Investigating the Influence of Periodontal Disease on the Association Between Complex Multimorbidity and Health: A Cross-Sectional Study

Aims and Objectives

The aim of this study was to evaluate whether periodontal disease (PD) moderates the association between complex multimorbidity (MM) and fair/poor general health in a US representative sample of older individuals.

Materials and Methods

This study identified 937 participants who were at least 60 years of age from the 2013-2014 National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to estimate the association between complex MM (including chronic conditions, functional limitations, and geriatric syndromes) and self-reported fair/poor general health. Subsequently, we specified interactions between complex MM and PD to determine whether PD moderates the effect of complex MM on fair/poor general health.

Results

Nineteen percent of participants reported fair/poor general health. Complex MM was associated with 2.2 times greater odds of self-reported fair/poor health. However, PD was neither independently associated with fair/poor health nor an effect modifier for the association between complex MM and fair/poor general health. Age, white race, those with at least a high-school education level, a family income-to-poverty ratio of at least 2, former smoking status, and being married were significantly associated with fair/poor general health.

Conclusion

Complex MM, but not PD, was associated with greater odds to report fair/poor general health, and PD did not moderate the association between complex MM and fair/poor general health. People with complex MM are more likely to have worse general health; however, PD did not strengthen this association. Further studies are needed to evaluate whether treatment for PD for people vulnerable to the development of complex MM has a positive effect on their general health.

Identifying Factors Associated with Periodontal Disease Using Machine Learning

Objective

This study aimed to identify combinations of chronic conditions associated with the presence and severity of periodontal disease (PD) after accounting for a series of demographic and behavioral characteristics in a nationally representative sample of US adults.

Materials and Methods

A cross-sectional study of the 2013-2014 National Health and Nutrition Examination Survey (n = 4555). Outcome measure: PD using clinical attachment loss (measured as none, mild, moderate, or severe). The main independent variables were self-reported chronic conditions, while other covariates included demographic and behavioral variables. Classification and regression tree analysis was used to identify combinations of specific chronic conditions associated with PD and PD with higher severity. Random forest was used to identify the most important variables associated with the presence and severity of PD.

Results

The prevalence of PD was 77% among the study population. The percentage of those with PD was higher among younger and middle-aged (< 61 years old) than older (> 61 years old) adults. Age and education level were the two most important predictors for the presence and severity of PD. Other significant factors included alcohol use, type of medical insurance, sex, and non-white race. Accounting for only chronic conditions, hypertension and diabetes were the two chronic conditions associated with the presence and severity of PD.

Conclusions

Sociodemographic and behavioral factors emerged as more strongly associated with the presence and severity of PD than chronic conditions. Accounting for the co-occurrence for sociodemographic and behavioral factors will be informative for identifying people vulnerable to the development of PD.

Combinations of chronic conditions, functional limitations and geriatric syndromes associated with periodontal disease

OBJECTIVE

To identify complex multimorbid conditions, including chronic conditions, functional limitations and geriatric syndromes, associated with the presence and severity of periodontal disease (PD), after accounting for a series of demographic and behavioural characteristics.

DESIGN

This cross-sectional study used secondary data from a nationally representative sample, classification and regression tree analysis and random forest identified combinations of specific conditions constituting complex multimorbidity associated with the presence and severity of PD.

SETTING

US National Health and Nutritional Examination Survey (2013-2014).

PARTICIPANTS

Individuals 60 years of age or older who completed a periodontal examination.

RESULTS

Among 937 participants aged 60 and over, the prevalence of PD was 72.6%. PD was associated with sociodemographic factors and limitations in instrumental activities of daily living. Male sex and non-white race were the two most critical predictors of stage III/IV PD. Other important factors included age, education level and the federal poverty level.

CONCLUSIONS

Rather than chronic conditions or geriatric syndromes, PD was associated with sociodemographic factors and functional limitations. Accounting for the co-occurrence of sociodemographic and functional limitations will help recognise older adults who are at an increased vulnerability to the severity of PD.

Presence of Specific Periodontal Pathogens in Prostate Gland Diagnosed With Chronic Inflammation and Adenocarcinoma

Background

Intraprostatic inflammation is frequently observed in the prostate and linked to prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and cancer. The etiology of prostate diseases is unclear. Periodontal diseases are associated with an increased risk of prostate diseases. In men, chronic prostatitis and moderate/severe periodontitis have significantly elevated serum prostate-specific antigen (PSA) levels. Treatment of periodontal disease reduced PSA levels in men. The presence of periodontal pathogens deoxyribonucleic acid (DNA) was identified in the prostate fluid of prostatitis patients. These pathogenic bacteria might have the potential to trigger prostatitis progressing to prostatic adenocarcinoma. The mechanism(s) explaining the etiology of association between periodontal disease and prostate cancer remains unclear. However, the presence of periodontal pathogens has not been analyzed in the prostate gland.

