo Ávila‐Gómez
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - María Pérez‐Mato
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francisco Campos
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francesco D'Aiuto
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
| | - Rogelio Leira
- Department of NeurologyHeadache UnitUniversity Clinical HospitalUniversity of Santiago de Compostela Santiago de Compostela Spain
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Juan Blanco
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Medical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
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Leira Y, Ameijeira P, Domínguez C, López-Arias E, Ávila-Gómez P, Pérez-Mato M, Sobrino T, Campos F, D'Aiuto F, Leira R, Blanco J. Severe periodontitis is linked with increased peripheral levels of sTWEAK and PTX3 in chronic migraineurs. Clin Oral Investig 2019; 24:597-606. [PMID: 31111284 DOI: 10.1007/s00784-019-02950-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/13/2019] [Accepted: 05/03/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Periodontitis (PD) and chronic migraine (CM) have been recently linked, and inflammatory processes and vascular endothelial changes are hypothesized as potential mediators of this relationship. The aim of this cross-sectional analysis was to investigate the potential association of PD with vascular systemic inflammation and complement activation in patients with CM. MATERIALS AND METHODS Ninety-four chronic migraineurs underwent a full-mouth periodontal evaluation and a measure of PD activity and severity, namely the periodontal inflamed surface area (PISA) was calculated for each patient. We divided CM patients according to their periodontal status: mild PD (N = 14), moderate PD (N = 22), severe PD (N = 19), and non-PD (N = 39). Serum levels of C-reactive protein (CRP), pentraxin 3 (PTX3), soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), and complements C3 and C4 were measured outside of migraine attacks. RESULTS We found that severe periodontal patients had significantly higher circulating levels of PTX3 and sTWEAK compared with those without PD (2475.3 ± 1646.8 pg/mL vs. 516.6 ± 1193.8 pg/mL, P < 0.0001 and 672.4 ± 118.2 pg/mL vs. 485.7 ± 112.2 pg/mL, P < 0.0001; respectively). For the remaining biomarkers, no significant differences were found between groups. Severe PD was independently associated with higher levels of PTX3 (β = 1997.6, P < 0.0001) and sTWEAK (β = 187.1, P < 0.0001) but not with CRP, C3, and C4. PISA positively correlated to PTX3 (r = 0.475, P < 0.0001) and sTWEAK (r = 0.386, P < 0.0001). CONCLUSIONS Based on these preliminary results, severe PD was linked with vascular systemic inflammation in patients with CM. However, further longitudinal studies should be performed to confirm these findings. CLINICAL RELEVANCE sTWEAK and PTX3 measured in serum could be used as biomarkers in the PD-CM link.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK. .,Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain. .,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Pablo Ameijeira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Clara Domínguez
- Department of Neurology, Headache Unit, University Clinical Hospital, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Esteban López-Arias
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Paulo Ávila-Gómez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
| | - Rogelio Leira
- Department of Neurology, Headache Unit, University Clinical Hospital, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Abstract
The purpose of this paper was to identify and summarize current evidence describing periodontal complications associated with obesity. Electronic searches supplemented with manual searches were carried out to identify relevant systematic reviews. Identification, screening, eligibility, and inclusion of studies were performed independently by two reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess the quality and risk of bias of the included reviews. From 430 titles and abstracts screened, 14 systematic reviews were considered as eligible for inclusion in this meta-review. Eight reviews reported on cross-sectional studies investigating the association of obesity and periodontal diseases, 4 included longitudinal studies, 5 addressed response to periodontal therapy, 5 reported on studies investigating biomarkers, and only 2 were related to pediatric population samples. Systematic review summaries in the various study design domains (cross-sectional, longitudinal and experimental) report that obese individuals are more likely to have periodontal diseases, with more severe periodontal conditions, than nonobese individuals, with cross-sectional evidence congruent with longitudinal studies showing that obesity or weight gain increases the risk of periodontitis onset and progression. Published research on the effect of obesity on responses to periodontal therapy, or systemic or local biomarkers of inflammation, is variable and therefore inconclusive based on the evidence currently available, which suggests that overweight/obesity contributes to periodontal complications independently of other risk factors, such as age, gender, smoking, or ethnicity. This evidence supports the need for risk assessments for individual patients to facilitate personalized approaches in order to prevent and treat periodontal diseases.
