The Influence of Orthodontic Treatment on Periodontal Health between Challenge and Synergy: A Narrative Review

By correctly repositioning teeth, orthodontic therapy improves both the function and appearance of an occlusion. The relationship between teeth and the tissues that surround and support them significantly influences these alterations. With ever more adults seeking orthodontic care, orthodontists are increasingly seeing patients with periodontal issues. Concerns about the patient's appearance, such as uneven gingival margins or functional issues caused by inflammatory periodontal diseases, should be accounted for when designing orthodontic treatment plans. Furthermore, orthodontics may increase the chances of saving and recovering a degraded dentition in cases of severe periodontitis. Today, general dentists, dontists, and orthodontists play integrative roles that enable them to achieve the best possible results for their patients. This review will improve the results of interdisciplinary treatments and increase cooperation between dental specialists by drawing attention to the essential connection between orthodontics and periodontics in regular clinical practice.

Antibacterial Properties of an Experimental Dental Resin Loaded with Gold Nanoshells for Photothermal Therapy Applications

This study explored the chemical and antibacterial properties of a dental resin loaded with gold nanoshells (AuNPs) in conjunction with photothermal therapy (PTT) as a novel method against Streptococcus mutans (S. mutans) to prevent secondary caries. First, a 20-h minimum inhibitory concentration (MIC) assay was performed on solutions of AuNPs with planktonic S. mutans under an LED device and laser at 660 nm. Next, resin blends containing 0, 1 × 1010, or 2 × 1010 AuNPs/mL were fabricated, and the degree of conversion (DC) was measured using an FTIR spectroscopy. Lastly, a colony forming unit (CFU) count was performed following 24 h growth of S. mutans on 6 mm diameter resin disks with different light treatments of an LED device and a laser at 660 nm. The MIC results only showed a reduction in S. mutans at AuNP concentrations less than 3.12 µg/mL under a laser illumination level of 95.5 J/cm2 compared to the dark treatment (p < 0.010 for each). CFU and DC results showed no significant dependence on any light treatment studied. The AuNPs expressed antibacterial effects following PPT against planktonic S. mutans but not in a polymerized dental adhesive resin. Future studies should focus on different shapes, structure, and concentrations of AuNPs loaded in a resin blend.

Using 8-Hydroxy-2'-Deoxiguanosine (8-OHdG) as a Reliable Biomarker for Assessing Periodontal Disease Associated with Diabetes

In recent years, research has shown that oxidative stress plays a significant role in chronic inflammatory conditions. The alteration of the oxidant/antioxidant balance leads to the appearance of free radicals, important molecules involved in both diabetes mellitus and periodontal disease. Diabetes is considered to be one of the major risk factors of periodontal disease and the inflammation characterizing this condition is associated with oxidative stress, implicitly resulting in oxidative damage to DNA. 8-Hydroxydeoxyguanosine (8-OHdG) is the most common stable product of oxidative DNA damage caused by reactive oxygen species, and its levels have been reported to increase in body fluids and tissues during inflammatory conditions. 8-OHdG emerges as a pivotal biomarker for assessing oxidative DNA damage, demonstrating its relevance across diverse health conditions, including neurodegenerative disorders, cancers, inflammatory conditions, and periodontal disease. Continued research in this field is crucial for developing more precise treatments and understanding the detailed link between oxidative stress and the progression of periodontitis. The use of the 8-OHdG biomarker in assessing and managing chronic periodontitis is an area of increased interest in dental research, with the potential to provide crucial information for diagnosis and treatment.

The Role of the Prognostic Inflammatory and Nutritional Index (PINI) in the Evolution of Patients with Chronic Kidney Disease and Other Pathologies

BACKGROUND

Protein-energy loss and inflammation are the main risk factors in the occurrence of complications in hemodialysis patients. The Prognostic Inflammatory and Nutritional Index (PINI) is a simple, inexpensive test to identify the early onset of inflammation and malnutrition in hemodialysis patients, critically ill subjects and those with malignancies.

METHODS

A systemic review of English literature was conducted on the topic published between 1985 and 2022. A focused and sensitive search strategy was applied to the PUBMED database to identify relevant scientific articles in English. Once articles were identified, a detailed quality and bias assessment was performed. Two independent researchers analyzed the detailed data extraction.

RESULTS

PINI proved to be a sensitive, powerful, low-cost and simple test. PINI has been useful in assessing evolution and prognostics in clinical care, with values above one being associated with a high risk of mortality and morbidity. It is useful in cases with surgical and postoperative complications, long hospitalization, as well as increased associated expenses.