Objective

To identify and compare the presence of specific periodontal pathogens in the areas of BPH, inflammation, and cancer of the prostate glands diagnosed with malignancy.

Materials and methods

Whole-mount radical prostatectomy sections from men (n=30) were identified for BPH, inflammation, and cancer areas and marked for tissue procurement. The tissues were subjected to DNA isolation and analysis of microbial DNA and total bacterial load for the following pathogens, including Porphyromonas gingivalis strain ATCC 33277, Prevotella intermedia strain B422, Treponema denticola strain 35405, Fusobacterium nucleatum subsp. fusiform strain, Tannerella forsythia strain ATCC 43037, and Campylobacter​​​​​​​ rectus strain ATCC 33238performed real-time PCR. The universal bacterial primer pairs were used to detect genomic DNA (gDNA) from the total bacteria present in the samples. All species-specific primers were designed to target the variable regions of the 16S ribosomal RNA (rRNA). Data were analyzed using the 2-ΔΔCT method, statistically validated using unpaired t-test and ANOVA test.

Results

A total of 90 samples of prostate tissue specimens were analyzed for periodontal pathogens; only one pathogen (F. nucleatum subsp. fusiform strain ATCC 51190) showed a significant difference compared to the expression of S. epidermidis (internal control). In particular, F. nucleatum expression was 9, 11.9, and 10.3-fold higher in BPH, inflammation, and cancer, respectively, at p-value <0.05. Moreover, the bacterial load abundance/expression was almost similar in BPH (46.8-fold), inflammation (40.9 fold), and cancer (41.5 fold) higher. There was no significant difference in bacterial load (folder change) among the three areas of BPH, inflammation, and cancer (p-valve>0.05). Similarly, there was no significant difference between F. nucleatum (folder change) among the three areas (p-valve>0.05).

Conclusion 

Fusobacterium nucleatum is identified in the prostates that harbor cancer, chronic inflammation, and BPH.

Periodontal Manifestation of Type Ib Glycogen Storage Disease: A Rare Case Report

INTRODUCTION

Glycogen storage diseases (GSD) are genetic metabolic disorders of glycogen metabolism. There are >15 types based on the enzyme deficiency and the affected organ. Glycogen storage disease Type Ib is the only type associated with neutropenia and periodontitis. This type is caused by a deficiency of glucose-6-phosphate (G6P) translocase which prevents the transport of G6P across the endoplasmic reticulum. As a result, glycogen cannot be metabolized into glucose with its subsequent accumulation in tissues. The affected organs involved in Type Ib are the liver, kidney, and intestine.

CASE PRESENTATION

A 5-year-old Jordanian boy from a consanguineous family referred to the periodontal clinic in February 2014 with an established diagnosis of GSD-Ib. The systemic manifestations include hepatomegaly, hypoglycemia, hyperprolactenemia, inflammatory bowel disease, osteoporosis, and neutropenia. Oral manifestations include severe gingival inflammation and recurrent oral ulceration disease.

CONCLUSIONS

The clinical signs and symptoms of periodontal disease in GSD Type Ib are similar to those found in patients diagnosed with neutropenia. Future studies are needed to clarify whether severe generalized inflammation of the gingiva in children is part of the GSD Type Ib or is a separate entity caused by neutrophil dysfunction.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

BACKGROUND

A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

METHODS

Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

RESULTS

Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

CONCLUSION

An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

BACKGROUND

A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

METHODS

Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

RESULTS

Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

CONCLUSION

An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Tuberosity versus palatal donor sites for soft tissue grafting: A split-mouth clinical study

OBJECTIVE

To compare postoperative pain associated with palatal and tuberosity donor sites for soft tissue grafting, and to evaluate the outcomes in both the donor and recipient sites.

METHOD AND MATERIALS

Twenty healthy nonsmokers requiring bilateral soft tissue grafts were recruited for the study. For the 10 patients who required free gingival graft (FGG), 10 epithelialized grafts were taken from the tuberosity and 10 from the palate. The other 10 patients who required coronally advanced flap (CAF) and connective tissue graft (CTG) received 10 de-epithelialized grafts from the tuberosity and 10 from the palate. A total of 20 receded areas were treated with CAF and CTG. A total of 20 mucogingival defects were treated by FGG. Pain level was reported by the patient using a subjective score on a scale of 0 to 10 (0 = no pain, 10 = very severe pain). The length, width, and thickness of the outcome was measured for the FGG group at 8 weeks. The percentage of root coverage along with the length, width, and thickness of the final outcome was measured for the FGG group as well as the CAF and CTG group.

