High Prevalence Of Periodontal Disease Research Articles

Prevalence of periodontal disease and characterization of its extent and severity in an adult population - an observational study.

Present study was undertaken to determine the prevalence of periodontal disease in an adult population and to further characterize the extent and severity of the disease. The study population consisted of 700 randomly selected individuals reporting to out patient department of dental college and hospital. Demographic details and lifestyle characteristics of the all the subjects were recorded and a thorough oral examination was performed. In order to evaluate the periodontal status of subjects, five indices (CAL, PD, OHI, PI and GI) were assessed and subjects having at least one site with clinical attachment loss (CAL) ≥3mm were diagnosed as having periodontitis. Further, to analyse the extent of disease, subjects having periodontitis were divided into two groups as having at least one site with CAL ≥5mm and having at least three sites with CAL ≥5mm. RESULTS showed that there was a high prevalence of periodontitis amongst population with almost 72% of the individuals having at least one site with CAL ≥3mm. A trend was noted in which periodontal status worsened as the age increased. Analysing the extent and severity of disease amongst the population, results revealed that almost 41% of population had at least one site with CAL ≥5mm whereas almost 21% of individuals had at least three sites with CAL ≥5mm. Present study provides with evidence of high prevalence of periodontal disease amongst the population. Importantly, this study also unveils the lack of awareness for dental health amidst the population.

Oral health in older patients with oropharyngeal dysphagia

oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S); (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis); and (iii) the presence of dental caries. 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent; 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.

Assessment of periodontal health among the rural population of Moradabad, India

Introduction: Oral health is an integral component of general health and is essential for well-being. India is one of the most populated countries in the world and majority of them resides in rural areas. Moradabad is one of the oldest cities of Uttar Pradesh with diverse culture and beliefs. Aim: The aim was to evaluate the periodontal health status of the rural Moradabad population. Materials and Methods: A representative transversal study on 550 adults aged 20-49 years of rural Moradabad was conducted from February 2011 to June 2011. The survey was carried out using a self-designed questionnaire. Periodontal health was assessed using WHO criteria (1997). Results: Overall the prevalence of periodontal diseases among study subjects was overall 91.6%. Males had a higher prevalence of periodontal disease (93.8%) as compared to females (89.5%). Out of total subjects 37.8% had Community Periodontal Index (CPI) score 4 and 32.5% had score 3. About 7.3% of subjects had loss of attachment (LOA) with 20.2% of them having LOA score 1. Statistically, there was a significant difference ( P 35 years, smoking, tobacco chewing (independent risk factors) were significantly associated with CPI > 2 (dependent variable) ( P Conclusion: The current periodontal health status of rural adult population of Moradabad city can be attributed to low literacy along with socio economic status and oral habits. To improve the periodontal health status of the rural population of Moradabad, it is suggested that a community-based approach can be designed.

Prevalence and severity of periodontal disease among non-insulin-dependent diabetes mellitus patients in Shimla City, Himachal Pradesh, India

Background: Periodontal disease has been labelled as the sixth complication of the diabetes. Abnormal collagen metabolism, abnormal polymorphonuclear cell function and altered sulcular microbial flora progresses periodontitis among diabetic patients. Aim : To find out the prevalence and severity of periodontal disease among Noninsulin-dependent Diabetes Mellitus Patients in Shimla City, Himachal Pradesh, India. Materials and Methods: The study was conducted among 100 subjects suffering from type-II diabetes mellitus and 100 non diabetic patients attending medicine department with age group between 35 to 75 years. Based on the values of glycated haemoglobin the diabetic subjects were divided into well, moderate and poorly controlled. Information regarding age, gender and duration of diabetes was recorded on the format. CPI index was used to evaluate the periodontal status of the subjects. Data was analysed using SPSS version 15. P ≤ 0.05 and ≤0.01 was considered as statistically significant and highly significant respectively. Results: Among both the genders, the mean CPI score was higher among diabetics as compared to the nondiabetics. Statistically this difference was highly significant ( P 1 C has also shown significant association with the occurrence of higher CPI scores with increase in its value. Longer duration was associated with higher CPI scores than lesser duration and statistically this difference was significant. ( P Conclusion: Type-II diabetic patients have a higher prevalence of periodontal disease than non diabetic individuals. More emphasis is to be put on the co-managemnt of oral and overall health in patients with diabetes by dental and general practitioners.

