Non-periodontitis Patients Research Articles

Prevalence of co-morbidities among periodontitis and non-periodontitis Indian patients.

Periodontitis being an immuno-inflammatory disease can act as an aggravating factor for various systemic diseases. Therefore, it is of interest to document the prevalence of comorbidities among periodontitis and non-periodontitis Indian patients. 680 patients were enrolled, categorized into non-periodontitis group (Group A) and periodontitis group (Group B). Each group was again sub-grouped into comorbidities and non-co-morbidities. Periodontitis patients were found to have significantly more co-morbidities than non-periodontitis patients. Osteoporosis and obesity showed statistically higher levels in periodontitis patients. Hypertension, diabetes mellitus, cardiovascular diseases, and COVID-19 infection showed higher prevalence in periodontitis group, though the difference was statistically non-significant.

Salivary interleukin-17A and interleukin-18 levels in patients with celiac disease and periodontitis.

An increased level of interleukin-17A and interleukin-18 in the serum and intestinal mucosa of celiac disease patients reflecting the severity of villous atrophy and inflammation was documented. Thus, the objective of this study was to evaluate the concentrations of salivary-17A, interleukin-1 beta, and interleukin-18 in patients with celiac disease who are on a gluten-free diet, both with and without periodontitis, and to compare these levels with those in healthy individuals. The study involved 23 participants with serologically confirmed celiac disease (CD) and 23 control subjects. The CD patients had been following a gluten-free diet (GFD) for a minimum of 1 year and had no other autoimmune disorders. The research involved collecting demographic data, conducting periodontal examinations, gathering unstimulated whole saliva, and performing enzyme-linked immunosorbent assays to measure salivary interleukin-17A, interleukin-1 beta, and interleukin-18 levels. Spearman's correlation analysis was utilized to explore the relationships between CD markers in patients on a GFD and their periodontal clinical findings. The periodontal findings indicated significantly lower values in celiac disease patients adhering to a gluten-free diet compared to control subjects (p = 0.001). No significant differences were found in salivary IL-17A, IL-18, and IL-1B levels between celiac disease patients and control subjects. Nevertheless, the levels of all interleukins were elevated in periodontitis patients in both the celiac and control groups. The IL-1 Beta level was significantly higher in periodontitis patients compared to non-periodontitis patients in the control group (p = 0.035). Significant negative correlations were observed between serum IgA levels and plaque index (r = -0.460, p = 0.010), as well as gingival index (r = -0.396, p = 0.030) in CD patients on a gluten-free diet. Celiac disease patients on gluten-free diet exhibited better periodontal health compared to control subjects. However, increased levels of salivary IL-17A, IL-18 and IL-1B levels were associated with periodontitis. Additionally, serum IgA level was significantly inversely associated with periodontitis clinical manifestations and with salivary inflammatory mediators in CD patients on GFD.

Attachment Loss Attributable to Third Molar Malposition/Extraction: The Case for Classification

Background: The 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions established a periodontitis staging and grading scheme that—for the first time—integrates an assessment of disease severity with an appraisal of therapeutic complexity and risk for disease progression. Individuals exhibiting attachment loss attributable to third molar malposition or extraction represent a large cohort of non-periodontitis patients highly likely to respond favorably to treatment. The purpose of this clinical report is to illustrate the value in formally categorizing this common periodontal condition. Case Description: Two male patients were referred to the Department of Periodontics, Army Postgraduate Dental School, for evaluation of bone and attachment loss limited to distal surfaces of mandibular second molars. Each patient was treated using a combination of guided tissue regeneration and bone replacement grafts. Favorable clinical and radiographic outcomes were observed over follow-up periods ranging from 4 months to 4 years. Practical Implications: Many patients experiencing bone and attachment loss attributable to third molar malposition or extraction lack periodontitis risk factors/indicators, have low susceptibility to the disease, and are highly likely to respond favorably to treatment. Future classification systems of periodontal diseases and conditions should formally categorize this commonly encountered periodontal condition.

Oral Lactobacillus zeae exacerbates the pathological manifestation of periodontitis in a mouse model.

