Chronic Periodontitis Research Articles

IDENTIFICATION OF PERIODONTAL PATHOGENS IN PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS DEPENDING ON THE SEVERITY OF INFLAMMATION

Introduction. The progression of chronic generalized periodontitis is associated with gram-negative anaerobic bacteria. Microbiological diagnostics of periodontal disease provides an opportunity for selecting the most effective therapeutic approach for both local and systemic conditions in patients. Aim of this study is to conduct a qualitative assessment of the presence of pathogenic microorganisms in the periodontal pockets of patients, based on the severity of inflammation. Materials and methods. The presence of five key pathogenic microorganisms in the periodontal pocket contents of 90 individuals aged 25-60 years (45 with grade I severity and 45 with grade II) was assessed using real-time polymerase chain reaction (PCR). The analysis was conducted with the CFX96™ Real-Time PCR Detection System (BIO-RAD) and the PeriodontScreen Real-TM reagent kit (Sacace Biotechnologies Srl, Italy). Non-parametric correlation statistical analysis was performed to calculate Kendall’s Tau and Gamma coefficients. In 27 patients (60%) with grade I severity, bacteria of a single species were identified. Two types of periodontal pathogens were detected in 13 patients (28.9%), with the most common combination being Tannerella forsythia and Aggregatibacter actinomycetemcomitans, found in 5 patients (11.1%); 5 patients (11.1%) showed the presence of three microbial species: Tannerella forsythia, Treponema denticola, and Porphyromonas gingivalis. Among the patients with grade II severity, 8 patients (17.8%) had bacteria of one species, specifically Prevotella intermedia. Two microbial species were identified in 9 patients (20%), while three species were present in 15 patients (33.3%). The most frequent combination included Prevotella intermedia, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans, found in 5 patients (11.1%). Four types of microbes were detected in 13 patients (28.9%), with the predominant combination being Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, and Aggregatibacter actinomycetemcomitans (17.8%). None of the patients with grade II severity had all five periodontopathogenic agents. The correlation analysis confirmed that chronic periodontitis is strongly associated with the presence of Tannerella forsythia within microbial associations. Conclusions. The spectrum of periodontal pathogens affects the severity of inflammation in the periodontium. In grade II inflammation, associations of periodontal pathogens were detected by 82.2% of cases, while in grade I by in 40%. Tannerella forsythia was detected in 42.2% of patients with grade I inflammation, 15.6% of them as a mono-infection; in patients with grade II inflammation in 71.1%, in associations with Treponema denticola in 48.9%. Determining the spectrum of periodontal pathogens, taking into account their characteristics and associated virulence factors, is necessary for choosing the effective differentiated treatment approach.

Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial

BackgroundBioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis.MethodsA total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman’s correlation test were used, and a p value < 0.05 was considered significant.ResultsVAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males.ConclusionThe level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h.Trial registrationClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered.

Neutrophil extracellular traps in the cross-talk between periodontitis and chronic kidney disease

BackgroundThe objective was to evaluate the level of neutrophil extracellular traps (NETs) in patients with chronic kidney disease (CKD) and periodontitis, and to explore the relationship between NETs and both diseases.Methods63 CKD and 40 non-CKD participants were recruited and underwent periodontal examination, among which 35 early CKD patients underwent periodontal therapy. The concentrations of NETs were determined by dsDNA assay in gingival crevicular fluid (GCF) and plasma, and by flow cytometry or immunofluorescence assay in blood and gingival tissues. The correlations between NETs and clinical parameters were analyzed. The influence of periodontal therapy on periodontitis, CKD and NETs concentrations was also evaluated.ResultsCKD patients had higher concentrations of NETs in plasma than non-CKD patients, and NETs concentrations were also increased in both GCF and plasma of patients with periodontitis than that of periodontally healthy patients. NETs concentrations were positively correlated with increased clinical parameters of CKD and periodontitis. The positive correlation between CKD and periodontitis was demonstrated. Moreover, periodontal therapy ameliorated periodontitis and CKD, and reduced NETs concentrations in GCF of patients.ConclusionsThis study revealed that NETs might be a possible bridge between periodontitis and CKD, and suggested the potential target for therapy.

