Moderate-severe Periodontitis Research Articles

Correlation Between the Severity of Chronic Periodontitis and Coronary Artery Stenosis Involvement in Coronary Heart Disease (CHD) Patients

Periodontitis is independently related to coronary heart disease and significantly impacts the quality of human life. The aim of this study was to investigate the relationship between the severity of chronic periodontitis and the severity of coronary artery stenosis in CHD patients. A total of 75 subjects were recruited for this study. The severity of the coronary artery was measured by coronary angiography. Quantitative coronary angiography (QCA) was conducted to determine 1 vessel disease (VD), 2 VD, and 3 VD, followed by stenosis. The severity of chronic periodontitis was determined based on the mean periodontal pocket depth (Mean PPD). The < 4 mm and 4 mm scores were categorized as mild and moderate-severe, respectively. Statistical analysis was conducted to determine the relationship between periodontitis and coronary artery by chi-square and followed by multivariate analysis using an ordinal regression test with a 95% confidence interval. P value < 0.05 was considered statistically significant. The proportion of moderate-severe periodontitis was more dominant than mild periodontitis. 79.20% and 20.80% of subjects were categorized as moderate-severe periodontitis and mild periodontitis in the 3 VD group. In groups 1 and 2 VD, the proportion of mild periodontitis was higher than moderate-severe periodontitis (61.30% vs. 38.7%) and (70% vs. 30%), based on bivariate analysis of the involvement of the coronary artery. Multivariate analysis showed chronic periodontitis and dyslipidemia had estimates of 1.084 (95% CI range 0.162 - 2.006) and 1.141 (95% CI range 0.217 - 2.066) for the severity of coronary artery involvement with p-values of 0.021 and 0.016, respectively. Gender, age, smoking, DM, hypertension, and obesity were not statistically significant. A significant relationship between moderate-severe chronic periodontitis was found, followed by an increase in the severity of coronary artery compared to mild chronic periodontitis.

Dysbiosis of the Subgingival Microbiome and Relation to Periodontal Disease in Association with Obesity and Overweight

Obesity causes gut dysbiosis; nevertheless, little is known about the oral microbiome. We aimed to identify differences in the subgingival microbiota influenced by body weight and periodontal status. Patients (n = 75) recruited at the University Dental Hospital Sharjah, United Arab Emirates, were distributed into three equal groups (healthy weight, overweight, and obese) sub-divided into having either no-mild (NM) or moderate-severe (MS) periodontitis. Subgingival plaques were collected. Microbiota were identified by 16S rRNA sequencing using nanopore technology. Linear discriminant analysis demonstrated significant bacterial biomarkers for body weight and periodontal health. Unique microbiota signatures were identified, with enrichment of periopathogens in patients with MS periodontitis (Aggregatibacter actinomycetemcomitans in obese, Tannerella forsythia and Treponema denticola in overweight, Porphyromonas gingivalis and Fusobacterium nucleatum in healthy weight), thus reflecting differences in the microbiota affected by body weight. Other pathogenic bacteria, such as Salmonella enterica and Klebsiella pneumoniae, were enriched in overweight subjects with NM periodontitis, suggesting an increase in the relative abundance of pathogens even in patients with good periodontal health if they were overweight. Alpha and beta diversities were significantly different among the groups. Dysbiosis of the subgingival microbiota in obese and overweight individuals was associated with increased prevalence and severity of periodontal disease, which was correlated with the body mass index. This study highlights the immense importance of the oral microbiome and the need for lifestyle and dental interventions to resolve oral dysbiosis and restore normal homeostasis.

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults

Background: Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention.Objective: Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age).Methods: Data from 6052 adults participating in NHANES 2009–2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status.Results: In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis.Conclusions: We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake.

Prevalence and correlates of periodontitis among Kenyan women planning to conceive