The worldwide prevalence of periodontitis is considerably high, and its pathogenic mechanisms must be investigated and understood in order to improve clinical treatment outcomes and reduce the disease prevalence and burden. The exacerbation of the host immune system induced by oral microbial dysbiosis and the subsequent tissue destruction are the hallmarks of the periodontitis. However, the oral bacteria involved in periodontitis are not fully understood. We used the Oxford Nanopore Technologies (ONT) sequencing system to analyze metagenomic information in subgingival dental plaque from periodontitis and non-periodontitis patients. The number of Lactobacillus zeae (L. zeae) in the periodontitis patients was 17.55-fold higher than in the non-periodontitis patients, suggesting that L. zeae is a novel periodontitis-associated pathogen. Although several Lactobacillus species are used in vivo as probiotics to treat periodontitis and compete with Porphyromonas gingivalis (P. gingivalis), the roles of L. zeae in periodontitis progression, and the relationship between L. zeae and P. gingivalis needs to be investigated. Both L. zeae and P. gingivalis were inoculated in the ligature-implant site of periodontitis mice. We collected mouse gingival crevicular fluid to analyze inflammatory cytokine secretion using a multiplex assay. Intact or sliced mouse maxilla tissue was used for micro-computed tomography analysis or hematoxylin and eosin staining, immunohistochemistry, and tartrate-resistant acid phosphatase staining to evaluate alveolar bone loss, neutrophil infiltration, and osteoclast activation, respectively. We observed that L. zeae competed with P. gingivalis, and it increased inflammatory cytokine secretion at the ligature-implant site. Similar to P. gingivalis, L. zeae promoted ligature-induced neutrophile infiltration, osteoclast activation, and alveolar bone loss. We, therefore, concluded that L. zeae accelerated the progression of periodontitis in the ligature-induced periodontitis mouse model.

Immunoaffinity-enriched salivary small extracellular vesicles in periodontitis.

aliva extracellular vesicles (EVs) serve as a significant reservoir of biomarkers that may be of clinical use in disease diagnosis. Saliva, however, contains EVs of both host- and bacterial- origin. Identifying suitable EVs for disease diagnosis involves enriching host EVs and limiting non-host contamination with effective isolation methods. The objectives of this research were: (1) to evaluate the salivary EVs enrichment in 12 periodontally healthy patients by two different methods: size exclusion chromatography (SEC) and bead-based immunoaffinity capture (EXO-NET®); (2) to analyze the variance expression of inflammatory cytokines in EXO-NET-enriched EVs, comparing individuals with periodontitis (n = 20) to non-periodontitis (n = 12). Whole unstimulated saliva samples were collected from 12 periodontally healthy and 20 periodontitis patients. EVs were isolated from the 12 non-periodontitis patients using SEC (referred to as SEC-EVs) and EXO-NET (referred to as EXO-NET EVs), after which their total protein content, 37 EV surface markers, and bacterial pathogens expression were compared. Subsequently, the inflammatory cytokines expression levels (interleukin-IL-6, IL-1β, IL-8, and IL-10) in EXO-NET EVs were measured for non-periodontitis and periodontitis. EXO-NET EVs contained more EV-specific protein and substantially higher expression of EV surface markers (CD9, CD81, CD63), but less pathogenic DNA was detected compared to that in SEC-EVs. Additionally, EXO-NET EVs from periodontitis patients contained higher amounts of IL-6 and IL-8, and decreased IL-10, compared to those from non-periodontitis patients. The findings suggest that immunoaffinity capture (EXO-NET) is a dependable method for salivary EVs enrichment, resulting in a higher yield of host EVs with reduced bacterial DNA detection compared to SEC. Furthermore, the research proposes that immunoaffinity capture enriched EVs can function as biomarkers for periodontitis, demonstrated by an increased expression of proinflammatory cytokines from periodontitis patients.

Periodontitis may predict the use of prescription medicines later in life, a database study.

Medications used for the treatment of diseases also affect oral health. We investigated how having/not having periodontitis at baseline in 1985 was associated with purchases of medicines in the long term. The study paradigm is in the oral health-systemic health connections. We hypothesized that periodontitis links to purchases of medicines later in life. The study cohort consisted of 3,276 individuals from the greater Stockholm area, Sweden. Of them, 1,655 were clinically examined at baseline. Patients were followed-up for >35years, using the national population and patient registers. The burden of systemic diseases and purchases of medicines were statistically analyzed comparing patients with (n = 285) and without (n = 1,370) periodontitis. The results showed that patients with periodontitis had purchased more of certain medications than non-periodontitis patients. Periodontitis patients purchased significantly more drugs used in diabetes (p = 0.035), calcium channel blockers (p = 0.016), drugs acting on the renin-angiotensin system (p = 0.024), and nervous system drugs (p = 0.001). Hence, patients with periodontitis indeed had purchased specific medications statistically significantly more than the periodontally healthy ones. This indicates that periodontitis, over time, might increase the risk for systemic diseases with the subsequent need for medication.