Relationship Between Tooth Loss Due to Chronic Periodontitis and Lower Urinary Tract Symptoms

Relationship Between Tooth Loss Due to Chronic Periodontitis and Lower Urinary Tract Symptoms

Efficacy of Chlorhexidine Chips as Local Drug Delivery in Nonsurgical Management of Chronic Periodontitis: A Systematic Review

Efficacy of Chlorhexidine Chips as Local Drug Delivery in Nonsurgical Management of Chronic Periodontitis: A Systematic Review

The comorbid pathology in patients with chronic apical periodontitis

The purpose of this study was to study the relationship between teeth after endodontic treatment and/or with apical periodontitis, in patients with a number of systemic diseases and smokers among the adult population of Yaroslavl.Materials and methods of research. Medical history data were collected, including age, gender, presence of cardiovascular diseases, diabetes mellitus, allergies, smoking habits and data on endodontic dental treatment of 421 patients (10,540 teeth). The prevalence of depulpated teeth and the periodontal condition were assessed by orthopantomograms. The periapical status was classified according to the periapical Index PAI (PAI), chronic apical periodontitis was defined as PAI-score ≥3. The statistical analysis was carried out using the Stata/MP v. program.17.0 (StataCorp LLC, Texas 77845-4512, USA) using chi-square tests, odds ratio and confidence intervals (95%).The results and their discussion. The overall prevalence of chronic apical periodontitis and the prevalence of teeth after endodontic treatment was 2.2 and 4.2%, respectively. The high prevalence of depulpated teeth increased the likelihood of chronic apical periodontitis (p&lt;0.0001). In the group of men, there was a higher percentage of teeth with chronic apical periodontitis (p&lt;0.0001), a lower percentage of teeth after endodontic treatment (p=0.05) and a greater number of residual roots (with complete destruction of the crown of the tooth) (2.3%). Smokers were more likely to have teeth with chronic apical periodontitis (p=0.002) and the prevalence of teeth after endodontic treatment (p=0.045). A positive correlation was observed between the prevalence of teeth after endodontic treatment and diabetes mellitus (p=0.040).Conclusion. A higher prevalence of chronic apical periodontitis and/or teeth after endodontic treatment in smokers and patients with diabetes mellitus may indicate a relationship between the condition of the oral cavity and a number of systemic diseases.

Association of ABO phenotype, rhesus factor, platelet count and hemoglobin level with oral hygiene status and severity of chronic periodontitis

BackgroundThe development of periodontal diseases has multifactorial causes including genetic factors. Limited investigations have been conducted to explore the association between ABO blood groups and the development and progression of periodontal diseases. AimTo evaluate and assess the association of ABO Phenotype and Rhesus factor with oral hygiene status, severity of chronic periodontitis and blood parameters like hemoglobin level and Platelet count in localized and generalized chronic periodontitis. Material and methodsStudy was carried out on 100 patients, out of which 80 patients of Generalized Chronic Periodontitis and 20 patients of Localized Chronic Periodontitis. Patients were categorized into Mild, Moderate and Severe Periodontitis. ResultA highly significant association was found between severity of periodontitis and blood groups with blood group B and O were found to be at a greater risk to develop moderate to severe form of chronic periodontitis. Also subjects with blood group B and O showed worst oral hygiene among all the blood groups. Also patients suffering from chronic periodontitis showed a general trend towards lower limit of both hemoglobin level and platelet. ConclusionGenetic factors such as ABO blood group antigens may act as a risk influencer that plays a role in progression and severity of the chronic periodontitis, with blood group B and O being worst affected. Another observation was that a long standing case of chronic periodontitis can lead to anemia thus having systemic implications.