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Affiliation(s)
- Jean E Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Nicholas Finer
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London WC1X 8LD, UK.
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
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Leira Y, Iglesias-Rey R, Gómez-Lado N, Aguiar P, Campos F, D'Aiuto F, Castillo J, Blanco J, Sobrino T. Porphyromonas gingivalis lipopolysaccharide-induced periodontitis and serum amyloid-beta peptides. Arch Oral Biol 2019; 99:120-125. [PMID: 30665148 DOI: 10.1016/j.archoralbio.2019.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 11/28/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this investigation was to determine the circulating levels of amyloid beta (Aβ) peptides using the Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS) model to induce periodontitis. METHODS Experimental periodontitis was induced in 6 male Sprague-Dawley rats. Alveolar bone loss was measure by micro computed tomography. Serum concentrations of Aβ1-40 and Aβ1-42 prior to periodontal induction, at 24 h, 7, 14, and 21 days the last injection of Pg-LPS. RESULTS The distance between the cemento-enamel junction and the bone crest (i.e., alveolar bone loss) was significantly higher at the end of periodontal induction compared to baseline (2.92 ± 0.29 mm vs. 3.8 ± 0.28 mm, P < 0.001). Periodontitis evoked a slight acute elevation of Aβ1-40 serum levels that were maintained during the whole experiment. Aβ1-42 peptide levels peak at the end of the study. A positive strong correlation was observed between alveolar bone loss and Aβ1-40 serum levels at 7 days (r = 0.695, P = 0.012) and as well as with serum Aβ1-42 concentrations at 21 days (r = 0.968, P = 0.002). CONCLUSIONS Periodontitis induced Pg-LPS produced increased serum levels of Aβ peptides. Further studies are needed to confirm our results and to investigate the mechanisms by which periodontitis could be associated with an overexpression of Aβ.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.
| | - Ramón Iglesias-Rey
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Noemí Gómez-Lado
- Molecular Imaging Group, Clinical University Hospital, Faculty of Medicine, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Aguiar
- Molecular Imaging Group, Clinical University Hospital, Faculty of Medicine, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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Vetri L, Messina LM, Drago F, D'Aiuto F, Vanadia F, Brighina F, Raieli V. Are paediatric headaches in the emergency department increasing? An Italian experience. Funct Neurol 2019; 34:188-195. [PMID: 32454000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to assess admissions, for headache, to the emergency department (ED) of the Di Cristina Children's Hospital in Palermo over a decade. The total number of ED admissions for headache was retrospectively analysed considering two 24- month periods: 2009-2010 and 2017-2018. Total admissions to the ED decreased from 55,613 to 50,096 (-10%) between the two periods considered, while the number of admissions for headache increased by 63.56% (p < 0.0001). There was also a significant increase in the number of multiple ED admissions by single children (9.5% versus 17.98% of the patients accessing the ED for headache). This significant increase in admissions for paediatric headache is probably due to limited efficacy of the Italian and international guidelines and of the educational strategies implemented in this setting, and also to communication difficulties, both with patients and between primary care networks and hospitals.
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D'Aiuto F, Gkranias N, Bhowruth D, Khan T, Orlandi M, Suvan J, Masi S, Tsakos G, Hurel S, Hingorani AD, Donos N, Deanfield JE. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 2018; 6:954-965. [PMID: 30472992 DOI: 10.1016/s2213-8587(18)30038-x] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes. METHODS In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304. FINDINGS Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA1c was 0·6% (95% CI 0·3-0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths. INTERPRETATION Compared with CPT, IPT reduced HbA1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes. FUNDING Diabetes UK and UK National Institute for Health Research.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.
