American Academy Of Periodontology Research Articles

Diagnostic accuracy of severe periodontitis case definitions: Comparison of the CDC/AAP, EFP/AAP, and CPI criteria.

This cross-sectional study aimed to evaluate the diagnostic accuracy of severe periodontitis by three different case definitions. Patients aged >35 years (n = 243, mean age = 47.8 ±9.3 years) were evaluated by periodontal examinations and classified in patients with severe periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Academy of Periodontology (AAP)-CDC/AAP, the new periodontal disease classification proposed jointly by the AAP and the European Federation of Periodontology (EFP/AAP), and the Community Periodontal Index (CPI). The primary outcome was to compare the diagnostic accuracy of severe periodontitis between the three case definitions. Sensitivity (SS), specificity (SP), and area under the receiver operating characteristic (ROC) curve were used to analyze the accuracy. The proportion of subjects presenting the most severe definitions of each classification was: severe periodontitis (CDC/AAP) = 47.3%, type III and IV periodontitis (EFP/AAP) = 43.2% and CPI code 4 = 44.4%. When comparing the CDC/AAP case definitions with the EFP/AAP classification, SS, SP, and ROC of 81.7%, 91.4%, and 0.866 (CI, 95%: 0.816 to 0.916), respectively, were obtained. Similarly, when comparing CDC/AAP to CPI code 4, SS, SP, and ROC of 81.7%, 89.1%, and 0.854 (CI, 95%: 0.802 to 0.906), respectively, were obtained. When type III and IV periodontitis (EFP/AAP) was compared with CPI code 4, the values were 92.4%, 92%, and 0.922 (CI, 95%: 0.883 to 0.961), respectively. The EFP/AAP classification and the CPI demonstrated high diagnostic accuracy with the CDC/AAP case definition to diagnose severe periodontitis.

Erbium-doped: yttrium-aluminum-garnet (Er:YAG) versus scaling and root planing for the treatment of periodontal disease: A single-blinded split-mouth randomized clinical trial.

This randomized, controlled clinical trial aimed to compare the differences in periodontal clinical outcomes, duration of the procedure, and patient's experience between conventional scaling and root planing and erbium-doped: yttrium-aluminum-garnet (Er:YAG) in the treatment of generalized moderate to severe chronic periodontitis or generalized Stages II or III, and Grade B periodontitis based on the Centers for Disease Control (CDC), American Academy of Periodontology (AAP), and European Federation of Periodontology (EFP) definitions. Thirty subjects were initially recruited. In a split-mouth fashion, right and left sides were randomly allocated into two treatment arms: conventional scaling and root planing (C-SRP) versus laser-assisted scaling and root planing (L-SRP). A blinded examiner recorded clinical measurements at baseline and 3 months. Duration of the procedure was also recorded for each visit, and the patient's experience was assessed with a questionnaire at baseline, 1, and 3 months. The final sample consisted of 26 subjects. Both treatments resulted in overall improvement, but no significant differences were found between modalities for clinical attachment gain or probing depth reduction. The duration of the procedure was approximately half for L-SRP, and postoperative sensitivity was greater in C-SRP. The low-energy protocol with Er:YAG (50 mJ) used for the non-surgical treatment of moderate-severe chronic or Stage II-III, Grade B periodontitis performed in this study population was a treatment modality that yielded similar clinical improvements when compared to conventional scaling and root planing.

Optimization of periodontal disease diagnosis by the results of clinical laboratory tests