BackgroundPeriodontitis has been associated with adverse pregnancy outcomes. Little is known about the burden and risk factors for periodontitis among reproductive age women in sub-Saharan Africa. This analysis aimed to determine the prevalence and correlates of periodontitis among Kenyan women planning to conceive.MethodsHIV-seronegative, reproductive-age women who were planning to conceive were enrolled and underwent a periodontal examination. Following the US Centers for Disease Control and Prevention clinical case definitions, the presence and severity of periodontitis was determined by establishing the level of clinical periodontal attachment loss and graded in three categories: no/mild, moderate, and severe. Secondary outcomes included the scores on the Gingival Index and Decayed, Missing, and Filled Teeth (DMFT) Index. Correlates of periodontitis were examined using univariable and multivariable logistic regression.ResultsOf the 647 women in the study, 84% (n = 541) had no/mild periodontitis, 15% (n = 97) had moderate periodontitis, and 1% (n = 9) had severe periodontitis. Mild gingivitis was present in 61% (n = 396) of women, while 27% (n = 176) had moderate gingivitis, and 1% (n = 9) had severe gingivitis. The majority (75%, n = 487) of women had a DMFT index in the very low range (score < 5). Periodontitis was observed in 12% (12/101) of nulliparous women compared to 13% (36/286) of women with one prior delivery (prevalence ratio [PR] 1.03, 95% confidence interval [95% CI] 0.57–1.96), 21% (36/170) of women with two prior deliveries (PR 1.78, 95% CI 0.97–3.26), and 24% (22/90) of women with 3 or more prior deliveries (PR 2.06, 95% CI 1.08–3.92).ConclusionThis study demonstrated a substantial prevalence of moderate-severe periodontitis among women planning to conceive in Kenya. These results highlight the need to address the oral care needs of reproductive age women, particularly those with multiple prior pregnancies.

Clinical evaluation of Er,Cr:YSGG laser therapy used as an adjunct to non-surgical treatment of periodontitis: Twelve-month results from a pilot study.

The purpose of this study was to evaluate the results of adjunctive Er,Cr:YSGG laser therapy with scaling and root planing (SRP) as compared with SRP alone in the treatment of moderate to severe periodontitis. Fifteen adults (aged 27 to 65 years) with 90 nonadjacent sites probing ≥ 5mm were treated in split-mouth design with SRP and laser therapy versus SRP alone. Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), plaque, and bleeding on probing were collected at baseline, 1, 3, 6, 9, and 12 months. Patient reported outcomes were measured to assess pain, sensitivity, and satisfaction. Clinical improvements were similar for test and control sites with no statistically significant difference. At 12 months, the average PPD reduced from 6.1 to 4.2mm for test and 6.2 to 4.3mm for control sites. GR increased by 0.4mm at test and control sites. CAL increased from 6.8 to 5.3mm for test and 6.9 to 5.5mm for control sites. Clinical outcomes were stratified by baseline PPD ( =5,=6 and ≥7mm) and analyzed for number of sites that reduced (≤4mm). No significant difference was observed when the baseline PPD was 5 or 6mm. Test sites with baseline PPD ≥7mm demonstrated a statistically significant difference in the percentage of reduced sites when compared with controls at nine (P=0.001) and 12 months (P=0.044). Adjunctive Er,Cr:YSGG laser therapy with SRP provides similar clinical improvement in the treatment of moderate-severe periodontitis as SRP alone and may offer some advantage for deeper (≥7mm) pockets.

Periodontal disease prevalence, extent, and risk associations in untreated individuals.

Objectivesto examine the prevalence, extent, and risk associations of untreated periodontitis.Materials and MethodsA purposive sample of subjects who were never treated for periodontal conditions was clinically examined after collecting information about their sociodemographic characteristics, medical conditions, oral health behaviors, perceived stress, and perceived social support.ResultsA total of 431 subjects were recruited (response rate, 97.0%), and their mean age (SD) was 35.4 (13.3) years. Overall, high plaque levels were observed in all untreated individuals. The prevalence of periodontitis and severe (stage III/IV) periodontitis using the American Academy of Periodontology and European Federation of Periodontology (AAP/EFP) classification were 85.4% and 48.5%, respectively. The prevalence of moderate‐severe and severe periodontitis using the definitions of the Centers for Disease Control and Prevention (CDC) and AAP were 78.4% and 31.1%, respectively. The extent of periodontitis expressed as mean% of clinical attachment loss (CAL) ≥ 3 mm and CAL ≥ 5 mm were 34.9% and 14.4%, respectively, while the mean% of a periodontal probing depth (PPD) ≥4 mm and PPD ≥6 mm were 22.0% and 9.2%, respectively. Risk determinants associated with AAP/EFP periodontitis after the adjustment for other variables were age ≥35 years (odds ratio [OR] = 11.5) and lower income (OR = 2.5). Adjusted risk associations with stage II/IV periodontitis included age ≥35 years (OR = 8.2), males (OR = 2.5), lower income (OR = 2.3), and lower perceived stress (OR = 2.0). Adjusted risk associations with CDC/AAP moderate‐severe periodontitis included age ≥35 years (OR = 12.0), lower income (OR = 2.1), and current cigarette smoking (OR = 4.2). Adjusted risk associations with CDC/AAP severe periodontitis included age ≥35 years (OR = 4.5), males (OR = 1.9), lower education (OR = 2.0), lower income (OR = 1.7), uncontrolled diabetes mellitus (OR = 2.0), and current cigarette smoking (OR = 2.3).ConclusionsThe prevalence and extent of periodontitis were high in untreated subjects. Risk associations with untreated periodontitis included age ≥35 years, males, lower income, lower education, current cigarette smoking, uncontrolled diabetes mellitus, and lower perceived stress.