CONCLUSIONS

This is the first review of the literature on the above-mentioned topic (PINI) and is a valuable candidate for validating prognosis in patients with different pathologies.

Mitochondrial Dysfunction, Oxidative Stress, and Therapeutic Strategies in Diabetes, Obesity, and Cardiovascular Disease

Mitochondria are subcellular organelles involved in essential cellular functions, including cytosolic calcium regulation, cell apoptosis, and reactive oxygen species production. They are the site of important biochemical pathways, including the tricarboxylic acid cycle, parts of the ureagenesis cycle, or haem synthesis. Mitochondria are responsible for the majority of cellular ATP production through OXPHOS. Mitochondrial dysfunction has been associated with metabolic pathologies such as diabetes, obesity, hypertension, neurodegenerative diseases, cellular aging, and cancer. In this article, we describe the pathophysiological changes in, and mitochondrial role of, metabolic disorders (diabetes, obesity, and cardiovascular disease) and their correlation with oxidative stress. We highlight the genetic changes identified at the mtDNA level. Additionally, we selected several representative biomarkers involved in oxidative stress and summarize the progress of therapeutic strategies.

The Role of Matrix Metalloproteinases (MMP-8, MMP-9, MMP-13) in Periodontal and Peri-Implant Pathological Processes

Severe periodontitis, a destructive inflammatory disease of the supporting tissues of the teeth, ranks sixth in terms of global spread, affecting about 11% of the population. Metalloproteinases (MMPs) are extracellular matrix (ECM) macromolecules that are important in cellular development and morphogenesis, and they are capable of activating growth factors in their proximity, cell surface receptors, and adhesion molecules. MMPs are part of a major family of zinc-dependent endopeptidases, and their activity is modulated and regulated by certain inhibitors known as tissue metalloproteinase inhibitors (TIMPs). Because type I collagen is the major component of the periodontal extracellular matrix, special attention has been paid to the role of collagenases, especially MMP-8 and MMP-13 and gelatinases, MMP-2 and MMP-9, in periodontal diseases. In fact, MMP-8 (or collagenase 2) is currently one of the most promising biomarkers for periodontitis in oral fluids. Among them, salivary MMP-9 has been shown to be a more sensitive marker for periodontal inflammation during orthodontic treatment, which opens new perspectives in reducing periodontal hazards during such treatments. Both MMP-8 and MMP-9 are extremely valuable diagnostic tools in treating periodontitis, and future studies and healthcare policies should focus on implementing more accessible methods of chairside testing in order to reduce the prevalence of this disease.

Clindamycin as an Alternative Option in Optimizing Periodontal Therapy

Periodontal disease is an oral infectious and inflammatory disease caused by microorganisms that determine the host-mediated destruction of soft and hard periodontal tissues, which ultimately leads to tooth loss. Periodontitis affects a large part of the population, with various degrees of severity. Treatment consists of etiologic therapy: the removal of biofilm through mechanical debridement plus microbial elimination by supplementary measures. Antibiotic administration, either systemically or through local delivery, has been shown to improve clinical outcomes after mechanical periodontal treatment. Clindamycin is a lincosamide with a broad spectrum, being active against aerobic, anaerobic, and β-lactamase-producing bacteria. This antibiotic offers several advantages and some disadvantages and has been used in periodontal treatment both systemically and locally with various degrees of success. Among the properties that recommend it for periodontal treatment is the bacteriostatic effect, the inhibition of bacterial proteins synthesis, the enhancement of neutrophil chemotaxis, phagocytosis and the oxidative burst–oxidative stress storm. Furthermore, it is easily absorbed at the level of oral tissues in a considerable amount. This substantial tissue penetration, especially inside the bone, is synergistic with a stimulating effect on the host immune system. The aim of this review is to explore the applicability of this antibiotic agent and to evaluate its antimicrobial potential and limitations at the level of the oral biofilm associated with periodontal disease.