| | - Nikolaos Gkranias
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Devina Bhowruth
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Tauseef Khan
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Stefano Masi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Hurel
- Department of Endocrinology, University College London Hospitals, University College London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Nikos Donos
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
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Leira Y, Rodríguez‐Yáñez M, Arias S, López‐Dequidt I, Campos F, Sobrino T, D'Aiuto F, Castillo J, Blanco J. Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct. J Periodontol 2018; 90:465-474. [DOI: 10.1002/jper.18-0560] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Yago Leira
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de CompostelaMedical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
| | - Manuel Rodríguez‐Yáñez
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Susana Arias
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Iria López‐Dequidt
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francisco Campos
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francesco D'Aiuto
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
| | - José Castillo
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Juan Blanco
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de CompostelaMedical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
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Leira Y, Rodríguez-Yáñez M, Arias S, López-Dequidt I, Campos F, Sobrino T, D'Aiuto F, Castillo J, Blanco J. Periodontitis as a risk indicator and predictor of poor outcome for lacunar infarct. J Clin Periodontol 2018; 46:20-30. [PMID: 30362631 DOI: 10.1111/jcpe.13032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/22/2018] [Revised: 10/02/2018] [Accepted: 10/21/2018] [Indexed: 12/27/2022]
Abstract
AIM To investigate the association between periodontitis (PD) and lacunar infarct (LI) as well as to analyse whether PD could be a predictor of poor functional prognosis in patients with LI. MATERIAL AND METHODS Full-mouth periodontal examination was done in 120 cases (patients with LI) and 157 healthy controls. Demographic, clinical, medical and neurological information were collected from all of them. In addition, a measure of periodontal inflammation and disease activity, namely the periodontal inflamed surface area (PISA), was also calculated for each patient. Poor functional outcome was considered as a modified Rankin Scale >2 at 3 months. RESULTS PD was independently associated with the presence of LI (OR = 3.3, p < 0.001). Poor outcome was observed in 31 patients with LI (25.8%), of which 90.3% had PD. A PISA value ≥727 mm2 was an independent predictor of poor prognosis, after adjusting for clinical confounders (OR = 6.5, p = 0.001). CONCLUSIONS PD and LI were associated. Active moderate to severe PD predicted poor prognosis in patients with LI. Further evidence is warranted to confirm our results and investigate potential mechanisms behind this association.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, Faculty of Medicine and Odontology, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.,Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Manuel Rodríguez-Yáñez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Susana Arias
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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Masi S, Orlandi M, Parkar M, Bhowruth D, Kingston I, O'Rourke C, Virdis A, Hingorani A, Hurel SJ, Donos N, D'Aiuto F, Deanfield J. Mitochondrial oxidative stress, endothelial function and metabolic control in patients with type II diabetes and periodontitis: A randomised controlled clinical trial. Int J Cardiol 2018; 271:263-268. [PMID: 30077530 PMCID: PMC6152589 DOI: 10.1016/j.ijcard.2018.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Periodontitis (PD) and type 2 diabetes (T2D) are characterized by increased mitochondrial oxidative stress production (mtROS), which has been associated with a greater risk of cardiovascular diseases (CVD). Intensive PD treatment (IPT) can significantly improve endothelial function and metabolic control, although the mechanisms remain unclear. We explored whether, in patients with PD and T2D, changes of mtROS are associated with improvement of endothelial function and metabolic control after IPT. METHODS 51 patients with T2D and PD were enrolled in a single-blind controlled trial and randomised to either intensive (n = 27) or standard (CPT, n = 24) PD treatment. Levels of mtROS in peripheral blood mononuclear cells (PBMC) were measured using a FACS-based assay at baseline and 24 h, 1 week, 2 and 6 months after PD treatment. Inflammatory cytokines, CVD risk factors, metabolic control and endothelial function were assessed at baseline and 6 months after intervention. RESULTS After 6 months from PD treatment, the IPT group had lower mtROS (in both the whole PBMC and lymphocytes), circulating levels of HbA1c, glucose, INF-γ, TNF-α (p < 0.05 for all), and improved endothelial function (p < 0.05) compared to the CPT group. There was an association between higher mtROS and lower endothelial function at baseline (r = -0.39; p = 0.01) and, in the IPT group, changes of mtROS were associated with changes of endothelial function (r = 0.41; p < 0.05). CONCLUSIONS Reduced mtROS is associated with improved endothelial function and accompanied by better metabolic control in patients with T2D and PD. mtROS could represent a novel therapeutic target to prevent CVD in T2D.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy; National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK.