Hemostasis disorder as a cause of periodontitis in type II diabetic patients

Relevance. In type II diabetes mellitus, hyperglycemia contributes to the endothelial dysfunction. It leads to hypercoagulation and significant microcirculation disorders, which cause periodontal tissue ischemia and inflammation. The study aimed to determine hemostatic parameters of endothelial dysfunction and evaluate its role in the origin of periodontitis in type II diabetic patients.Materials and methods. We examined 40 people aged 50-80 years with compensated type II diabetes mellitus and chronic generalized periodontitis of various severity during planned hospital admission. The control group consisted of 26 practically healthy people of comparable age and sex. We assessed blood on patient admission to the hospital.Results. Type II diabetic patients with chronic generalized periodontitis demonstrated pronounced changes in endothelial function. Compared to the controls, the patients with moderate-severe periodontitis exhibited a statistically significant (p &lt; 0.05) increase of D-dimer (10.5 times), factor XIIa (8.4 times), and von Willebrand factor (2 times) in the blood serum; the increase of fibrinogen by 64.8%, the elevation of INR and antiplasmin by 19.7% and 12.7% respectively, the decrease of antithrombin by 17%.Conclusion. The study confirms that type II diabetic patients show pronounced endothelial dysfunction. The detected changes in the coagulation system correlate with the severity of periodontitis.

Association Between Oral Health and Frailty Among American Older Adults

ObjectiveWe examined the association between tooth loss, periodontal diseases, and frailty among older American adults. Designs, Settings, and ParticipantsData from the National Health and Nutrition Examination Surveys (NHANES) 2011–2014 was used. We included 2368 community-dwelling adults aged 60 years and older. Frailty was measured with the 49-item frailty index. Oral health indicators included number of teeth and periodontal disease. A composite nutritional intake variable based on 13 micronutrients from the dietary assessment was created. Negative binomial regression was used to test the association between oral health and frailty. The first model was adjusted for age and gender, the second model was additionally adjusted for nutritional intake, and the third model was additionally adjusted for other covariates. ResultsFor each additional tooth, the rate ratio (RR) for frailty was 0.99 [95% confidence interval (CI) 0.98–0.99] in the fully adjusted model. Similarly, participants with moderate-severe periodontitis had 1.08 RR (95% CI 1.02–1.14) for frailty index compared with participants with no periodontitis after adjusting for age, gender, and poor nutritional intake. The association lost significance in the fully adjusted model. Conclusions and ImplicationsOral health is associated with the frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared with number of teeth. The findings highlight the importance of maintaining good oral health at older age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.

Social capital and periodontal disease in Hispanic/Latino adults in the United States: Results from the Hispanic Community Health Study/Study of Latinos.

To examine the association of social capital with periodontal disease severity. We analysed data obtained from 3,994 men and women aged 18-74years in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (HCHS/SOL SCAS). From 2008 to 2011, dentists assessed periodontitis status with a full-mouth periodontal examination. Periodontitis was classified using standardized case definitions. Multivariable logistic regression estimated odds of moderate-severe periodontitis associated with two measures of social capital: structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). For US-born participants, for each additional person in their social network, the adjusted odds of moderate-severe periodontitis was reduced 17% (OR=0.83, 95% CI=0.71, 0.96). However, no association was found between functional support and periodontal disease severity. Greater structural social support was associated with a lower prevalence of moderate-severe periodontitis in US-born Hispanics/Latinos. These findings suggest that US-born Hispanics/Latinos with less social support represent a vulnerable segment of the population at high-risk group for periodontal disease.