D-mannose alleviates chronic periodontitis in rats by regulating the functions of neutrophils

BackgroundPeriodontitis is a chronic inflammatory disease characterized by the destruction of the components of the periodontium. It significantly impacts oral health and has been linked to systemic conditions like cardiovascular disease and diabetes. The critical role of neutrophils in the occurrence and development of chronic periodontitis has been paid increasing attention. The study aimed to explore the protective effects of D-mannose on chronic periodontitis and determine whether its underlying mechanisms is related to neutrophils.MethodsTo explore the protective effects of D-mannose on chronic periodontitis, the eight-week-old Sprague Dawley rat model of lipopolysaccharide (LPS)-induced periodontitis was established, followed by D-mannose treatment by oral gavage. To evaluate the protective effects of D-mannose against periodontal bone loss, methylene blue staining, hematoxylin and eosin (H&E) staining, and micro-CT scanning were utilized. Then, immunofluorescence (IF), Western Blot, and RT-PCR were applied to assess the expression levels of pro-inflammatory cytokines (IL-1β, IL-6, and IL-17), anti-inflammatory cytokine (IL-10), tumor necrosis factor-alpha (TNF-α), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), ten-eleven translocation 2 (TET2), and key glycolytic enzymes (HK1, HK2, PFKFB3), and to examine D-mannose’s impact on the recruitment and activation of neutrophils in the gingiva. Additionally, neutrophils isolated from the peripheral blood of healthy rats were treated with LPS and D-mannose, and changes in the expression levels of myeloperoxidase (MPO), IL-1β, IL-6, IL-17, IL-10, and TET2 were observed via IF.ResultsIn vivo, D-mannose inhibited LPS-induced alveolar bone resorption in rats. After D-mannose treatment, the expression levels of IL-17 (p<0.01) and TET2 (p<0.01) were suppressed by IF, and the expression levels of IL-1β (p<0.05), IL-17 (p<0.05) and TET2 (p<0.01) were downregulated by WB. The results of qPCR showed that D-mannose reduced the expression levels of IL-1β (p<0.05), IL-6 (p<0.01), IL-17 (p<0.01), TNF-α (p<0.01), G-CSF (p<0.01), GM-CSF (p<0.01), TET2 (p<0.01), HK1 (p<0.01), HK2 (p<0.01), and PFKFB3 (p<0.01). D-mannose also inhibited the recruitment and activation of neutrophils in LPS-treated rat gingival tissues. In vitro, the results of IF showed that D-mannose inhibited the activation of neutrophils stimulated by LPS, downregulated the expression of IL-1β (p < 0.05), IL-6, IL-17 (p < 0.01), and TET2 (p < 0.01), and upregulated the expression of IL-10 (p < 0.01).ConclusionsD-mannose can alleviate chronic periodontitis in rats by regulating the functions of neutrophils, potentially associated with the expression of TET2 and glycolysis, providing new insights into the potential application of D-mannose to chronic periodontitis.

Periapical cemento-osseous dysplasia masquerading as asymptomatic chronic apical periodontitis in a Chinese woman: A case report.

Cemento-osseous dysplasia (COD) belongs to a group of fibrous osseous disorders that can masquerade as periapical inflammatory conditions in the jawbones. We present a rare case of COD occurring in a patient who also had periapical periodontitis concurrently. When faced with a patient exhibiting no symptoms, diagnosis may be challenging. COD is a fibrous osseous disorder similar to periapical chronic inflammatory conditions and other cysts in the jaw bones on the radiograph. There is a rare case of COD occurring in a 49-year-old Chinese woman who also had chronic periapical periodontitis concurrently. The lesions were incidentally discovered in the mandibular anterior tooth region during the patient's imaging examination. The patient exhibited no symptoms, and diagnosing the conditions may be challenging due to the confusingly similar radiological features that present as a radiolucent lesion in the periapical region. The final diagnosis was made through pulp vitality tests, cone beam computed tomography (CBCT), and clinical examinations. The COD was recommended for annual follow-up. Root canal therapy has been performed for chronic apical periodontitis. According to the diagnostic process of COD, a thorough history check, multiple clinical examinations, and imaging studies should be emphasized to prevent misdiagnosis and avoid unnecessary or inappropriate therapies. The patient was followed up for 6 years. The recovery of chronic apical periodontitis in tooth #31 and the transformation of osteolytic and osteogenesis of COD had been observed in CBCT.