Relevance. The authors have established that the microbiological and local risk factors prevail in changing the clinical condition of the periodontium. Aim – сlinical and diagnosis argumentation of the gingival tissue condition according to the criteria of the New International Classification of Periodontal and Peri-implant Diseases and Conditions and Proceedings of the 2017 World Workshop jointly held together by the American Association of Periodontology (AAP) and the European Federation of Periodontology (EFP).Materials and methods. Clinical and laboratory assessment of 105 young patients was conducted. Three patient groups were formed according to the detected risk factor and according to the data of the New International Classification of Periodontal and Peri-implant Diseases and Conditions. The main group consisted of 70 (66.6%) patients with diagnosed chronic plaque-induced gingivitis (33.3%) and initial periodontitis (33.3%) (mild chronic periodontitis). The control group comprised 35 patients with clinically healthy gingiva on an intact periodontium (71.1%) and reduced periodontium (22.9%). Periodontal pathogens as a risk factor were assessed by PCR using DNA-express commercial sets (Liteh, LLC, scientific manufacturing company, Russia). Cytology of the gingival crevicular fluid impression smears stained by Romanovsky-Giemsa method was performed.Results. Changes in the hygiene and periodontal indices were revealed on full dental examination. PCR detected low or critical number of periodontal pathogens in the studied samples. Neutrophilic leukocytes, histiocytes and epithelial cells were present in the impression smears, polymorphonyclear neutrophils significantly increased and macrophages, histiocytes, epithelial cells appeared; macrophages decreased.Conclusion. Full dental examination and laboratory tests revealed the following clinical conditions: clinically healthy gingiva on an intact periodontium, clinically healthy gingiva on a reduced periodontium, plaque-induced gingivitis, stage I periodontitis – initial periodontitis, which corresponded to the New International Classification of Periodontal and Peri-Implant Diseases and Conditions and Proceedings of the 2017 World Workshop held by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP).

Association between periodontitis and glycated hemoglobin levels in individuals living in rural Southern Brazil.

To estimate the prevalence of prediabetes in individuals with moderate or severe periodontitis and to verify the association between periodontitis and glycated hemoglobin levels. A cross-sectional study was conducted including individuals age 18-93 years from a representative sample residing in rural Southern Brazil. Data collection included full mouth periodontal clinical examinations, laboratory screens, and structured questionnaires. Glycemic levels were based on glycated hemoglobin. Periodontitis case definition was based on criteria established by the Centers for Disease Control and Prevention and the American Academy of Periodontology. A logistic regression model adjusted for body mass index was used to estimate odds ratios (OR) and 95% confidence intervals (CI). The association between periodontal parameters and changes in glycated hemoglobin levels was evaluated using linear regression models. A higher prevalence of prediabetes was observed among individuals with moderate (39.6%) and severe periodontitis (49.7%) than in individuals with mild (23.8%) or no periodontitis (27.8%). Adjusting for body mass index, individuals with severe periodontitis exhibited a 2.5 greater chance of being prediabetic (OR=2.5; 95% CI: 1.3-4.9) that was significantly associated with an increase of 0.10% in HbA1c. Severe periodontitis was associated with elevated blood glucose levels. Individuals with this condition having a higher percentage HbA1c are more likely to be prediabetic. This study highlights the importance of the clinicians' awareness of the association between severe periodontitis and prediabetes allowing its early detection in the dental office.

Periodontal Disease Status in a Population at Najran Province of Saudi Arabia

Background: The common periodontal diseases are of public health concern, with 20-50 percent of the global population affected by gingivitis and or periodontitis.
 Aim: The aim of this study was to explore the common periodontal diseases occurring among the patients who attended the College of Dentistry hospital of Najran University. And also, to determine the correlation among the age groups, nationalities and risk factors related to periodontal diseases.
 Methods: A retrospective hospital-based descriptive type study was performed, providing 352 records of male patients suffering from various types of periodontal diseases. The Centers for Disease Control and the American Academy of Periodontology (CDC-AAP) classification was used for periodontal diagnosis. Patients were grouped by age as group A (6-20 years), group B (21-40 years), group C (41-60 years) and group D (above 60 years). Chi-square test and multinomial logistic regression model were adapted for data analyses.
 Results: Out of 352 patients, 217 (61%) and 135 (39%) patients suffered from gingivitis and periodontitis, respectively. Mean age of the patients was 32.81 ± 15.96 (range 6-97) years. Sixty-nine (19.6%), 200 (56.8%), 60 (17.0%) and 23 (6.5%) patients of Group A, B, C and D suffered from different forms of periodontal diseases, respectively. Eighty three percent patients were of Saudis and Yemenis and the rest were of Egyptian, Bangladeshi, Pakistani, Indian, Sudanese, Jordanian, Syrian, Chadian, Ghanaian and Tunisian nationalities. Highest number of patients suffered from moderate generalized gingivitis 142 (40.3%) and moderate localized periodontitis 57 (16.2%). Majority had plaque & calculus 290 (82.4%) and the rests had diabetes mellitus, smoking and tobacco chewing habit, asthma, hypertension and heart disease. Correlations among periodontal disease, age group and risk factor were found significant (p <0.05) though between the nationality and risk factor was found not significant (p 0.999).
 Conclusions: Significant relationships were observed among periodontal diseases and age, nationality and risk factors. This small study of Najran may reflect the periodontal status in a population of Saudi Arabia. Further broad scale study would be conclusive establishing such relationship in Saudi Arabian population.