Mitigation and Education

Mitigation and Education

Adverse Mandibular Bone Effects Associated with Kidney Disease Are Only Partially Corrected with Bisphosphonate and/or Calcium Treatment

Background/Aims: Patients with chronic kidney disease (CKD) have a high prevalence of periodontal disease that may predispose to tooth loss and inflammation. The goal of this study was to test the hypotheses that a genetic rat model of progressive CKD would exhibit altered oral bone properties and that treatment with either bisphosphonates or calcium could attenuate these adverse changes. Methods: At 25 weeks of age, rats were treated with zoledronate (ZOL), calcium gluconate, or their combination for 5 or 10 weeks. Mandible bone properties were assessed using micro-computed tomography to determine bone volume (BV/TV) and cementum-enamel junction to alveolar crest distance (CEJ-AC). Results: Untreated CKD animals had significantly lower BV/TV at both 30 (-5%) and 35 (-14%) weeks of age and higher CEJ-AC (+27 and 29%) compared to normal animals. CKD animals had a significantly higher parathyroid hormone (PTH) compared to normal animals, yet similar levels of C-reactive protein (CRP). ZOL treatment normalized BV/TV over the first 5 weeks but this benefit was lost by 10 weeks. Calcium treatment, alone or in combination with ZOL, was effective in normalizing BV/TV at both time points. Neither ZOL nor calcium was able to correct the higher CEJ-AC caused by CKD. Calcium, but not ZOL, significantly reduced serum PTH, while neither treatment affected CRP. Conclusions: (i) This progressive animal model of CKD shows a clear mandibular skeletal phenotype consistent with periodontitis, (ii) the periodontitis is not associated with systemic inflammation as measured by CRP, and (iii) reducing PTH has positive effects on the mandible phenotype.

Association Between Periodontitis and Gestational Diabetes Mellitus: A Case‐Control Study

Some studies have reported an association between gestational diabetes mellitus (GDM) and periodontitis. The aim of the present study is to analyze this potential association and the influence of risk variables associated with GDM. This case-control study includes 360 women, 90 with GDM and 270 controls. Participants received a full-mouth periodontal examination with a record of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Periodontitis is defined as the presence in ≥4 teeth of ≥1 sites with PD ≥4 mm and CAL ≥3 mm associated with BOP. The influence of risk variables in the occurrence of GDM is tested through univariate analysis and multivariate logistic and multinomial regression. Odds ratio (ORs) and respective confidence intervals (CIs) are calculated and reported. The prevalence of periodontitis was 40% in the case group (GDM) and 46.3% in the control group. There was a lack of association between periodontitis and GDM (OR = 0.74; 95% CI = 0.40 to 1.38). The multivariate final logistic regression model retained the following as significant variables associated with GDM: maternal age (OR = 2.65; 95% CI = 1.97 to 3.56), chronic hypertension (OR = 3.16; 95% CI = 1.35 to 7.42), and body mass index (OR = 1.99; 95% CI = 1.41 to 2.81). A high prevalence of periodontitis was found among cases and controls, with no association between periodontitis and GDM. The present study suggests the need for implementation of health policies directed to the periodontal care of pregnant women.

Prevalence and clinical variety of periodontitis in patients attending dental policlinics in Kazan, Russia

Aim. To determine different periodontal diseases prevalence and distribution in patients attending dental policlinics in Kazan, Russia. Methods. Clinical screening, computed statistical analysis were used as a study methods. 517 medical charts of dental patients (form 043/A) were randomly selected. Different forms of periodontitis were classified according to ICD-10. Results. A high prevalence of periodontal diseases reaching 100% was found among the examined patients who had attended dental policlinics in Kazan, Russia. Chronic (34-89%) and acute (11-44%) apical periodontitis were the most prevalent types of periodontitis in all age groups of patients who had attended dental policlinics. In patients aged 18-39 years acute apical periodontitis was the most common type of periodontitis (11-44%). Conclusion. A high prevalence of periodontal diseases in patients who had attended dental policlinics in Kazan, Russia, was found, with a tendency of chronic periodontitis prevalence to grow, reaching highest levels in elderly patients. Thus, measures for periodontitis prevention and early treatment are vital.

Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases

This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. This report examined biological plausibility, epidemiology and early results from intervention trials. PLAUSIBILITY: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.

Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAPWorkshop on Periodontitis and Systemic Diseases.

This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. This report examined biological plausibility, epidemiology and early results from intervention trials. Plausibility: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.

Association between periodontal disease and venous thromboembolic disease.