Chronometric vs. Structural Hypercoagulability

Prolonged tourniquet stasis induced by venepuncture can lead to the release of the plasma of cell lysis products, as well as tissue factor (TF), impairing the quality of coagulation test results. The accidental presence of TF in vitro can trigger the coagulation mechanism, generating a false decrease in prothrombin time (PT). Background and Objectives: Identification of short PT tests below the normal reference value that could suggest a situation of hypercoagulability. The study aimed to compare the results of the shortened PT tests at their first determination with the eventual correction following duplication of the analysis from the same sample. Materials and methods: Identification of the shortened PT tests has been carried out for a period of 4 months, upon 544 coagulation samples referred to the Hematology department of Sf. Spiridon County Clinical Emergency Hospital from Iasi, Romania. Results: Out of the 544 samples of which the results indicated a state of hypercoagulability, by repeating the determination from the same sample, for 200 (36.76%) PT tests (p = 0.001) the value was corrected, falling within the normal reference range. For 344 (63.24%) tests, the results suggested a situation of hypercoagulability. Conclusions: In order to guarantee the highest quality of the laboratory services, a proper interpretation and report of the patients' results must be congruent and harmoniously associated to the actual clinical condition of the patient. Duplication of the PT determination from the same sample would exclude situations of false hypercoagulability and would provide significant improvement for the patient's safety.

Collagenase-2- (MMP-8) as a Poimt - of- care Biomerker in Periodontal Disease in Patients with or Without Fixed Prosthesis Therapeutic Response to Doxycycline

Periodontal diseases ranges from simple gum inflammation to serious disease that consists in major damage to the soft tissue and bone teeth support. Periodontal diseases affects the marginal and apical periodontium and results from the interaction between bacterial biofilm and the host response. To determine the concentrations of MMP-8, as a disease marker, in saliva in prosthetic and nonprosthetic, aggressive (AP) and chronic (CP) periodontitis, doxycycline treated patients. 40 patients were distributed into 3 groups: 12 diagnosed with aggressive (AgP), 18 with chronic (CP) periodontitis. Each of these groups was subdivided into 2 subgroups with and without fixed prosthesis. 10 patients were in the normal group. Matrix metalloproteinase 8 (MMP-8) was evaluated before and after systemic doxycycline (Dox) treatment. mean MMP-8 value into the control group was 0.57 ng/mL with a standard deviation (STD) of 0,094 ng/mL. Highest MMP-8 value was established for the nonprosthesis AgP subgroup, before Dox treatment. The highest reduction in MMP-8 levels (40.8%) was between nonprosthesis AgP before Dox treatment and the same group after Doxycycline treamtent. MMP-8 saliva levels are lower than GCF levels, mostly through a dilution mechanism as previous studies had shown. Our study revealed that saliva MMP-8 level is relible marker for AgP but not for CP. Doxycycline treatment, in terms of lowering MMP-8 levels is most effective in patients that have AP and are also wearing fixed.

Study Regarding the Relationship between Nutritional Status and Oral Health in the Elderly Patients

The aim of study was to investigate the relationship between oral health and nutritional status in a population of elderly patients with systemic chronic or acute pathology. Materials and method: Prospective cross-sectional clinical investigation of 115 aged patients (] 60 yo; mean age 66.2) from the Clinical Foundation, Faculty of Dental Medicine, University of Medicine and Pharmacy of Iasi. In the first stage of the study, the patients (able to understand and communicate) were submitted to a mini-test for the assessment of the mental status (MMSE) . In the second stage of the study, a questionnaire was used to record demographic and socioeconomic data of the subjects as well as information regarding systemic status and nutritional facts. In the third stage of the study, the nutritional status was evaluated by using Mini-Nutritional Assessment questionnaire (MNA). Finally, the oral status was evaluated by using clinical and radiographical exams as well as geriatric oral health assessment index (GOHAI). Results: Of the 60 old adults, 6% were severely malnourished, and 37.4% presented malnourished risk. 49.6% of the old people had difficulties eating firm foods, 25% of them being unable to prepare meals. Regarding oral status, only 5.2% had at least 20 natural teeth, 55.6% required dental care for decayed or broken teeth, 69.6% were affected by xerostomia, 21% of the completely or partial edentulous people were untreated by removable dentures, 25% of the edentulous patients complained by ill-fitted removable dentures. Conclusion: Lack of education, treatment with over 3 drugs daily, physical inability to buy foods or to prepare meals, as well as the difficulties eating firm foods are strongly associated with poor nutritional status. Also, the need for dental care was associated to nutritional deficiency.

ELISA Evaluation of RANKL Levels in Gingival Fluid in Patients with Periodontitis and Occlusal Trauma

The aim of this study was to evaluate the differences in RANKL levels in crevicular fluid (GCF) in patients with chronic periodontitis, with or without chronic occlusal trauma. The study group consisted of 40 patients from whom 72 samples of crevicular fluid were collected. RANKL levels were analyzed by ELISA. We noticed significantly higher differences in RANKL levels for the study group (occlusive trauma patients) than for systemic healthy patients (p = 8.008). Research has shown that secondary occlusal trauma associated with periodontal disease is characterized by significantly higher RANKL levels in patients with chronic occlusal trauma. This partially clarifies the molecular mechanisms that underlie more severe tissue destruction in patients with occlusal trauma.