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Mohamed Parkar
- Cruciform Teaching Facilities Unit, Faculty of Life Sciences, UCL, London, UK
| | - Devina Bhowruth
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
| | - Isabel Kingston
- Biomaterials and Tissue Engineering, University College London, UK
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, UK
| | - Steven J Hurel
- Department of Endocrinology, University College London Hospital, London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), UK
| | | | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
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Abstract
The association between invasive dental treatments (IDTs) and a short-term risk of myocardial infarction (MI) and ischemic stroke (IS) remains controversial. Bacterial dissemination from the oral cavity and systemic inflammation linked to IDT can induce a state of acute vascular dysfunction. The aim of study is to investigate the relation of IDTs to MI and IS by using case-only study designs to analyze data from a large Taiwanese cohort. A nationwide population-based study was undertaken by using the case-crossover and self-controlled case series design to analyze the Taiwanese National Health Care Claim database. Conditional logistic regression model and conditional Poisson regression model were used to estimate the risks of MI/IS. In addition, we used burn patients as negative controls to explore the potential effect of residual confounding. In total, 123,819 MI patients and 327,179 IS patients in the case-crossover design and 117,655 MI patients and 298,757 IS patients were included in the self-controlled case series design. Results from both study designs showed that the risk of MI within the first 24 wk after IDT was not significantly different from or close to unity except for a modest risk during the first week for patients without other comorbidities (odds ratios [95% confidence intervals] of 1.31 [1.08-1.58] and 1.15 [1.01-1.31] for 3 d and 7 d, respectively). We also observed no association between IDTs and IS, or the risk ratio was close to unity. IDTs did not appear to be associated with a transient risk of MI and IS in the Taiwanese population, with consistent findings from both case-only study designs. However, we cannot exclude that dental infections and diseases may yield a long-term risk of MI and IS.
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Affiliation(s)
- T T Chen
- 1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - F D'Aiuto
- 2 Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | - Y C Yeh
- 3 Department of Medical Research, National Taiwan University Hospital, National Taiwan University, Taipei
| | - M S Lai
- 1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - K L Chien
- 1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,4 Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei
| | - Y K Tu
- 1 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,3 Department of Medical Research, National Taiwan University Hospital, National Taiwan University, Taipei.,5 Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei
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D'Aiuto F, Gable D, Syed Z, Allen Y, Wanyonyi KL, White S, Gallagher JE. Evidence summary: The relationship between oral diseases and diabetes. Br Dent J 2018. [PMID: 28642531 DOI: 10.1038/sj.bdj.2017.544] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction This paper is the third of four rapid reviews undertaken to explore the relationships between oral health and general medical conditions in order to support teams within Public Health England, health practitioners and policymakers.Aims This review aimed to explore the nature of the association between poor oral health and diabetes when found in the same individuals or populations, having reviewed the most contemporary evidence in the field.Methods The reviews were undertaken by four groups each comprising consultant clinicians from medicine and dentistry, trainees, public health and academics. The methodology involved a streamlined rapid review process and synthesis of the findings.Results The results identified a number of systematic reviews of low to high quality suggesting that diabetes is associated with periodontal disease, tooth loss, and oral cancer in particular, and that the management of oral diseases, most notably periodontal care, has a short-term beneficial influence on metabolic outcomes related to diabetes; however, there is no evidence that this is sustained over the long-term and reduces the prevalence of the long-term complications.Conclusion Current evidence, of mixed quality, suggests a number of associations between oral diseases and diabetes mellitus (diabetes). Further high quality research is required in this field.