RESULTS

Pain level in the tuberosity donor site was significantly lower than in the palatal donor site during the first 2 postoperative weeks (2.6 ± 2.16 versus 5.9 ± 2.74 respectively, P < .001). Mean gingival thickness of the healed tuberosity donor graft was greater than of the palatal donor grafts in both groups; for CAF and CTG group 2.9 ± 0.5 versus 2.3 ± 0.6 mm, respectively (P = .016); for FGG group 2.7 ± 0.7 versus 2.1 ± 0.7, respectively (P = .026). No differences were observed in the length or width of both grafted sites at an 8-week follow-up. No significant difference in the mean percentage of root coverage resulting from tuberosity or palatal donor sites was noted (67 ± 12% versus 62 ± 13%, respectively, P = .102).

CONCLUSION

Soft tissue grafts harvested from the tuberosity site might provide a better option than soft tissue donor grafts obtained from the palate in terms of function and less postoperative pain.

Association between oral pathogens and prostate cancer: building the relationship

BACKGROUND

Chronic inflammation and infections are associated with increased risk of prostate cancer development. There is considerable evidence that proves the interrelationship between bacterial/viral infections and carcinogenesis. Periodontitis is a chronic inflammatory disease triggered by gram-negative anaerobic bacteria. In this narrative review, we investigate the relationship between periodontal disease and prostate cancer by reviewing previous studies of the association and possible mechanisms that may explain this link.

METHODS

A comprehensive search for articles published was performed using the key words, "periodontal disease", "prostate disease", "prostate cancer", "prostatic inflammation". Thorough reviews of each study were conducted and assessed for eligibility, and data was summarized.

RESULTS

The role of inflammatory responses in the prostate as drivers of malignancy appears to be predisposed by periodontal pathogens and/or periodontitis inflammatory mediators.

CONCLUSION

Periodontal diseases might be associated with prostate cancer. However, the mechanism(s) explaining this relationship remains unclear and requires further elucidation.

Factors Influencing Dental Students' Interest in Advanced Periodontal Education: Perspectives of Department Chairs

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

Simultaneous Detection of Oral Pathogens in Subgingival Plaque and Prostatic Fluid of Men With Periodontal and Prostatic Diseases

BACKGROUND

Chronic prostatitis (CPr) and benign prostatic hyperplasia (BPH) are complex inflammatory conditions for which etiologic determinants are still poorly defined. Periodontitis is caused by subgingival colonizing bacteria in the oral cavity. The causal effect of periodontal disease on prostatic inflammation has not been established. The purpose of this study is to isolate oral pathogens from expressed prostatic secretions of patients with periodontal disease and CPr or BPH.

METHODS

Twenty-four men diagnosed with CPr/BPH participated in the study. A complete periodontal examination consisting of probing depth, bleeding on probing, tooth mobility, gingival index, and plaque index was performed on the men, and prostatic secretion was collected for the study. Dental plaque and prostatic secretion samples were used for analysis of bacterial DNA for Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Treponema denticola (Td), and Escherichia coli using reverse transcription-polymerase chain reaction.

RESULTS

Six patients were diagnosed with severe, seven with moderate, and four with mild chronic periodontitis. Seventeen of 24 (70.8%) of the prostatic secretion samples showed one or more of the studied oral pathogens. Nine of 10 BPH and eight of 14 patients with CPr had at least one oral pathogen in their prostatic secretions. Pg was found in both prostatic secretion and plaque samples in six of 17 (35.3%) patients, Td was found in both samples in seven of 15 (46.7%) patients, and E. coli was found in both samples in three of 15 (20%) patients. Pi was detected in all dental plaque samples but not in the prostatic secretion.

CONCLUSION

An association between chronic inflammatory prostate and periodontal diseases has been demonstrated by the presence of similar bacterial DNA in both prostatic secretion and subgingival dental plaque from the same individual.

Comparison of Preprosthetic Implant Complications and Failures Between Obese and Nonobese Patients

PURPOSE

Obesity as a systemic risk factor associated with implant failure or other complications has not been studied. The aim of this study was to compare the frequency of implant failure and complications between obese and nonobese patients.

MATERIALS AND METHODS

Charts from 220 partially edentulous patients with 321 implants were examined for demographic information, medical health history, diabetes, smoking, patient-reported height and weight, periodontal status (no, mild, moderate, or severe periodontitis), tooth number, date of the implant and prosthesis placement, and treatment notes pertinent to the complications or failure. Subjects were classified according to their body mass index (BMI) as normal (18.5 to 24.5 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or obese (≥ 30 kg/m(2)) based on self-reported height and weight. Variables including sex, smoking, diabetes, and periodontal condition were considered as confounders. Data were analyzed to examine differences in frequency of complications and occurrence of failures.

RESULTS

Implant failure was low (2.1%) and did not differ by BMI category. Compared with normal BMI patients, obese patients had increased odds of experiencing an implant complication (OR = 4.9, 95% CI [1.4, 17.6]) after adjustment for other variables. Diabetes was not associated with an increased risk of complications; obese patients with diabetes had decreased odds of an implant complication compared with obese patients without diabetes.