Lack of association between periodontitis and rheumatoid arthritis

Background and objectivePeriodontitis and rheumatoid arthritis (RA) have been associated in a bidirectional way. The objective of this study was to determine the association between clinical parameters of periodontitis and RA. Materials and methodsSeventy-five (75) participants distributed in 3 groups (21 patients with periodontitis without RA, 33 patients with periodontitis with RA and 21 patients with reduced periodontium with RA) were included in this cross-sectional study. A full periodontal and medical examination was performed in each patient. Additionally, subgingival plaque samples for the detection of Porphyromonas gingivalis (P. gingivalis) and blood samples for biochemical markers of RA were also taken. Logistic regression analysis adjusted for confounding variables, Spearman's rank correlation coefficient and a linear multivariate regression were used to analyze the data. ResultsPatients with RA presented less severity of periodontal parameters. The highest levels of anti-citrullinated protein antibodies were detected in non-periodontitis patients with RA. Covariates such as age, P. gingivalis, diabetes, smoking, osteoporosis and use of medication were not associated with RA. All periodontal variables and P. gingivalis expressed a negative correlation with biochemical markers of RA (P<0.05). ConclusionsPeriodontitis was not associated with RA. Furthermore, there was no correlation between periodontal clinical parameters and biochemical markers of RA.

Biomarkers for the severity of periodontal disease in patients with obstructive sleep apnea:IL-1 β, IL-6, IL-17A, and IL-33

ObjectiveThis study aims to compare the salivary and gingival crevicular fluid (GCF) concentrations of five cytokines: IL-1β, IL-6, IL-17A, IL-33, and Tumor Necrosis Factor-alpha (TNF-α) in patients with OSA and their association with periodontitis. MethodsSamples of saliva and GCF were obtained from 84 patients classified into four groups according to periodontal and OSA diagnosis: G1(H) healthy patients, G2(P) periodontitis and non-OSA patients, G3(OSA) OSA and non-periodontitis patients, and G4(P-OSA) periodontitis and OSA patients. The cytokines in the samples were quantified using multiplexed bead immunoassays. Data were analyzed with the Kruskal-Wallis test, Dunn's multiple comparisons test, and the Spearman correlation test. ResultsStage III periodontitis was the highest in patients with severe OSA (69%; p=0.0142). Similar levels of IL-1β and IL-6 in saliva were noted in G2(P) and G4(P-OSA). The IL-6, IL-17A and IL-33 levels were higher in the GCF of G4(P-OSA). There was a significant positive correlation between IL-33 in saliva and stage IV periodontitis in G4(P-OSA) (rs = 0.531). The cytokine profile of the patients in G4(P-OSA) with Candida spp. had an increase of the cytokine's levels compared to patients who did not have the yeast. ConclusionsOSA may increase the risk of developing periodontitis due to increase of IL-1β and IL-6 in saliva and IL-6, IL-17A and IL-33 in GCF that share the activation of the osteoclastogenesis. Those cytokines may be considered as biomarkers of OSA and periodontitis.

Biomechanical properties of periodontal tissues in non-periodontitis and periodontitis patients assessed with an intraoral computerized electronic measurement device

ObjectiveTo identify tooth mobility (TM) by time-dependent tooth displacement using an electronic intra-oral loading device (ILD) in periodontally healthy and periodontally compromised patients.Materials and methodsTwenty-eight untreated periodontitis and 20 periodontally healthy patients [25 female and 26 male; ages: 20–81 years], contributing with 68 teeth (periodontitis: nteeth = 28; non-periodontitis: nteeth = 40), participated in the study. TM was measured in vivo by displacing central or lateral incisors to a maximum of 0.2 mm orally over durations of 0.5 s, 1 s, and 10 s with the ILD. The maximum force (Fmax) was extracted from the measured force/deflection curves for every single measurement.ResultsDifferences in TM-ILD values were found for periodontitis as compared to non-periodontitis patients derived from the same loading durations (differences of 3.9 (0.5 s), 3.1 (1 s), 2.8 (10 s), (95% CI for 0.5 s (1.2–6.7), p = 0.024; 1 s (1.4–6.0), p = 0.067; 10 s (0.2–5.3), p = 0.001), rejecting the null hypothesis of no difference (T-test) for durations of 0.5 and 10 s. There was a significant correlation of TM-ILD (Fmax) with BOP at 0.5 s (– 0.52) and with attachment loss at all time durations (– 0.47 at 0.5 s; – 0.57 at 1 s; – 0.47 at 10 s).ConclusionsThis clinical investigation could demonstrate that time-dependent tooth displacements using a new computerized electronic device were associated with attachment loss and bleeding on probing.Clinical relevanceILD can improve the monitoring of tooth mobility, as TM-ILD values reflect qualitative (inflammatory status interpreted by BOP) and quantitative parameters (interpreted as the amount of CAL loss) of periodontal disease.