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Affiliation(s)
- F D'Aiuto
- Professor in Periodontology, Head of Periodontology, Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD
| | - D Gable
- Consultant, Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, Diabetes and Endocrinology, 1st Floor Mint Wing, St Mary's Hospital, Praed Street, Paddington, W2 1NY
| | - Z Syed
- Specialist trainee in Oral Medicine, Leeds Teaching Hospital NHS Trust, Clarendon Way, Leeds, LS2 9LU
| | - Y Allen
- Clinical Fellow in leadership, Health Education England, Stewart House, 32 Russell Square, London, WC1B 5DN
| | - K L Wanyonyi
- (Formerly Research Associate, King's College London Dental Institute, Population and Patient Health) Senior Lecturer in Dental Public Health, University of Portsmouth Dental Academy, William Beatty Building, Hampshire Terrace, Portsmouth, PO1 2QG
| | - S White
- Director of Dental Public Health, Population Health &Care Division, Health and Wellbeing Directorate, Public Health England, Skipton House, 80 London Road, London, SE1 6LH
| | - J E Gallagher
- Newland Pedley Professor of Oral Health Strategy, Head of Population and Patient Health, Honorary Consultant in Dental Public Health, King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London, SE5 9RS
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Orlandi M, Guinto J, Bakshi J, Cotton A, Wilton J, Bernstein BS, D'Aiuto F, Ciurtin C. 116 Prevalence of periodontitis in patients with rheumatoid arthritis and systemic lupus erythematosus. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Orlandi
- Periodontology, UCL-Eastman Dental Institute, London, UNITED KINGDOM
| | - Jesusa Guinto
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
| | - Jyoti Bakshi
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
| | - Alice Cotton
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
| | - James Wilton
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
| | - Brett S Bernstein
- Rheumatology, University College London Hospitals, London, UNITED KINGDOM
| | - Francesco D'Aiuto
- Periodontology, UCL-Eastman Dental Institute, London, UNITED KINGDOM
| | - Coziana Ciurtin
- Rheumatology, University College London, London, UNITED KINGDOM
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Brett PM, Zygogianni P, Griffiths GS, Tomaz M, Parkar M, D'Aiuto F, Tonetti M. Functional Gene Polymorphisms in Aggressive and Chronic Periodontitis. J Dent Res 2016; 84:1149-53. [PMID: 16304445 DOI: 10.1177/154405910508401211] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [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: 11/17/2022] Open
Abstract
There is strong evidence that genetic as well as environmental factors affect the development of periodontitis, and some suggestion that aggressive and chronic forms of the disease share the same genetic predisposition. This study addresses the hypothesis that there are both shared and unique genetic associations in these forms of periodontitis. A sample of 51 patients with aggressive disease, 57 patients with chronic disease, and 100 healthy controls was recruited for this study. Ten functional polymorphisms in 7 candidate genes were genotyped. The results show statistically significant (p ≤ 0.05) differences between genotype frequencies in aggressive and controls (IL-1B +3954 & IL-6 −174); chronic and controls (IL-6 −174 & VDR −1056); chronic and aggressive periodontitis (IL-1A −889); and periodontitis as a whole and controls (VDR −1056, TLR-4 399 & IL-6 −174). These results suggest that there are in fact both shared and unique genetic associations in aggressive and chronic periodontitis.
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Affiliation(s)
- P M Brett
- Department of Periodontology, Eastman Dental Institute, University College London, UK.
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O'Neill F, Charakida M, Topham E, McLoughlin E, Patel N, Sutill E, Kay CWM, D'Aiuto F, Landmesser U, Taylor PC, Deanfield J. Anti-inflammatory treatment improves high-density lipoprotein function in rheumatoid arthritis. Heart 2016; 103:766-773. [PMID: 27852695 PMCID: PMC5529963 DOI: 10.1136/heartjnl-2015-308953] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 09/20/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
Objective Patients with rheumatoid arthritis (RA) are at increased cardiovascular risk. Recent studies suggest that high-density lipoprotein (HDL) may lose its protective vascular phenotype in inflammatory conditions. However, the effects of common anti-inflammatory treatments on HDL function are not yet known. Methods We compared the function of HDL in 18 patients with RA and 18 matched healthy controls. Subsequently, patients were randomised to (methotrexate+infliximab (M+I) (5 mg/kg)) or methotrexate+placebo (M+P) infusions for 54 weeks. At week 54 and thereafter, all patients received infliximab therapy until completion of the trial (110 weeks), enabling assessment of the impact of 1 year of infliximab therapy in all patients. HDL functional properties were assessed at baseline, 54 weeks and 110 weeks by measuring the impact on endothelial nitric oxide (NO) bioavailability and superoxide production (SO), paraoxonase activity (PON-1) and cholesterol efflux. Results All HDL vascular assays were impaired in patients compared with controls. After 54 weeks, NO in response to HDL was significantly greater in patients who received M+I compared with those who received M+P. Endothelial SO in response to HDL was reduced in both groups, but PON-1 and cholesterol efflux remained unchanged. All vascular measures improved compared with baseline after ≥1 infliximab therapy in the analysis at 110 weeks. No significant trend was noted for cholesterol efflux. Conclusions HDL function can be improved with anti-inflammatory treatment in patients with RA. The M+I combination was superior to the M+P alone, suggesting that the tumour necrosis factor-α pathway may have a role in HDL vascular properties.