CONCLUSION

No association was observed between obesity and implant failures. BMI category was associated with implant complications; obese patients have greater odds of experiencing implant complications postsurgically. Treating obese patients with the existing protocol for diabetic patients (antibiotic regimens, more frequent follow-up, and maintenance appointments) may improve clinical outcomes.

Aggressive Gingival Metastasis of Adenocarcinoma of Unknown Origin: Case Report

A case of localized soft tissue growth located on the lingual aspect of the left mandibular gingiva is reported in a 61-year-old male patient in whom excisional biopsy of the lesion was performed. The histopathologic diagnosis was adenocarcinoma. Further clinical and biopsy examinations taken from several organs indicated the presence of metastatic adenocarcinomas in the brain, spleen, lymph nodes, and liver. The oral tumor recurred after repeated surgical removal. Based on histopathological examination and immunoprofiling analysis the primary tumor probably originated in the gastrointestinal tract.

Arthritis and Periodontitis: An Association Debated for Over Two Centuries

The chronic diseases, rheumatoid arthritis (RA) and periodontal disease (PD) lead to confined destruction of soft and hard tissues as a result of inflammatory processes. Their pathogenesis is dictated by a network of inflammatory cells and its mediators. They also share some etiological risk factors and therapeutic alternatives. The evolution of focal infection theory is summarized in this review, with special reference to PD and its relationship to RA. Foci of chronic infections exist in the oral cavity and may result in anatomically distant disease in certain individuals. Recent cumulative evidences document the influence of inflammatory diseases such as RA on the development of PD. Historical evidences and new theories on the interrelationship between the two diseases have the potential to identify novel mechanisms and therapy to improve patient outcomes. This review focuses on not only the association of focal infection theory and RA, but also on the reciprocal effects of RA and PD.

Ridge preservation surgery after single and multiple adjacent tooth extractions: a microcomputed tomography study in dogs

PURPOSE

The aim of this study was to determine, before implant placement, the outcome of ridge preservation surgery after extractions of one or more adjacent teeth on the dimensions of the edentulous ridge.

MATERIALS AND METHODS

Nineteen extraction sites in four dogs were randomly divided into three groups: group 1 = single premolars (n = 7 sites); group 2 = two adjacent premolars (n = 6 sites); group 3 = three adjacent premolars (n = 6 sites). Extraction was followed by ridge preservation surgery using a combination of xenograft and collagen membrane after full-thickness flap reflection. All animals were sacrificed 4 months later, and each extraction site was sectioned in the sagittal plane so that alveolar bone measurements could be made in both the buccolingual and apicocoronal directions using microcomputed tomography.

RESULTS

Mean buccolingual width of the ridges postsurgery was 4.80 ± 2.78 mm, 4.98 ± 2.65 mm, and 4.79 ± 2.79 mm in groups 1, 2, and 3, respectively. The mean vertical distance from the cementoenamel junction to the crest of the ridge was 1.94 ± 0.42 mm, 2.05 ± 0.48 mm, and 2.60 ± 0.67 mm in groups 1, 2, and 3, respectively. No statistically significant difference was seen between single and multiple extraction sites.

CONCLUSION

Ridge preservation surgery results in a similar pattern of bone remodeling in the horizontal and vertical dimensions of the edentulous ridge after single and multiple adjacent tooth extractions.

Short chain fatty acids potently induce latent HIV-1 in T-cells by activating P-TEFb and multiple histone modifications

HIV patients with severe periodontitis have high levels of residual virus in their saliva and plasma despite effective therapy (HAART). Multiple short chain fatty acids (SCFAs) from periodontal pathogens reactivate HIV-1 in both Jurkat and primary T-cell models of latency. SCFAs not only activate positive transcription elongation factor b (P-TEFb), which is an essential cellular cofactor for Tat, but can also reverse chromatin blocks by inducing histone modifications. SCFAs simultaneously increase histone acetylation by inhibiting class-1/2 histone deacetylases (HDACs) and decrease repressive histone tri-methylation at the proviral LTR by downregulating expression of the class-3 HDAC sirtuin-1 (SIRT1), and the histone methyltransferases enhancer of Zeste homolog 2 (EZH2) and suppressor of variegation 3-9 homolog 1 (SUV39H1). Our findings provide a mechanistic link between periodontal disease and enhanced HIV-1 replication, and suggest that treatment of periodontal disease, or blocking the activities of SCFAs, will have a therapeutic benefit for HIV patients.

Reduced systemic inflammatory mediators after treatment of chronic gingivitis

OBJECTIVE

To assess the changes in the level of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) in gingival crevicular fluid (GCF) after treatment of chronic gingivitis in systemically healthy individuals.