Exosomal miR-155-5p promote the occurrence of carotid atherosclerosis.

Periodontitis is a significant independent risk factor for atherosclerosis. Yet, the exact mechanism of action is still not fully understood. In this study, we investigated the effect of exosomes-miR-155-5p derived from periodontal endothelial cells on atherosclerosis invitro and invivo. Higher expression of miR-155-5p was detected in the plasma exosomes of patients with chronic periodontitis (CP) and carotid atherosclerosis (CAS) compared to patients with CP. Also, the expression level of miR-155-5p was associated with the severity of CP. miR-155-5p-enriched exosomes from HUVECs increased the angiogenesis and permeability of HAECs and promoted the expression of angiogenesis, permeability, and inflammation genes. Along with the overexpression or inhibition of miR-155-5p, the biological effect of HUVECs-derived exosomes on HAECs changed correspondingly. In ApoE-/- mouse models, miR-155-5p-enriched exosomes promoted the occurrence of carotid atherosclerosis by increasing permeable and angiogenic activity. Collectively, these findings highlight a molecular mechanism of periodontitis in CAS, uncovering exosomal miR-155-5p derived periodontitis affecting carotid endothelial cells in an 'exosomecrine' manner. Exosomal miR-155-5p may be used as a biomarker and target for clinical intervention to control this intractable disease in future, and the graphic abstract was shown in FigureS1.

Applications Of Photodynamic Therapy In Periodontal Diseases

Background: According to A. Marcacci et al (1888), when many reports emerged on light absorbing properties and of fluorescence of various dyes, it became clear that dye excitation by light exerts destructive action in biological systems. This so-called photodynamic action was described as a process in which light, after being absorbed by dyes sensitizes organisms for visible light inducing cell damage. The supra- and subgingival plaque biofilm on tooth surfaces should easily be accessible for flushing with the dye and for activating them by light. Thus, periodontal diseases are promising applications of Photodynamic Therapy. Introduction: Chronic periodontitis is the most common periodontal disease which is related to the chronic accumulation of bacterial plaque. Since mechanical methods are not sufficient in the treatment of this disease, administration of local/systemic antibiotic is recommended following mechanical debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of these suggested methods is the antimicrobial photodynamic therapy (aPDT). PDT is a local noninvasive treatment modality without the side effects caused by antibiotics. Objectives: In this review, the mechanism of action of PDT and its application in the treatment of various periodontal conditions along with its future trends are discussed. Conclusion: Even though PDT is still in experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology and Implant related perspectives.

Expression of CCL2 signaling pathway genes in patients with periodontitis and atherosclerosis.

Periodontitis and atherosclerosis are chronic inflammatory diseases characterized by leukocyte infiltration. We investigated the expression of CCL4, CCR5, c-Jun, c-Fos, NF-κB, and CCL2 as well as the possible mechanism involved in the regulation of CCL2 in human periodontitis tissues and atherosclerotic aorta based on previous research on the CCL4/CCR5/c-Jun and c-Fos/CCL2 pathway leading to CCL2 expression in collagen-induced arthritis (CIA) rat. Sixty-five volunteers were recruited and the condition of their gingiva and coronary arteries were assessed. The subjects were divided into four groups: healthy control, chronic periodontitis (CP), coronary artery diseases (CAD), and noncoronary artery diseases (non-CAD). Total RNA was isolated from gingiva in periodontitis patients and control populations and from the aorta in patients with and without CAD. PCR was used to examine CCL4, CCR5, c-Jun, c-Fos, NF-κB, and CCL2 levels. The production of CCL2 in the gingiva and aorta was analyzed by immunostaining. PCR revealed that CCL4, CCR5, and CCL2 mRNA levels were increased in CP patients' gingivae and aortas from coronary artery bypass grafting (CABG) patients. Marked c-Jun, c-Fos, and NF-κB gene productions were detected in CP patients' gingivae but did not show statistical differences between the CAD and non-CAD groups. Stronger immunoreactivity against CCL2 was observed in periodontitis gingiva and aorta from CABG patients. Our findings suggest that the CCL4/CCR5/c-Jun and c-Fos/CCL2 pathways may be involved in CCL2 expression in periodontitis. CCL4, CCR5, and CCL2 might act as possible nodes to link the presence of periodontitis and atherosclerosis.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Periodontal pathogens in the appearance and progression of chronic periodontitis