Detection of periodontal bone loss in mandibular area from dental panoramic radiograph using image processing techniques

AbstractMedical imaging plays the vital role in diagnosis of abnormalities. Periodontitis is a common chronic inflammatory disease damaging the soft tissue that untreated can lead to loss of bone, which supports the teeth. The severity of periodontitis is correlated to pocket depth in alveolar area. Even if analyses of the pocket depth can be manually performed, an automatic assistive tool can drastically help radiologists conduct more accurate analyses. In the proposed research, image processing algorithms were developed to compute pocket depth and diagnose the periodontitis. Radiologists manually segmented 350 panoramic radiographic images, dividing them into normal and periodontitis. The same dataset is used in our work to validate the Classification algorithm. The images are preprocessed with median filter and histogram equalization to improve the contrast and then segmented using two‐dimensional‐Otsu thresholding method into teeth and bony area in the mandibular region. Normal pocket depth of 3 mm as reported by American Academy of Periodontology is equivalently converted to pixel height in the radiographic images. Based on this pocket depth rule based classification method classifies the images into normal and periodontitis. The proposed work achieved 91.34% accuracy, 92.8% sensitivity, and 95.47% F‐score in classifying the dental panoramic radiography.

A fogágybetegség és a krónikus obstruktív tüdőbetegség kapcsolatának jelentősége

A fogágybetegség és a krónikus obstruktív tüdőbetegség (COPD) is a leggyakrabban megjelenő krónikus betegségekcsoportjába tartozik. A fogelvesztéssel járó előrehaladott fogágybetegség a világ 6. leggyakrabban előforduló krónikusbetegsége, mely kb. 743 millió embert érint, míg a COPD világszerte évente átlagosan 3 millió emberéletet követel (ez5,3%-a az összes haláloknak világszerte) és 2016 óta a világ 3. vezető halálokává vált. Egy norvég tanulmány szerinta nagyon súlyos COPD-ben szenvedő, tüdőtranszplantáció előtt álló betegek esetén a parodontitisz prevalenciája megközelítia 44%-ot, szemben a nem COPD-s kontrollcsoport 7,3%-os gyakoriságával. A két betegség összefüggése jelenlegdirekt módon nem bizonyított, ám egyre több tanulmány támasztja alá a két betegség közti kapcsolat lehetőségét.Tanulmányunkban összegezni szeretnénk a jelenleg elérhető szakirodalmi adatokat és ez által betekintést nyújtania két betegség kölcsönhatásába és feltételezett patomechanizmusába. Szükség lenne olyan klinikai vizsgálatokra, melyekbennagy esetszámmal vizsgálnak parodontálisan érintett COPD-s betegeket, így megerősítve vagy cáfolva azta feltevést, miszerint a fogágybetegek parodontális terápiája hozzájárulhat-e a COPD-ben szenvedő betegek életminőségénekjavításához.