METHODS

This is a clinical trial conducted at Case Western Reserve University, Cleveland, Ohio, United States of America from February to December 2011. A total of 41 systemically healthy subjects were assigned to 2 groups according to the severity of gingival inflammation. Group I consisted of 18 subjects who had mild gingival inflammation; and group II consisted of 23 with more severe gingival inflammation. Periodontal assessment consisted of gingival index (GI), probing depths (PD), and GCF volume. Four to six weeks after prophylaxis and oral hygiene instruction, the same measurements were repeated. The level of CRP and TNF-alpha in the GCF was determined using enzyme-linked immunosorbent assays.

RESULTS

A statistically significant reduction in the mean CRP and TNF-alpha levels after the treatment was found in the severe, but not in the mild gingivitis group. Both groups showed a statistically significant reduction in GI, PD, and periotron readings after the treatment.

CONCLUSION

Treatment of severe chronic gingivitis reduces the levels of CRP and TNF-alpha in GCF of otherwise systemically healthy individuals, which could have an impact on preventing or controlling future or existing systemic disease conditions.

Obesity and periodontitis: a link

Obesity and periodontitis are both diseases that represent significant health problems. Obesity currently impacts approximately one-third of the United States population and periodontitis affects an estimated 50% of the same population, ages 30 and over. It has been suggested that the possible relationship between obesity and periodontitis lies in the diseases' underlying inflammatory processes. The aim of this paper is to present those inflammatory pathways and to review the literature that has examined the association between obesity and periodontitis.

Women's health: periodontitis and its relation to hormonal changes, adverse pregnancy outcomes and osteoporosis

PURPOSE

To examine the literature with respect to periodontitis and issues specific to women's health, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis.

MATERIALS AND METHODS

The literature was evaluated to review reported associations between periodontitis and genderspecific issues, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis.

RESULTS

Collectively, the literature provided a large body of evidence that supports various associations between periodontitis and hormonal changes, adverse pregnancy outcomes and osteoporosis; however, certain shortcomings were noted with respect to biases involving definitions, sample sizes and confounding variables. Specific cause and effect relationships could not be delineated at this time and neither could definitive treatment interventions.

CONCLUSION

Future research must include randomised controlled trials with consistent definitions, adequate controls and sufficiently large sample sizes in order to clarify specific associations, identify cause and effect relationships, define treatment options and determine treatment interventions which will lessen the untoward effects on the at-risk populations.

Autogenous bone grafting in a patient on long-term oral bisphosphonate therapy: case report

A 66-year-old patient was referred to the Periodontal Clinic at Case Western Reserve University for implant placement in the mandibular left first molar area. The patient reported a history of oral bisphosphonate intake for the last 7 years for the treatment of osteoporosis. Autogenous bone block grafting was planned to augment the ridge before implant placement. The surgery was performed under local anesthesia, and the implant was successfully placed 8 months after ridge augmentation. Healing was uneventful postoperatively, and the buccolingual width of the ridge increased significantly, allowing placement of a 5-mm-diameter dental implant. The patient showed proper healing of both the donor site and the recipient site, in spite of the long-term oral bisphosphonate therapy, with no resulting osteonecrosis of the jawbone.

Mandibular incisive canal: cone beam computed tomography

PURPOSE

Panoramic radiography is often used to analyze the anatomical structure of the teeth, jaws, and temporomandibular joints. Cone beam computed tomography (CBCT) imaging allows multiple axial slices of the image to be obtained through these anatomical structures. The aim of this study was to assess CBCT compared with panoramic radiography to verify the presence, location, and dimensions of the mandibular incisive canal.

MATERIALS AND METHODS

CBCT scan images and panoramic radiographs of 89 subjects were compared for the presence of the mandibular incisive canal, its location, size, and anterior-posterior length. The distance between the incisive canal and the buccal and lingual plate of the alveolar bone, and the distance from the canal to the inferior border of the mandible and the tooth apex were also measured. A paired t-test was used to calculate any significant difference between the two imaging techniques.

RESULTS

Eighty-three percent of the CBCT scans showed the presence of the incisive canal, as did 11% of the panoramic radiographs. The range of the incisive canal diameter, as seen in the CBCT scans, was from 0.4 × 0.4 mm to 4.6 × 3.2 mm. The mean length of the canal was 7 ± 3.8 mm. The distance from the inferior border of the mandible to the canal was 10.2 ± 2.4 mm, and the mean distance to the buccal plate was 2.4 mm. The apex-canal distance (in dentate subjects) was 5.3 mm.

CONCLUSION

The presence, location, and dimensions of the mandibular incisive canal are better determined by CBCT imaging than by panoramic radiography.

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors

BACKGROUND

Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed.

METHODS

Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not.

RESULTS

Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P <0.001), and serum TNF-alpha (P <0.05). There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI.