Identification of Bacteria Involved in Periodontal Disease Using Molecular Biology Techniques

Periodontal disease is progressive and episodic in nature, with tissue destruction resulting from the host response to bacterial antigens and irritants.This study aimed to evaluate the genotype of a certain group of pathogen agents. In order to to this we used a total of 45 patients with PAG included in the epidemiological analyzes with a mean age of 34.7 Four samples were collected from the subgingival plaque from each patient, a total of 224 samples of dental plaques were investigated. All samples were tested for the presence of Tannerella forsythensis, Porphyromonas gingivalis and Treponema denticola. We found that patients had a large number of pockets colonized by Tannerella forsythensis gingivalis (88.6%) Porphyromonas gingivalis (59%) and Aggregatibacter actinomycetemcomitans (25%). The data of this study support the evidence Tannerella forsythensis as a periodontopatogen and confirmed a strong association between Porphyromonas gingivalis and Tannerella forsythensis in aggressive periodontitis and support previous findings that generalized aggressive periodontitis are associated with more complex microbiota.

Preparation and cytocompatibility evaluation for hydrosoluble phosphorous acid-derivatized cellulose as tissue engineering scaffold material

Chemical modification of cellulose by phosphorylation enhances its bioactivity and provides new derivatives and materials with specific end uses. In the present study, cellulose derivatized with phosphorous acid was obtained using the reaction of microcrystalline cellulose with phosphorous acid-urea mixture, in molten state, in comparison with others methods that used different solvents and catalysts. Completely water soluble films with a substitution degree close to one were obtained and characterized by analytical and spectral analysis (FT-IR, (31)P NMR), contact angle, metallographic microscopy and atomic force microscopy (AFM). 31P NMR spectra of derivatized cellulose showed a signal at 2.58 ppm (assigned to P-O-C6) while the doublets at 4.99-5.29 and at 7.38 ppm were assigned to P-O-C2 and P-O-C3, respectively; thus, the formation of monosubstituted phosphorous acid esters of cellulose is advocated. Contact angle measurements showed that the work of adhesion is more important in water than in ethylene glycol, for the phosphorous acid derivatized cellulose. The cytocompatibility of this hydrosoluble derivatized cellulose was tested by direct contact and also by indirect assays on normal human dermal fibroblasts and on osteoblast-like cells (human osteosarcoma). Cell growth on phosphorylated cellulose pellicle and the results from viability assays had shown a good cytocompatibility and lack of toxicity. Phosphorous acid derivatized cellulose would offer a promising biomaterial, useful as scaffolds for new biopolymer composites, and subject for further development as an ionic crosslinker.

Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

Background

The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations.

Patients and methods

Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions.

Results

The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement.

Conclusion

These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people.

A Comparative Study Regarding the Efficiency of Two Different Systems of Chlorhexidine Release in Periodontal Therapy

Supragingival scaling and especially the subgingival one represent together with root planning (SRP) the main elements of periodontal therapy. Chlorohexidine gluconate represents an realiable option as an anstiseptic that can be associated with SRP in order to reduce the probing depth (PD). The current research involved selecting 30 pacients with periodontal disease and at least one situs with PD greater than 5 mm. The patients were randomly and equally divided into three groups that were named A, B and C. The patients that were included in Group A received SRP without any additional substances. At the level of Group B the patients received SRP and inside the pockets with PD greater than 5 mm we applied the topical gel Glucosite Gel (Cerkamed) for three consecutive times, every 24 hours. Patients that were included in Group C were treated using SRP and at the level of pockets with PD greater or equal with 5 mm we applied the product PerioChip (Dexcel). Our results proved that for all three groups the values of PD recorderd after treatment were significantly lower compared to the initial ones (p]0.05) but in case of group C (SRP+PerioChip) the the drop of the PD values were significantly higher. After treatment the values of PBI were significantly lower in the case of patients included in group C (SRP+PerioChip) in comparison with the ones recorded in patients included in group A (SRP) (p=0.00053) or group (SRP+Glucosite) (p=0.0178). The slow release of chlorohexidine gluconate into periodontal pockets is an effective solution, superior to the topical application of this active product.