Evaluation of the FDI Chairside Guide for Assessment of Periodontal Conditions: A Multicentre Observational Study

ObjectiveThere is a need to develop easy-to-use tools to screen for periodontal conditions in daily practice. This study aimed to evaluate the FDI World Dental Federation “Chairside Guide” (FDI-CG) developed by the Task Team of the FDI Global Periodontal Health Project (GPHP) as a potential tool for screening. MethodsDatabases from 3 centres in Germany, Hong Kong, and Spain (n = 519) were used to evaluate the association of the FDI-CG and its individual items with the periodontitis case definitions proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) for population-based surveillance of periodontitis. ResultsStatistically significant differences were observed among the databases for the prevalence of periodontitis and the items included in the FDI-CG. The FDI-CG score and its individual components were significantly associated with the periodontal status in the individual databases and the total sample, with bleeding on probing showing the strongest association with severe periodontitis (odds ratio [OR] = 12.9, 95% CI [5.9; 28.0], P < .001, for those presenting bleeding on probing >50%), followed by age (OR = 4.8, 95% CI [1.7; 4.2], P = .004, for those older than 65 years of age). Those subjects with a FDI-CG score >10 had an OR of 54.0 (95% CI [23.5; 124.2], P < .001) and presented with severe periodontitis. A significant correlation was found between the different FDI-CG scoring categories (mild, moderate, and severe) and the categories for mild, moderate, and severe periodontitis using the Centers for Disease Control and Prevention and the American Academy of Periodontology criteria (r = 0.57, Spearman rank correlation test, P < .001). ConclusionThe FDI Chairside Guide may represent a suitable tool for screening the periodontal condition by general practitioners in daily dental practice.

Comparative evaluation of laser biostimulation as an adjunct to NSPT and ITS effects on AST levels in the management of chronic periodontitis: A randomized controlled trial

Aim: Clinical evaluation of aspartate aminotransferase (AST) in gingival crevicular fluid (GCF) with and without laser biostimulation as an adjunctive to non-surgical periodontal therapy (NSPT). Materials and Methods: This is a split-mouth randomized trial. Ten patients (20 sites) were diagnosed with chronic periodontitis as per the American Academy of Periodontology (AAP) classification (1999), and radiographic evidence of horizontal bone loss was provided. Scaling and root planning (SRP) was performed in both the test groups. One of the test groups was treated with low-level laser therapy (LLLT) along with SRP and another with only SRP. GCF collection was done at baseline, during the third and sixth months by using microcapillary tubes for the estimation of AST. Quantification of AST was done by a Semi-automated Clinical Chemistry Analyzer. The data were subjected to statistical analysis by an independent t-test, Kruskal–Wallis test, Mann–Whitney U test, Wilcoxon signed-rank test, and post hoc pairwise comparison. Results: The results revealed a statistically significant reduction in pocket probing depth (PPD) (P < 0.001) and relative attachment gain (P < 0.001) at the test sites when compared from baseline till six months. Similarly, there was a statistically significant reduction in AST levels in GCF at the sites treated with laser biostimulation along with NSPT (P < 0.001). Conclusion: Laser biostimulation along with NSPT has shown propitious results as per clinical and biochemical marker analysis and evaluation.

Antibiotic prescribing practices in various periodontal surgeries in vicinity of Nagpur City: A survey