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Affiliation(s)
- Francis O'Neill
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Marietta Charakida
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Eric Topham
- Institute of Structural & Molecular Biology and London Centre for Nanotechnology, University College London, London, UK
| | - Eve McLoughlin
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Neha Patel
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Emma Sutill
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Christopher W M Kay
- Institute of Structural & Molecular Biology and London Centre for Nanotechnology, University College London, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, University College London Eastman Dental Institute, London, UK
| | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Peter C Taylor
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - John Deanfield
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK.,National Institute for Cardiovascular Outcomes Research, University College London, London, UK
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Masi S, D'Aiuto F, Cooper J, Salpea K, Stephens JW, Hurel SJ, Deanfield JE, Humphries SE. Telomere length, antioxidant status and incidence of ischaemic heart disease in type 2 diabetes. Int J Cardiol 2016; 216:159-64. [PMID: 27156058 PMCID: PMC4900130 DOI: 10.1016/j.ijcard.2016.04.130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/16/2016] [Indexed: 12/14/2022]
Abstract
Background Type 2 diabetes (T2D) is associated with an increased risk of ischaemic heart disease (IHD). An accelerated process of vascular ageing induced by an increased oxidative stress exposure is suggested as potential pathway accounting for this association. However, no studies have explored the relationship between markers of vascular ageing, measures of oxidative stress and risk of IHD in T2D. Objectives To explore the association between plasma antioxidant status, marker of cellular ageing (leukocyte telomere length, LTL) and 10 years risk of IHD in patients with T2D. Methods Between 2001 and 2002, 489 Caucasians subjects with T2D were enrolled at the diabetic clinic, University College London Hospital. Plasma total anti-oxidant status (TAOS) and LTL were measured by photometric microassay and RT-PCR, respectively. The incidence of IHD over 10 years was determined through linkage with the national clinical audit of acute coronary syndrome in UK. Results At baseline, TAOS was associated with LTL (age adjusted: r = 0.106, p = 0.024). After 10 years, 61 patients developed IHD. Lower TAOS and shorter LTL at baseline predicted an increased IHD risk at follow-up (age adjusted: p = 0.033 and p = 0.040, respectively). These associations were independent of age, gender, cardiovascular risk factors, circulating levels of CRP and medication differences. Conclusions Reduced TAOS and short LTL are interrelated pathways which predict risk of IHD in patients with T2D. Our findings suggest that antioxidant defences are important to maintain telomere integrity, potentially reducing the progression of vascular ageing in patients with T2D.
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Affiliation(s)
- Stefano Masi
- National Centre for Cardiovascular Prevention and Outcomes (NCCPO), Institute of Cardiovascular Science, University College London, UK; Department of Clinical Gerontology, King's College London, UK.
| | - Francesco D'Aiuto
- Periodontology Department, Eastman Dental Institute, University College London, UK
| | - Jackie Cooper
- Division of Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, UK
| | - Klelia Salpea
- Institute of Molecular Biology and Genetics, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Jeffrey W Stephens
- Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK
| | - Steven J Hurel
- Department of Endocrinology, University College London Hospital, London, UK
| | - John E Deanfield
- National Centre for Cardiovascular Prevention and Outcomes (NCCPO), Institute of Cardiovascular Science, University College London, UK
| | - Steve E Humphries
- Division of Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, UK
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2016; 40 Suppl 14:S85-105. [PMID: 23627337 DOI: 10.1111/jcpe.12061] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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