In recent years, periodontal disease has been related to a large number of systemic disorders. The aim of this study was to find a relationship between periodontal disease and venous thromboembolic disease. A total of 197 patients were included in the study, 97 patients with a diagnosis of venous thromboembolic disease and 100 healthy controls, in order to establish an association between these two conditions. All patients were subjected to periodontal examination, with evaluation of the number of teeth, Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Community Periodontal Index of Treatment Needs, Clinical Attachment Level, Probing Pocket Depth, number of pockets >= 4 mm, and number of pockets >= 6 mm. A high prevalence of periodontal disease was detected in patients with thromboembolic disease (P < .001). Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Clinical Attachment Level, and Probing Pocket Depth were higher in venous thromboembolic disease patients than in the control group (P < .001). A high prevalence of periodontal disease was detected in venous thromboembolic patients. There exists an association between periodontal disease and venous thromboembolic disease.

Trends and attitude of edentate patients towards conventional and implant rehabilitative therapies: An Indian outlook

International Journal of Medicine and Public Health,2013,3,2,126-127.DOI:10.4103/2230-8598.115195Published:April 2013Type:Letter to EditorTrends and Attitude of Edentate Patients towards Conventional and Implant Rehabilitative Therapies: An Indian OutlookSukant Sahoo, Prince Kumar, Karan Sethi, and Meenu Goel Sukant Sahoo, Prince Kumar, Karan Sethi, Meenu Goel1 Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Masuri, 1Department of Orthodontics, Institute of Dental Studies and Technologies (IDST), Modinagar, Ghaziabad, India Abstract:Sir, Teeth play a vital role in the maintenance of a positive self-image and outlook that is why event of loss of teeth results in considerable disabilities, which can intensely interrupt social activities and quality of life. World Health Organization has clearly reported that “people rarely visit the dentist and only in the event of pain, as oral rehabilitation is restricted to the necessity.”[1] Complete edentulism is the end result of a multifactorial process involving biological factors and patient-related factors. It is the major problem in the developing countries and is widely spread in the current population although the prevalence is declining and incidence of tooth loss is decreasing in the developed nations like India.[2,3] The overall rate of total edentulism is said to be increasing in developing countries chiefly due to the high prevalence of periodontal diseases and caries. This relative non-homogeneous allocation and prevalence of complete edentulism between developed and less developed countries is frequently associated with interrelated interaction between cultural, individual, attitude, behavior, dental attendance, etiopathogenesis of edentulism, access to care and socio-economic factors. View:PDF (192.57 KB)

Effects of Areca Nut Extracts on Phagocytosis of Actinobacillus actinomycete mcomitans ATCC 33384 by Neutrophils in Patients with Chronic Periondontitis

A higher prevalence of periodontal disease among areca nut chewers than non chewers has been demonstrated. Neutrophils, the first line of defence mechanism against microbial infection play an important role in maintaining the periodontal health. In this context our aim was to evaluate the effects of areca nut extracts on phagocytic activity by neutrophils isolated from gingival crevicular washing of healthy subjects and patients with chronic periodontitis. Sample size consisted of a total of 60 subjects which were divided into two groups of 30 each. Group I consisted healthy subjects and Group II consisted clinically diagnosed cases of chronic periodontitis. Neutrophils isolated from gingival crevicular washings of both groups were treated with aqueous extracts of ripe areca nut (rANE) and tender areca nut (tANE) and examined for their effect on cellular viability of neutrophils using typan blue exclusion assay. The possible/ ableffects on the phagocytic activity of neutrophils against a periodontal pathogen Aggregatibacter actinomycetemcomitans(ATCC 33384) was determined by using microscopic method. Both rANE and tANE affected the phagocytic activity by neutrophils in healthy and patients with chronic periodontitis. Ripe areca nut extract has altered the neutrophil functions more than tender areca nut in both the groups. There was no difference seen in the cell viability of neutrophils when treated with rANE and tANE in both the groups (p> 0.05). Both ripe and tender arecanut extract affected the neutrophil function in healthy and patients with chronic periodontitis. Ripe arecanut extract significantly altered the neutrophils functions more than tender areca nut extract. Thus, alterations in these functions of neutrophils may lead to signs of clinical diseases associated with areca chewing.