Background: Among the postoperative complications following periodontal surgery, the risk of infection stands out the most since infection of the surgical site can lead to poor surgical outcomes in terms of wound healing. Aim: This study aims to evaluate antibiotic-prescribing practices for various periodontal surgeries in vicinity of Nagpur city. Materials and Methods: An anonymous survey was distributed to periodontists through Google forms. The survey questioned prescribing practices for various periodontal surgeries, the demographic data and place of practice of the clinician, rationale for prescribing or not prescribing antibiotics, and acceptability of guidelines. The survey consisted of 12 questions, 7 of which were questioned to the practitioners “In an otherwise healthy patient, would you prescribe antibiotics for a X procedure” where X included various periodontal surgeries. Response choices were limited to “In most cases yes, in most cases no and I do not perform this procedure.” Results were analyzed using statistical software. Results: A total of 50 periodontists responded out of 98 who were contacted to participate in the survey with a response rate of 51%. Nearly 58% of practitioners had a predominant work setting of a dental college and 42% have a predominant work setting of private practice. Practitioners were significantly more likely to prescribe antibiotics all the periodontal surgical procedures. The most common rationale for prescribing antibiotics was to decrease the chances of developing an infection, whereas the most common rationale for not prescribing antibiotics was a healthy patient and based on current and previous literature. Nearly 66% of practitioners reported that they would follow the guidelines for antibiotic prescription if they were developed by American Academy of Periodontology (AAP). Bivariate analysis revealed that there is no significant role of other characteristics on the response of an individual. Even multivariate analysis does not reveal significance of baseline characteristics although it revealed that respondents working in a dental college are 2.15 times more likely to follow AAP guidelines as compared to private practitioners. Females are 1.64 times more likely to follow AAP guidelines as compared to males and respondents practicing inside Nagpur are 1.35 times more likely to follow AAP guidelines as compared to those practicing outside city. Conclusion: Practitioners are more likely to prescribe antibiotics in the majority of the periodontal surgical procedures despite the standard indications for prescription. This misuse can lead to numerous complications in treatment and development of antibiotic resistance. Based on these results, specific guidelines for the use of antibiotics suggesting a particular antibiotic to be used in a particular periodontal surgery and its duration is the need of the hour to prevent the overuse of antibiotics.

On the value of the 2017 classification of phenotype and gingival recessions.

The 2017 World Workshop completely restructured knowledge in periodontology with a series of official consensus statements jointly agreed upon by the American Academy of Periodontology and the European Federation of Periodontology. Among them, the 2017 classification of phenotype and gingival recession successfully incorporated the most relevant previous classifications into a treatment-oriented diagnostic matrix. Despite the significant advantages related with the implementation of this new classification of gingival recessions, recent articles still report data based on previous outdated systems. Therefore, the present commentary aimed to dive into the key advantages of the 2017 classification of phenotype and gingival recession, and to stress why it should be fully integrated into research and practice settings.

Critical Evaluation of the 2017 Classification of Periodontal and Peri-implant diseases and Conditions – An Update

Periodontal disease is the multifactorial disease that leads to the destruction of the tooth-supporting structures. A classification system provides a framework that helps in diagnosis and assembles similar disease phenotypes in a more homogeneous form. Several classifications have been proposed by many authors. Till date, the American Academy of Periodontology (AAP) 1999 Classification was the most extensively used classification, which was designed to overcome the drawbacks and deficiencies of the 1989 classification. However, presence of some drawbacks has limited its use in routine clinical practice. So, the current classification has been developed in 2017 by AAP and the European Federation of Periodontology (EFP) to overcome the disadvantages of the 1999 classification. The 2017 classification is extremely extensive and more intricate than 1999 classification, which is useful to the overall dentist and periodontists to select the best treatment options for the patients. This review summarizes the newer classification, key changes from 1999 Classification/modification and disadvantages of the newer classification.

Role of Occlusion as a Risk Factor in Periodontal Disease

Occlusion can be described in very simple terms as an intercuspal relationship between the set of maxillary and mandibular teeth. It plays an important role in the pathogenesis of periodontal diseases and traumatic lesions are often manifestation of faulty occlusion. Mc neil defined occlusion as the functional relationship between the components of the masticatory system, temporomandibular joint (TMJ), and craniofacial skeleton. From a research point of view, the TMJ serves primarily as a reference from which mandibular movements are duplicated. Most patients function with the built-in discrepancies in occlusion throughout their life. Periodontal treatment modalities may be required when alterations or abnormalities in the occlusal relationship place undue stress on the periodontium and TMJ, thereby causing dysfunction. The role of trauma from occlusion (TFO) in periodontal disease is still controversial. According to American Academy of Periodontology (AAP), the lesion of TFO may occur in conjunction with, or independent of, inflammatory periodontal diseases. Pathologic occlusion has been proposed as a risk factor for periodontitis. In certain cases, traumatogenic occlusion can cause periodontal destruction, and therefore, occlusal adjustment occasionally is indicated as part of periodontal therapy. The present review focuses on TFO as a risk factor and its impact on the periodontium and its treatment.