Oral Diseases Associated with Nonalcoholic Fatty Liver Disease in the United States

The US prevalence of nonalcoholic fatty liver disease (NAFLD) is 30.6% and increasing. NAFLD shares some risk factors with periodontitis and dental caries. We explored the association between NAFLD and several oral conditions among US adults, using data from the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES), 1988 to 1994. NAFLD was assessed with ultrasonography (USON), the screening gold standard not available in the more recent NHANES, and the noninvasive Fibrosis Score (FS), Fatty Liver Index (FLI), and US Fatty Liver Index (US-FLI) as other screening alternatives. There were 5,421 eligible dentate adults aged 21 to 74 y with complete relevant data, with transferrin levels ≤50%, without hepatitis B or C, who were not heavy drinkers. Multivariable models were developed to examine the independent effects of moderate-severe periodontitis, untreated dental caries, caries experience, and tooth loss (<20 teeth) on NAFLD while controlling for clinical, biological, and sociodemographic factors. Weighted estimates for odds ratios (ORs) and 95% CIs were calculated with logistic regression. Between 17% and 24% of adults had NAFLD depending on the classification criteria. In adjusted models, as compared with those with better oral health, adults with <20 teeth were more likely to have NAFLD depending on the measure (USON: OR = 1.50, 95% CI = 1.11 to 2.02; FS: OR = 4.36, 95% CI = 3.47 to 5.49; FLI: OR = 1.99, 95% CI = 1.52 to 2.59; US-FLI: OR = 2.32, 95% CI = 1.79 to 3.01). People with moderate-severe periodontitis were more likely to have NAFLD (USON: OR = 1.54, 95% CI = 1.06 to 2.24; FS: OR = 3.10, 95% CI = 2.31 to 4.17; FLI: OR = 1.61, 95% CI = 1.13 to 2.28; US-FLI: OR = 2.21, 95% CI = 1.64 to 2.98). People with any untreated caries were more likely to have NAFLD (USON: OR = 1.51, 95% CI = 1.20 to 1.90; FLI: OR = 1.80, 95% CI = 1.33 to 2.44). NAFLD was associated with tooth loss, periodontitis, and, for some NAFLD measures, untreated dental caries but not overall caries experience after controlling for several key sociodemographic and behavioral factors. Results suggest that further evaluation is needed to better understand this health–oral health interrelationship and potential opportunities for medical-dental integration.

Evaluation of Systemic Inflammation Parameters in Dogs with Periodontitis

Abstract Periodontal diseases are the most common diseases in veterinary medicine. The first clinical finding is chewing difficulty, saliva flow and bad oral odor. It further develops into plaque and tartar formation, gingival inflammation and hemorrhagic appearance of the gingiva, periodontal pockets formation, alveolar bone resorption and tooth loss. In this study an evaluation has been made to determine which degree reflects on the parameters of systemic inflammatory reaction with special attention to IL-6 (Interleukine-6), CRP (C-reactive protein), osteopontin, superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPx) and Ig (Immunglobulins = Total protein – Albumin) and hematological parameters in dogs with periodontitis. Two groups have been defined in this study. The first group included 10 healthy and owned dogs as a control group. The second group consisted of 10 owned dogs with moderate-severe periodontitis. The difference between monocyte (p &lt;0.001) and neutrophil (p &lt;0.05) counts was found to be significant. In addition, the difference between SOD, MDA, glutathione peroxidase, CRP, IL-6 measurements in group 1 and group 2 was significant. (p &lt;0.001). The level of osteopontin in moderate-severe periodontitis cases was found significantly higher than the level measured in the healthy group. Measured values in the moderate-severe periodontitis cases are higher than the healthy group in terms of CRP, IL-6, and osteopontin levels. Increasing severity of periodontitis was associated with changes in oxidative stress parameters: increased MDA, decreased SOD and glutathione peroxidase levels. These differences provide important information about the evaluation of the cellular responses. There is a need for continued research into the systemic impact of periodontal disease.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011\u20132014