Periodontal disease as a potential risk factor for the development of diabetes in women with a prior history of gestational diabetes mellitus

To examine if periodontal disease is associated with later development of impaired glucose metabolism in women with a recent history of gestational diabetes (GDM). Women with (n = 19) and without (n = 20) a history of GDM were prospectively followed at 22 months postpartum. All subjects underwent: a) a 75-gram oral glucose tolerance test (OGTT); and b) an oral examination for measuring periodontal disease. Insulin sensitivity and pancreatic β-cell secretory capacity derived from fasting (HOMA-IR) and glucose-stimulated measures (SI(OGTT) and IGI/HOMA-IR) were determined. Periodontitis was defined as the presence of any site with a probing depth ≥ 4 mm or a clinical attachment loss ≥ 4 mm. Compared to women without a history of GDM, prior GDM women had significantly higher fasting glucose and insulin concentrations, increased insulin resistance and decreased β-cell function. Although not statistically significant, prior GDM women had a higher prevalence of periodontal disease (42.1%) than women without a history of GDM (25.0%). Women with periodontal disease showed greater insulin resistance and lower β-cell function. Women with both prior GDM and periodontal disease had the most impaired glucose metabolism; the insulin secretion-sensitivity index was significantly lower in women with both prior GDM and periodontal disease (208.20 ± 2.60) than in women without prior GDM and periodontal disease (742.93 ± 1.78) (P < 0.05). Women with prior GDM show reduced insulin sensitivity and inadequate β-cell secretory function at 22 months postpartum. Periodontal disease may contribute to their impaired glucose metabolism and future risk of developing diabetes.

Bidirectional Relationship between Chronic Kidney Disease &amp; Periodontal Disease: A Review

Non communicable diseases (NCDs) affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus (DM), cardiovascular diseases (CVD), pulmonary diseases, osteoporosis and chronic kidney diseases (CKD). About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Sources of Data: Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. Data Extraction: The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Conclusion: Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy.

Periodontal disease and the oral microbiota in new‐onset rheumatoid arthritis

To profile the abundance and diversity of subgingival oral microbiota in patients with never-treated, new-onset rheumatoid arthritis (RA). Periodontal disease (PD) status, clinical activity, and sociodemographic factors were determined in patients with new-onset RA, patients with chronic RA, and healthy subjects. Multiplexed-454 pyrosequencing was used to compare the composition of subgingival microbiota and establish correlations between the presence/abundance of bacteria and disease phenotypes. Anti-Porphyromonas gingivalis antibody testing was performed to assess prior exposure to the bacterial pathogen P gingivalis. The more advanced forms of periodontitis were already present at disease onset in patients with new-onset RA. The subgingival microbiota observed in patients with new-onset RA was distinct from that found in healthy controls. In most cases, however, these microbial differences could be attributed to the severity of PD and were not inherent to RA. The presence and abundance of P gingivalis were also directly associated with the severity of PD and were not unique to RA. The presence of P gingivalis was not correlated with anti-citrullinated protein antibody (ACPA) titers. Overall exposure to P gingivalis was similar between patients with new-onset RA and controls, observed in 78% of patients and 83% of controls. The presence and abundance of Anaeroglobus geminatus correlated with the presence of ACPAs/rheumatoid factor. Prevotella and Leptotrichia species were the only characteristic taxa observed in patients with new-onset RA irrespective of PD status. Patients with new-onset RA exhibited a high prevalence of PD at disease onset, despite their young age and paucity of smoking history. The subgingival microbiota profile in patients with new-onset RA was similar to that in patients with chronic RA and healthy subjects whose PD was of comparable severity. Although colonization with P gingivalis correlated with the severity of PD, overall exposure to P gingivalis was similar among the groups. The role of A geminatus and Prevotella/Leptotrichia species in this process merits further study.

Periodontal health of dental clients in a community health setting

The aim of this study was to investigate the prevalence and severity of periodontal disease and possible risk factors in clients attending the Plenty Valley Community Health (PVCH) dental clinic. After ethics approval and calibration of examiners, all consenting patients attending PVCH were examined for periodontal status using the Community Periodontal Index (CPI) system and a World Health Organization (WHO) probe. A total of 2861 patients were screened, of which 1751 were female. The majority of patients were Australian born followed by Mediterranean birth. Just under 50% brushed their teeth twice a day and only 20% flossed regularly. It was found that 28.4% had CPI scores of 3 and 4 with only 3.1% recording 0 and a widespread presence of calculus. The severity of periodontal status increased with age, male gender, decreased frequency of brushing, lower level of education, diabetes and reflected country of birth. PVCH has a higher prevalence of periodontal disease than the most recent national survey which reflects the population studied.