Periodontal diseases are considered a public health problem due to their high prevalence worldwide, so the authors set out to describe the role of periodontal pathogens in the onset and progression of chronic periodontitis. The documentary analysis method was used and a total of 18 bibliographies were reviewed. Current scientific evidence supports the association between periodontal pathogens and the development of periodontitis, demonstrating that bacteria such as Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola play a crucial role in the pathogenesis of periodontal disease by triggering inflammatory responses and promoting the destruction of tooth-supporting tissues.

Primary endodontic infections - key issue in pathogenesis of chronic apical periodontitis

Primary endodontic infections - key issue in pathogenesis of chronic apical periodontitis

Results of the study on the baseline status of flight-associated periodontal pathology in civil aviation flight personnel

Aim. To assess the baseline condition of periodontal structures in civil aviation flight personnel in order to improve the algorithm for treatment and preventive dental care.Materials and Methods. A periodontal examination of the oral cavity was conducted for 120 flight personnel at the physician-sanitary unit of Dushanbe International Airport. The participants were divided into five groups: flight personnel with mild chronic gingivitis, moderate chronic gingivitis, mild chronic periodontitis, moderate chronic periodontitis, and a control group of flight personnel with healthy periodontium. The clinical course of chronic gingivitis and periodontitis was evaluated using oral hygiene and periodontal indices.Results and Discussion. Inflammatory periodontal diseases, such as chronic gingivitis and periodontitis of moderate severity (Groups II and IV), presented with more pronounced symptoms, including severe inflammatory reactions of the periodontal tissues and poor oral hygiene, compared to those in Groups I and III.Conclusion. The study demonstrated that papillary-marginal-alveolar (PMA) index, bleeding index, and oral hygiene scores were significantly elevated in flight personnel with mild to moderate chronic periodontitis, highlighting the need for targeted treatment and preventive care.

The association between low serum vitamin D level &amp; periodontal diseases in Bangladeshi population- An observational study

Aims: Bangladeshi population (20-45 age) presents early loss of tooth without any history of systemic disease. Low serum vitamin D level is one of the factors of early tooth loss. The aim of the study is to assess the significance of low or insufficient serum vitamin D level as a factor of early tooth loss in Bangladesh perspective. Materials and Methods: An observational study was performed in dental unit of TMSS Medical College from January 2021 to December 2022 after ethical clearance of IRB of this institute. Total number of patients was 70 selected by non-random sampling (judgment sampling) who fulfilled the inclusion and exclusion criteria. We assessed the variable like gingivitis, periodontal pocket &amp; tooth mobility clinically. The depth of the periodontal pocket &amp; gingivitis was assessed by the periodontal probe &amp; the mobility by using a blunt instrument &amp; feel with the fingers before &amp; after Vit D supplementation. Data were processed and analyzed using computer software SPSS version 26.0. Results: Deficiency of low serum vit D level has significant effect on periodontal bone resorption and after correction of serum vit D level resulted clinical improvement on periodontal health. Conclusion: Vitamin D deficiency may place subject at risk of developing chronic periodontitis. J Bangladesh Coll Phys Surg 2024; 42: 363-367

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial

Comparative Evaluation of Mogibacterium timidum in Diabetic Patients With Chronic Periodontitis, Nondiabetic Patients with Chronic Periodontitis, and Healthy Patients During Pretreatment and Posttreatment: A Real-Time PCR Study

Comparative Evaluation of Mogibacterium timidum in Diabetic Patients With Chronic Periodontitis, Nondiabetic Patients with Chronic Periodontitis, and Healthy Patients During Pretreatment and Posttreatment: A Real-Time PCR Study