CONCLUSIONS

Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

Control of periodontal infection reduces the severity of active rheumatoid arthritis

OBJECTIVE

To determine if eliminating periodontal infection and gingival inflammation affects the severity of active rheumatoid arthritis (RA) in patients with chronic inflammatory periodontal disease.

METHODS

Twenty-nine subjects with confirmed diagnosis of RA and mild-to-moderate chronic periodontitis of at least 3 years' duration were enrolled in the study. The activity of RA was assessed using the disease activity score test (DAS28). Seventeen subjects completing the study received periodontal treatment consisting of scaling/root planing and oral hygiene instruction; 12 subjects completing the study received no treatment. Participants continued their usual disease-modifying medications for RA without any changes in DMARD therapy during the study period. RA measurements, and periodontal indices were recorded at baseline and at 8 weeks for each participant. Mann-Whitney U and chi tests were used to test for significant differences in the severity of RA in the periodontally treated group compared with the untreated groups.

RESULTS

Ten of 17 subjects (58.8%) in the treated group and 2 of 12 subjects (16.7%) in the untreated group showed improvement in RA scores. There was a statistically significant difference in DAS28 (4.3 +/- 1.6 vs. 5.1 +/- 1.2) and erythrocyte sedimentation rate (31.4 +/- 24.3 vs. 42.7 +/- 22) between the treatment and the control groups.

CONCLUSION

Control of periodontal infection and gingival inflammation by scaling/root planing and plaque control in subjects with periodontal disease may reduce the severity of RA. This notion is supported by reported subjective improvement in treated patients.

Skeletal bone diseases impact the periodontium: a review of bisphosphonate therapy

Healthcare professionals should be aware that systemic bone conditions impact the periodontium. Bisphosphonate drugs used for systemic bone loss affect the maxilla and mandible. Alveolar bone loss in periodontitis and skeletal bone loss share common mechanisms. At present, bisphosphonates are in wide use for prevention and treatment of osteoporosis, Paget's disease and metastatic bone conditions. This therapy is linked to a negative side effect called osteonecrosis of the jaws. At the same time, bisphosphonate therapy is also reported to be beneficial to the periodontium. In fact, periodontal therapy using bisphosphonates to modulate host response to bacterial insult may develop into a potential strategy in populations in which periodontal therapy is not convenient. Unlocking the full potential of bisphosphonates involves understanding the mechanisms of action of different classes of bisphosphonates, limiting unwanted side effects and expanding its indications. Developing bisphosphonates to slow the progression of periodontal disease depends on identifying an effective dosage regimen and delivery system that would reach the target site in the periodontium, while limiting unwanted side effects.

Transmission of an uncultivated Bergeyella strain from the oral cavity to amniotic fluid in a case of preterm birth

Intrauterine infection is a recognized cause of preterm birth. The infectious organisms are believed to originate primarily from the vaginal tract and secondarily from other parts of the body. It is plausible that microbes in the oral cavity can be transmitted to the pregnant uterus. However, direct evidence supporting such a transmission is lacking. In this study, amniotic fluids of 34 pregnant women were examined by PCR using 16S and 23S rRNA universally conserved primers. Bacterial DNA was amplified from the only patient with clinical intrauterine infection and histologic necrotizing acute and chronic chorioamnionitis. One strain, Bergeyella sp. clone AF14, was detected and was 99.7% identical to a previously reported uncultivated oral Bergeyella strain, clone AK152, at the 16S rRNA level. The same strain was detected in the subgingival plaque of the patient but not in her vaginal tract. The 16S-23S rRNA sequence of clone AF14 matched exactly with the sequences amplified from the patient's subgingival plaque. These observations suggest that the Bergeyella strain identified in the patient's intrauterine infection originated from the oral cavity. This is the first direct evidence of oral-utero microbial transmission. The patient's periodontal health during pregnancy was unclear. She did not have detectable periodontal disease during postpartum examination. Bergeyella spp. had not been previously associated with preterm birth and were detected in subgingival plaque of women without clinical levels of intrauterine infection. Uncultivated species may be overlooked opportunistic pathogens in preterm birth. This study sheds new light on the implication of oral bacteria in preterm birth.

Aggressive periodontitis in a patient with chronic cutaneous lupus erythematosus: a case report

Lupus erythematosus is considered to be a high risk factor for periodontitis. As an autoimmune disease of unknown origin, cutaneous lupus erythematosus (CLE) is subdivided into 3 categories: chronic (CCLE), subacute (SCLE), and acute (ACLE). While the ACLE has a high prevalence of conjunctive periodontal lesions, aggressive periodontitis in patients with CCLE has been rarely reported. This article describes the case of a patient diagnosed with aggressive periodontitis. Three months after the diagnosis of periodontitis, the patient experienced advancing hair loss (alopecia), pale fingers and toes, as well as edema in the legs and around the eyes. Skin biopsy showed follicular hyperkeratosis with perivascular mononuclear cell infiltrate. Colliquation of the basal cells, thickening of the basal lamina, and vacuolar degeneration of basal keratinocytes were also found. A lupus band test was positive, and diagnosis of CCLE was established. Three months following the treatment of lupus with antimalarial agents, the periodontal condition became stable with no further exacerbation or progression of the existing periodontitis. An 11-month postsurgical follow-up revealed stable periodontal and general medical conditions. A patient's medical history should be re-evaluated in the event of recurrence of periodontal lesions refractory to periodontal treatment. The control of systemic conditions like lupus erythematosus is essential for a good prognosis in the treatment of periodontitis as well as for the general health of the patient.