Socioeconomic Factors and Complete Edentulism in North Karnataka Population

Complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient related factors. Tooth loss associated with periodontal disease and caries has an apparent impact on an individual's quality of life, and has been associated with lower levels of satisfaction with life and a lower morale. The rate of total edentulism is said to be increasing in developing countries and this had been attributed mainly to the high prevalence of periodontal diseases and caries. The distribution and prevelance of complete edentulism between developed and less developed countries may be associated with a complex interrelationship between cultural, individual, attitude, behavior, dental attendance, etiopathogenesis of edentulism, access to care and socioeconomic factors. The purpose of this study was to assess the relationship between socio-demographic factors and edentulism. In order to plan for future oral health care provisions for the society, collecting epidemiological data on oral health particularly related to prosthodontics and its related issues are very important.

Analysis of the normative conditions of oral health, depression and serotonin‐transporter‐linked promoter region polymorphisms in an elderly population

To investigate the association between depression, the normative conditions of oral health and serotonin-transporter-linked promoter region (5-HTTLPR) polymorphisms in a community-dwelling elderly sample. Elderly adults living in a community (n=200) were submitted to an oral clinical examination. Depression was assessed using the 15-item Geriatric Depression Scale. The 5-HTTLPR was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Associations between the biomarkers and clinical covariates were assessed by bivariate and multivariate statistical tests. Statistical significance was set at P<0.05. The prevalence of dental caries, periodontal disease, edentulism and oral mucosal lesions was 51.2%, 20.8%, 58.0% and 21.5%, respectively. The prevalence of depression was 21.5%. A higher frequency of the S allele was recorded in older individuals with depression (P=0.017). The present findings showed no significant association between depression and the normative conditions of oral health. The observed allelic polymorphisms were 44% S and 56% L, respectively. Genotypic variants were 33.5% LL, 45.0% SL and 21.5% SS. Individuals carrying the SS genotype showed a significantly high prevalence of periodontal disease (prevalence ratio=3.077, CI 95%=1.008-9.393, P=0.048). The present findings suggest that depressive community-dwelling older individuals did not show any association with alterations of oral health normative conditions. However, the SS genotypic polymorphic variant of 5-HTTLPR seems to contribute to the occurrence of periodontal disease in the elderly.

Treatment of Periodontal Diseases Reduces Chronic Systemic Inflammation in Maintenance Hemodialysis Patients

Background: Evidences suggest that chronic systemic inflammation is associated with increasing mortality in maintenance hemodialysis patients due to atherosclerosis and malnutrition. Periodontal diseases are treatable sources of systemic inflammation in hemodialysis patients. We therefore evaluated the effect of periodontal treatment in maintenance hemodialysis patients. Method: Periodontal diseases were evaluated in 30 stable maintenance hemodialysis patients by using clinical periodontal status by plaque index (PI) and periodontal disease index (PDI). Hematologic, biochemical, nutritional, and dialysis-related parameters as well as highly sensitive C-reactive protein (hs-CRP), a sensitive systemic inflammatory marker, were analyzed before and after periodontal therapy. Result: Maintenance hemodialysis patients had high prevalence of periodontal disease (63%). At baseline, hs-CRP positively correlated with clinical periodontal status (PI, r = 0.74, p < 0.001; PDI, r = 0.66, p < 0.001), but negatively correlated with hemoglobin (r = −0.51, p < 0.001), serum albumin (r = −0.61, p = 0.002), and normalized protein catabolic rate (r = −0.42, p = 0.043). After completion of periodontal therapy (duration 6 ± 2 weeks), the PI and PDI significantly declined from 2.13 to 1.48 (p = 0.001) and 3.53 to 2.52 (p = 0.001), respectively, while hs-CRP significantly declined from 3.8 to 0.6 mg/L (p < 0.001). Moreover, erythropoietin dosage could be reduced from 8000 to 6000 unit/week (p = 0.03) after treatment. Pre-dialysis blood urea nitrogen increased from 66.18 to 79.54 mg/dL (p = 0.003) and serum albumin level increased from 3.15 to 3.38 mg/dL (p = 0.003), reflecting improved nutritional status of the patients after periodontal treatment. Conclusion: Periodontitis is an important source of chronic inflammation. Treatment of periodontal diseases can improve systemic inflammation, nutritional status, and erythropoietin responsiveness in the hemodialysis population.