Is inadequate sleep a potential risk factor for periodontitis?

This study was undertaken to investigate the potential association between sleep duration and periodontitis. The study population consisted of 10,291 individuals who participated in the United States National Health and Nutrition Examination Survey (NHANES) from the 2009–2014 cycles. Sleep duration was categorized into sleep deficient (< 7 hours), sleep adequate (7–8 hours), and sleep excessive (> 8 hours). We used the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) periodontitis case definition. Descriptive statistics and logistic regression models were used for data analyses. The prevalence of periodontitis was 36% higher in individuals who reported sleep deficiency when compared to the sleep adequate group (odds Ratio (OR) = 1.36, 95% confidence interval (CI): 1.23–1.50). Those who reported excessive sleep had 41% higher odds of periodontitis (OR: 1.40, 95% CI: 1.16–1.71). After adjusting for confounding factors, sleep deficient individuals were 19% more likely to have periodontitis when compared to sleep adequate individuals (OR: 1.19, 95% CI: 1.06–1.38). Among sleep excessive individuals, the association was non-significant (OR: 1.16, 95% CI: 0.94–1.43). Sleep deficiency was associated with a higher prevalence of periodontitis in this study population. The association however needs to be confirmed in longitudinal studies.

A new classif ication in Periodontology (Chicago 2017). Impact in Orthodontics

In 2018, a new « Classification of Periodontal and Peri-implant Diseases and Conditions » was adopted by the American Academy of Periodontology and the European Federation of Periodontology. Numerous studies in recent years have improved the understanding of periodontal diseases and their risk factors, leading to an update of the 1999 classification. Among the major changes is the development of a classification of periodontitis into different stages and grades and the notion of periodontal health, an essential prerequisite for orthodontic treatment. Based on the analysis of the 24 published articles, this work provides explanations regarding the main changes that orthodontists may face. The classification of Chicago precisely defines periodontal health and proposes a new system for characterizing periodontitis in stages and grades. It then becomes a valuable aid for the orthodontist in risk detection and periodontal screening. The knowledge of this new classification is essential for reliable communication between dentists, periodontists and orthodontists, in order to guarantee the success of orthodontic treatment.

Severe and moderate periodontitis are associated with acute myocardial infarction.

An association between periodontitis and cardiovascular disease is now well documented; however, the effect of periodontitis severity levels on this outcome, specifically on acute myocardial infarction (AMI), remains unexplored. This study investigated the association between levels of periodontitis severity (exposure) and AMI (outcome). This case-control study, matched by sex and age, was conducted with 621 participants, with 207 individuals treated in the emergency department of Santa Izabel and Ana Nery Hospitals in Salvador, Bahia, Brazil, diagnosed with a first AMI event, and compared to 414 individuals without a diagnosis of AMI. Levels of periodontitis severity followed two criteria: (1) Center for Disease Prevention and Control and American Academy of Periodontology; (2) Gomes-Filho etal. (2018) using criteria that also evaluated bleeding upon probing. Conditional logistic regression analysis was performed and odds ratios (ORs) and their 95% confidence intervals (CIs) were obtained. The adjusted association measurements showed a positive association between both severe (ORadjusted ranged from 2.21 to 3.92; 95% CI ranged from 1.03 to 10.05) and moderate periodontitis (ORadjusted ranged from 1.96 to 2.51; 95% CI ranged from 1.02 to 6.19), and AMI, for both periodontitis diagnostic criteria. It demonstrated that among those with moderate and severe periodontitis, the chance of having AMI was approximately two to four times greater than among those without periodontitis. The findings demonstrate that there is an association between the severity of the periodontal condition and AMI, suggesting a possible relationship among the levels of periodontitis severity and the cardiovascular condition.

Periodontitis and rheumatoid arthritis: An update 2012-2017.

Rheumatoid arthritis and chronic periodontitis are both chronic inflammatory diseases characterized by an exacerbated inflammatory reaction that leads to destruction of bone and other connective tissue. Owing to these similarities, the relationship between these two diseases has been investigated for over two decades. In the 2013 proceedings from a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology in 2012 it was concluded that there was at least minimal evidence of an association between periodontitis and rheumatoid arthritis. In this review, we consider publications in the field over the past 5years and determine whether the evidence for this relationship has increased.