BackgroundFollowing implementation in 2009–2010 to the oral health component for the National Health and Nutrition Examination Survey (NHANES), a full-mouth periodontal examination was continued during 2011–2014. Additionally, a comprehensive dental caries assessment was re-introduced in 2011 after a 6-year absence from NHANES. This report provides oral health content information and results of dental examiner reliability statistics for key intraoral assessments conducted by dentists during 2011–2014.MethodsDuring the 2011–2014 NHANES 17,463 persons age 1 and older representing the US civilian, non-institutionalized population received an oral health examination. From this group, 387 individuals underwent a repeat examination conducted by the survey reference examiner. A combination of examiner training and calibration, electronic data capture, and ongoing performance evaluation with statistical monitoring was used to ensure conformance with NHANES protocols and data comparability to prior data collection periods.ResultsDuring 2011–2014, the Kappa statistics for the tooth count assessment ranged from 0.96 to 1.00, for untreated dental caries Kappa scores were 0.93 to 1.00. The overall Kappa statistics for identifying combined moderate-severe periodontitis using the CDC/AAP case definition was 0.66 and 0.69 with percent agreement of 83 to 85% during 2011–2014. When evaluating inter-examiner agreement using information collected from 3 periodontal sites for comparability to the NHANES 2003–04 periodontal examination protocols, Kappa scores for combined moderate-severe periodontitis was 0.65 and 0.80 during 2011–2014. For total mean attachment loss and pocket depth across all 6 periodontal sites, the inter-class coefficients (ICCs) ranged from 0.80–0.90 and 0.79–0.86 respectively. Site-specific mean attachment loss ICCs were generally higher for the 4 interproximal measurements compared to the 2 mid-site probing measurements and this observation was similar in 2009–2010.ConclusionDuring 2011–2014, results overall indicate a high level of data quality and substantial examiner reliability for tooth count and dentition; reliability for periodontal disease, across various assessments, was at least moderate. When comparing the 2011–2014 examiner performance to findings from 2003 to 2004, comparable concordance between the examiners and the reference examiner exists.

Whole metagenomic shotgun sequencing of the subgingival microbiome of diabetics and non-diabetics with different periodontal conditions

ObjectiveThe aim of this study was to use high-resolution whole metagenomic shotgun sequencing to characterize the subgingival microbiome of patients with/without type 2 Diabetes Mellitus and with/without periodontitis. DesignTwelve subjects, falling into one of the four study groups based on the presence/absence of poorly controlled type 2 Diabetes Mellitus and moderate-severe periodontitis, were selected. For each eligible subject, subgingival plaque samples were collected at 4 sites, all representative of the periodontal condition of the individual (i.e., non-bleeding sulci in subjects without a history of periodontitis, bleeding pockets in patients with moderate-severe periodontitis). The subgingival microbiome was evaluated using high-resolution whole metagenomic shotgun sequencing. ResultsThe results showed that: (i) the presence of type 2 Diabetes Mellitus and/or periodontitis were associated with a tendency of the subgingival microbiome to decrease in richness and diversity; (ii) the presence of type 2 Diabetes Mellitus was not associated with significant differences in the relative abundance of one or more species in patients either with or without periodontitis; (iii) the presence of periodontitis was associated with a significantly higher relative abundance of Anaerolineaceae bacterium oral taxon 439 in type 2 Diabetes Mellitus patients. ConclusionsWhole metagenomic shotgun sequencing of the subgingival microbiome was extremely effective in the detection of low-abundant taxon. Our results point out a significantly higher relative abundance of Anaerolineaceae bacterium oral taxon 439 in patients with moderate to severe periodontitis vs patients without history of periodontitis, which was maintained when the comparison was restricted to type 2 diabetics.

Relationship between Moderate-Severe Periodontitis and Ischemic Stroke

This paper aims to make a preliminary discussion on the relationship between periodontitis, serum inflammatory factors and ischemic stroke based on measurements of the first two diseases. A case-control study operates between patients with ischemic stroke (experimental group) and healthy cases (control group) in comparison to the incidence of periodontitis, serum hype-sensitivity C-reactive protein, interleukin and tumor necrosis factor. The results reveal that the experimental group presents higher than the control group in all these areas, and the differences in these regards are statistically significant. In the end, it is concluded that periodontitis and serum inflammatory factors are correlated to ischemic stroke. Hype-sensitivity C-reactive protein, interleukin and tumor necrosis factor may serve as the serological indicators for testing the periodontitis and ischemic stroke in clinical practices.

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults

Background: Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention.Objective: Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age).Methods: Data from 6052 adults participating in NHANES 2009–2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status.Results: In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis.Conclusions: We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake.

Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates

Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates

Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease.