Periodontitis and cardiovascular disease: a review of shared risk factors and new findings supporting a causality hypothesis

Periodontitis is a common chronic disease worldwide. It is a major cause of tooth loss among adults and recently has been suggested to increase the risk for developing several systemic diseases, including cardiovascular disease. Populations are not equally affected by periodontal disease because there are several environmental and host factors modulating susceptibility. Cardiovascular disease shares many of the same susceptibility factors. The purpose of this report is to identify risk factors and indicators common to periodontitis and cardiovascular disease, and also to discuss their possible interrelationship in this association. Recent findings to support a causal association between the 2 conditions are also presented.

Increased physical activity reduces prevalence of periodontitis

OBJECTIVES

Physical activity has been shown to have a protective relationship with several chronic diseases. Recently, physical activity was also found to reduce the risk of periodontitis in a study in male health professionals. However, the relationship between physical activity and periodontitis in a diverse group of individuals is not thoroughly examined. The purpose of this study was to examine if there is an association between sustained physical activity and periodontitis in a subset of the third national health and nutrition examination survey (NHANES III).

METHODS

NHANES III participants 18 years of age or older who had had a periodontal examination and reported to have a similar physical activity (or inactivity) level for 10 years or longer were selected (n=2521). Multivariable logistic regression analysis was used to estimate the association between physical activity and periodontitis. The analysis was adjusted for: age, gender, race, education, smoking, body mass index, poverty index, vitamin use, healthy eating index, time since last dental visit, gingival bleeding, and dental calculus.

RESULTS

Engaging in the recommended level of physical activity was significantly associated with lower periodontitis prevalence (OR=0.58, 95% CI, 0.35-0.96). Smoking, however, was found to modify this relationship. The association was strong and significant among never (OR=0.46, 95% CI, 0.23-0.93) and former smokers (OR=0.26, 95% CI: 0.09-0.72), but not among current smokers (OR=1.10, 95% CI: 0.48-2.53).

CONCLUSIONS

These results suggest that engaging in the recommended level of exercise is associated with lower periodontitis prevalence, especially among never and former smokers.

Periodontal assessment of postmenopausal women receiving risedronate

OBJECTIVE

The purpose of this study was to compare periodontal status of postmenopausal women with mild to moderate osteoporosis who use risedronate therapy with those who do not.

DESIGN

In this cross-sectional study, a total of 60 age-matched postmenopausal women with mild to moderate osteoporosis diagnosed by a bone density scan T score below -2.5 at either spine or hip were divided into two groups. Women in the experimental group had used systemic risedronate once weekly (35 mg) for at least 3 months. Women in the control group had never used bisphosphonate therapy. The periodontal status of each subject was evaluated through a clinical periodontal examination including evaluation of periodontal probing depth, gingival recession, gingival index, plaque score, attachment loss, and alveolar bone level. The significance in differences between the two groups was assessed using two-tailed paired t tests.

RESULTS

Significant differences (P < 0.05) were found between risedronate and control groups for periodontal probing depth (2.6 vs 2.9 mm), gingival index (0.37 vs 0.71), plaque score (56.2 vs 77.0), attachment loss (2.8 vs 3.2 mm), and alveolar bone level (3.1 and 4.0), respectively. Gingival recession parameters did not differ significantly. Five of six periodontal parameters evaluated show that postmenopausal women with mild to moderate osteoporosis using risedronate therapy have healthier periodontal status than those who do not use bisphosphonates.

CONCLUSIONS

Women using risedronate therapy show significantly less plaque accumulation, less gingival inflammation, lower probing depths, less periodontal attachment loss, and greater alveolar bone levels. These observations suggest that risedronate therapy may play a beneficial role in periodontal status.

Predictability of connective tissue grafts for root coverage: clinical perspectives and a review of the literature

Several techniques using subepithelial connective tissue for root coverage have recently been described in the periodontal literature. The predictability of such procedures, however, varies among the different reports. The factors responsible for these differences are not fully understood. The purpose of this article is to review and comment on factors that may enhance the predictability of root coverage.