Salivary markers of oxidative stress and periodontal pathogens in patients with periodontitis from Santander, Colombia.

Introduction: Periodontitis affects more than 20% of the Latin American population. Oxidative markers are associated with greater progression of periodontitis; therefore, its role in pathogenesis should be studied.Objective: To determine the prevalence of the main oral bacteria and viruses associated with periodontitis and estimate the total antioxidant capacity and lipid peroxidation in saliva from patients with periodontitis.Materials and methods: We conducted systemically a cross-sectional study in 101 healthy subjects, 87 of whom had been diagnosed with periodontitis (P), according to the criteria of the Centers of Disease Control and Prevention and the American Academy of Periodontology, and 14 without periodontal pockets as controls (C). In subgingival samples, major viruses and dental pathogenic bacteria were identified using PCR techniques. The levels of total antioxidant capacity and malon-di-aldehyde (MDA) were determined by spectrophotometry in samples of unstimulated saliva.Results: The mean of periodontal depth pocket and clinical attachment loss in patients with periodontitis was 5.6 ± 1.7 and 6.1 ± 3.1 mm, respectively. The most prevalent microorganisms were Aggregatibacter actinomycetemcomitans (32.5%) and Porphyromonas gingivalis (18.6%). The patients from rural areas showed a higher percentage of A. actinomycetemcomitans (urban: 17.9% vs. rural: 48.9%, p=0.0018). In patients with periodontitis, the frequency of EBV, HSV1 & 2, and HCMV genes was 2.3%. Periodontitis patients had higher levels of MDA (P: 2.1 ± 1.5; C: 0.46 ± 0.3 µmol/g protein; p=0.0001) and total antioxidant capacity (P: 0.32 ± 0.2; C: 0.15 ± 0.1 mM; p< 0.0036). Oxidative markers showed no modifications due to the presence of periodontopathic bacteria.Conclusions: Aggregatibacter actinomycetemcomitans was the most prevalent bacteria; its presence did not modify the levels of oxidative markers in the saliva of patients with periodontitis.

Introducing the Oral-B iO electric toothbrush: next generation oscillating-rotating technology

A novel oscillating-rotating electric toothbrush (Oral-B iO) has been developed with a linear magnetic drive, resulting in oscillation-rotations with micro-vibrations. The mechanism directs motor energy directly to the bristle tips. The brush also has a redesigned round brush head and smart pressure sensor to enhance plaque removal and encourage proper brushing technique. The plaque removal and gingival health effects of this new electric toothbrush technology were evaluated in three randomized controlled studies summarized in this supplement, including an 8-week trial versus a manual toothbrush, an 8-week trial versus a premium sonic toothbrush, and a single-brushing, repetitive-use study versus a manual toothbrush. Outcomes from these studies demonstrate statistically significantly greater plaque removal and gingival health improvements for the Oral-B iO toothbrush technology versus manual and sonic toothbrush controls. Plaque removal advantages demonstrated in the replicate-use single-brushing trial resulted in significant gingival health benefits as evidenced in the longer-term trials. In addition, gingivitis case status assessments based on the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) guidelines show that over 80% of subjects using the Oral-B iO transitioned from 'gingivitis' (≥10% bleeding sites) at baseline to 'generally healthy' (<10% bleeding sites) at week 8 in both longer-term clinical trials, versus 24% in the manual toothbrush group and 53% in the sonic toothbrush group. This uniquely designed oscillating-rotating electric toothbrush with a linear magnetic drive delivers significantly greater plaque removal and gingival health benefits with additional features to improve brushing experience and clinical outcomes.

Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients

Objective To investigate the associations of impaired glucose metabolism and insulin resistance with chronic periodontitis in pre-diabetes patients. Methods A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose metabolism and chronic periodontitis was investigated by multivariable logistic regression analysis. Results FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic periodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis. Conclusion Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.