BackgroundPeriodontitis and Alzheimer disease (AD) are associated with systemic inflammation. This research studied serum IgG to periodontal microbiota as possible predictors of incident AD.MethodsUsing a case-cohort study design, 219 subjects (110 incident AD cases and 109 controls without incident cognitive impairment at last follow-up), matched on race-ethnicity, were drawn from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a cohort of longitudinally followed northern Manhattan residents aged >65 years. Mean follow-up was five years (SD 2.6). In baseline sera, serum IgG levels were determined for bacteria known to be positively or negatively associated with periodontitis (Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans Y4, Treponema denticola, Campylobacter rectus, Eubacterium nodatum, and Actinomyces naeslundii genospecies-2). In all analyses, we used antibody threshold levels shown to correlate with presence of moderate-severe periodontitis.ResultsMean age was 72 years (SD 6.9) for controls, and 79 years (SD 4.6) for cases (p<0.001). Non-Hispanic Whites comprised 26%, non-Hispanic Blacks 27%, and Hispanics 48% of the sample. In a model adjusting for baseline age, sex, education, diabetes mellitus, hypertension, smoking, prior history of stroke, and apolipoprotein E genotype, high anti-A. naeslundii titer (>640 ng/ml, present in 10% of subjects) was associated with increased risk of AD (HR = 2.0, 95%CI: 1.1–3.8). This association was stronger after adjusting for other significant titers (HR = 3.1, 95%CI: 1.5–6.4). In this model, high anti-E. nodatum IgG (>1755 ng/ml; 19% of subjects) was associated with lower risk of AD (HR = 0.5, 95%CI: 0.2–0.9).ConclusionsSerum IgG levels to common periodontal microbiota are associated with risk for developing incident AD.

Lysophosphatidic acid (LPA) 18:1 transcriptional regulation of primary human gingival fibroblasts.

The pleiotropic, bioactive lipid lysophosphatidic acid [(LPA), 1-acyl-sn-glycerol-3-phosphate] exerts critical regulatory actions in physiology and pathophysiology in many systems. It is present in normal bodily fluids, and is elevated in pathology (1). In vivo, “LPA” exists as distinct molecular species, each having a single fatty acid of varying chain length and degree of unsaturation covalently attached to the glycerol backbone via an acyl, alkyl, or alkenyl link. These species differ in affinities for the individual LPA receptors [(LPARs), LPA1-6] and coupling to G proteins (2). However, LPA 18:1 has been and continues to be the most commonly utilized species in reported studies. The actions of “LPA” remain poorly defined in oral biology and pathophysiology. Our laboratory has addressed this knowledge gap by studying in vitro the actions of the major human salivary LPA species [18:1, 18:0, and 16:0 (3)] in human oral cells [4], [5], [6], [7]. This includes gingival fibroblasts (GF), which our flow cytometry data from multiple donors found that they express LPA1-5 (6). We have also reported that these species are ten-fold elevated to pharmacologic levels in the saliva and gingival crevicular fluid obtained from patients with moderate–severe periodontitis (8). As the potential of LPA to regulate transcriptional activity had not been examined in the oral system, this study used whole human genome microarray analysis to test the hypothesis that LPA 18:1-treated human GF would show significant changes in gene transcripts relevant to their biology, wound-healing, and inflammatory responses. LPA 18:1 was found to significantly regulate a large, complex set of genes critical to GF biology in these categories and to periodontal disease. The raw data has been deposited at NCBI's GEO database as record GSE57496.

Tooth loss in individuals under periodontal maintenance therapy: 5‐year prospective study

Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5years. The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p<0.01). Individuals that were >55years old, males and smokers lost significantly more teeth in both groups (with IC>RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p<0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6mm in up to 10% of sites and irregular compliance. IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT.

Periodontal disease is associated with metabolic syndrome in hemodialysis patients

Periodontitis and metabolic syndrome are highly prevalent in hemodialysis (HD) patients but little information is available on their association. Thus, this study aimed to assess the association between these two conditions in a HD cohort. Data from 253 HD patients were analyzed. The association of periodontitis, gingival inflammation and dental plaque burden with metabolic syndrome and its individual component conditions were evaluated. Adjustments for age, gender, socioeconomic status, comorbidity and smoking status were considered. The prevalence of metabolic syndrome was 65.1% among individuals (n = 149) with moderate-severe periodontitis, 54.5% among individuals (n = 55) with mild periodontitis and 36.7% among individuals (n = 49) without periodontitis. After adjustment of confounders, patients with moderate-severe periodontitis were 2.736 [95% confidence interval (CI), 1.293-5.790] times more likely to develop metabolic syndrome than were those without periodontitis. In addition, the odds ratio for metabolic syndrome was 1.561 (95% CI, 1.121-2.166) per score of gingival inflammation severity and 1.724 (95% CI, 1.135-12.615) per score of dental plaque burden. Moderate-severe periodontitis is associated with metabolic syndrome in HD patients. Whether improved oral health reduces the risk of metabolic syndrome is worth determining through further studies.