Periodontitis and Three Health-Enhancing Behaviors: Maintaining Normal Weight, Engaging in Recommended Level of Exercise, and Consuming a High-Quality Diet

BACKGROUND

Maintaining normal weight, engaging in the recommended level of exercise, and eating healthy food are known to improve general health. The impact of these behaviors on periodontal health is not well documented. This study is aimed at examining whether the increased number of these behaviors is associated with a decrease in the prevalence of periodontitis in a United States population.

METHODS

This study utilized data on 12,110 individuals who participated in the third National Health and Nutrition Examination Survey. Multivariate logistic regression analysis was used to estimate the association between the number of health-enhancing behaviors and periodontitis prevalence. Health enhancing behaviors included maintaining normal weight (body mass index [BMI], 18.5 to 24.9 kg/m(2)), engaging in the recommended level of exercises (>or=episodes of moderate or >or=episodes of vigorous-intensity physical activity per week), and having a high-quality diet (healthy eating index >80).

RESULTS

After controlling for age, gender, race\ethnicity, cigarette smoking, other tobacco products, education, diabetes, poverty index, census region, acculturation, vitamin use, time since the last dental visit, dental calculus, and gingival bleeding, a 1-unit increase in the number of the three health-enhancing behaviors was associated with a 16% reduction in the prevalence of periodontitis (odds ratio [OR]=0.84; 95% confidence interval [CI]: 0.77 to 0.93). Individuals who maintained normal weight, engaged in the recommended level of exercise, and had a high-quality diet were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors.

CONCLUSION

An increased number of health-enhancing behaviors is associated with a lower periodontitis prevalence.

Gingival enlargement and resolution during and after orthodontic treatment

Gingival enlargement (GE) is a condition that commonly develops during orthodontic treatment. Thirty adolescent subjects with clinically significant GE were analyzed at pre-orthodontic treatment (T1), when the appliances were removed (T2), and 3 to 12 months after (T3). The mean GE decreased from T2 to T3, but was significantly higher on T3 than T1 (p<.05). It may be concluded that complete resolution of GE developed during orthodontic treatment is not always attained after removal of the fixed appliances.

Diet and periodontitis

The importance of diet in maintaining optimum body health is well recognized. An unhealthy diet has been implicated as a risk factor for several chronic diseases such as cardiovascular disease, hypertension, diabetes and certain cancers. The relationship between diet and periodontitis is not clear. The purpose of this article is to critically review the available literature and to shed new light on the impact of the overall diet on the prevalence and severity of chronic periodontitis in a given population.

Effect of connective tissue graft orientation on root coverage and gingival augmentation

The present study was undertaken to assess the width of keratinized tissue and root coverage achieved when orienting the superficial surface of a connective tissue graft toward either the gingival flap or the root surface. Sixteen pairs of bilateral gingival recessions (Miller Class I and II) in 13 subjects were divided into two groups. In each subject, one side received a connective tissue graft with its superficial surface facing the gingival flap, while the contralateral side received a connective tissue graft with its superficial surface facing the root surface. Plaque Index, Gingival Index, probing depth, gingival recession, and relative clinical attachment level were recorded at baseline and 3 months postoperative. Root length was measured on periapical radiographs to calculate the percentage of actual root coverage. ANOVA was used to detect significant differences between the two treatment groups. The results indicated that surface orientation of a connective tissue graft has no significant effect on the clinical outcome of either root coverage or gingival augmentation.

Poor overall diet quality as a possible contributor to calculus formation

PURPOSE

An association between diet and calculus deposits was suggested by animal studies. The objective of the present analysis was to examine whether or not there is an association between overall diet quality, as measured by the healthy eating index, and extent of dental calculus deposits using a subset of the third National Health and Nutrition Examination Survey (NHANES III) data.

MATERIALS AND METHODS

NHANES III participants 18-years of age or older who had data on dental calculus and diet quality were selected (n = 12405). The healthy eating index (HEI), used as an indicator of overall diet quality, has a minimum score of zero (poorest) and a maximum score of 100 (best) and was divided into three categories, poor (HEI < 51), fair (HEI, between 51 - 80) and good (HEI > 80). Ordinal logistic regression models were used to examine the association between the HEI and the percentage of sites with calculus deposits.

RESULTS

Overall diet quality was found to be significantly associated with calculus deposits controlling for: age, gender, race, education, poverty income ratio, smoking, diabetes, history of vitamin and mineral use, body mass index, time elapsed since last dental visit and gingival bleeding. The adjusted odds ratios for having a greater percentage of sites with calculus were 1.54 (1.19 - 1.98), 1.30 (1.02 - 1.60) and 1.00 (reference) for subjects with poor, fair, and good diet quality respectively.

CONCLUSION

Poor diet quality is significantly associated with more calculus deposits. Further studies are needed to examine if poor diet quality is a predisposing factor for calculus formation and/or a risk factor for periodontal diseases.