The relationship between glycated hemoglobin level and the stage of periodontitis in individuals without diabetes.

Glycemic control appears to have a significant impact on the relationship between periodontitis and diabetes. The current study aimed to investigate the association between the stage of periodontitis and hemoglobin A1c (HbA1c) levels in patients considered to be normoglycemic. A total of 135 patients (100 females and 35 males) with no history of diabetes were included in the study. The mean age of the participants was 38.4 years old. All patients underwent a full-mouth periodontal examination. Periodontal diagnosis was determined according to the 2017 World Workshop on the Classification of Periodontal Disease. The glycemic state of the patients was assessed using a chair-side HbA1c analyzer. Ninety patients were diagnosed with periodontitis. Higher average HbA1c levels were associated with the different stages of periodontitis (p<0.01). Most of the non-periodontitis patients were in the non-diabetes group (67%), while most of the periodontitis patients were in the undiagnosed pre-diabetes group (47% of the stages I and II group, and 44% of the stages III and IV groups) (p<0.001). Periodontitis was found to be significantly associated with elevated glycated hemoglobin levels in patients not previously diagnosed with diabetes, and the elevation in HbA1c levels was more evident in patients with stage III and IV periodontitis.

BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective.

Introduction The new world classification of periodontal diseases and conditions was developed in 2017. The British Society of Periodontology and Implant Dentistry (BSP) implemented the classification in a series of papers published in the British Dental Journal in January 2019.Aims and objectives This study aimed to investigate if the BSP implementation was workable in general dental practice and to reveal if any lessons were learnt from its regular use two years following its release.Materials and methods This was a cross-sectional, retrospective, non-intervention analysis of a patient population (n = 891) drawn from a complete list of a private dental surgeon. Diagnostic and demographic data were drawn from the patient records, collated and analysed using SPSS Statistics v26.Results Diagnoses derived from the new classification were identified for 92% of subjects, indicating a high level of implementation. In total, 20.9% of subjects were diagnosed with periodontitis, and of these, 57% were unstable, 39% stable and 4% in remission. The mean bleeding on probing score across the cohort was 7.7%. Moreover, 76% of the non-periodontitis patients were diagnosed with 'clinical gingival health', 23% with localised gingivitis and 1% with generalised gingivitis.Conclusion The new classification has been found to be readily implemented in a general practice setting. Use of the new classification allows for close monitoring of periodontal status, and as a result, close monitoring of the effectiveness of pathways of care.

Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study

Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.

Patients with periodontitis are at a higher risk of stroke: A Taiwanese cohort study.

This study aimed to investigate the risk of stroke incidence in patients with periodontitis. Data on patients diagnosed with periodontitis were collected from Taiwan's National Health Insurance Research Database and were matched (1:1) with patients without periodontitis between 2001 and 2010. A multivariable Cox survival model was used to predict stroke between patients with and without periodontitis, and the possibility of confounders. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to explore the risk of stroke in the case and control groups. Diseases found during the follow-up period were analyzed to determine possible effects on the study. A total of 282 560 periodontitis and nonperiodontitis patients were enrolled, with most subjects aged 40 to 59 years. The overall cumulative incidence of stroke was 2.14 times higher in periodontitis than in nonperiodontitis, and the highest HR was in the more than 80 years age group (HR = 9.30; 95% CI, 7.06-12.26). The multivariate Cox model indicated that the adjusted HR (aHR) between the case and control was 2.03 (95% CI, 1.99-2.08), and a higher aHR was associated with hypertension. Atherosclerosis, atrial fibrillation, obesity, kidney disease, anxiety, and gout discovered during follow-up also showed a potential risk of stroke in patients with periodontitis. Therefore, this study suggests a high risk of stroke in patients with periodontitis.

Periodontal and Hepatic Parameters in Obese Patients Undergoing Bariatric Surgery.

Current discoveries imply a connection between periodontitis and metabolic associated fatty liver disease (MAFLD). This study aimed to determine the prevalence of periodontitis and MAFLD in obese patients with BMI >40, employing the most reliable diagnostic methods, namely liver biopsy, and detailed periodontal examination. Liver biopsy and periodontal examination were performed in 30 obese patients with BMI BMI >40 undergoing bariatric surgery. Kleiner's classification was used to determine non-alcoholic steatohepatitis (NAS) activity score, non-alcoholic steatohepatitis (NASH) and liver fibrosis. The periodontal condition was classified following the recent AAP/EFP classification. Patients were divided into periodontitis (PG) and non-periodontitis groups (NPG). Data on systemic health parameters were collected from patients' medical records. Descriptive statistics and simple statistical tests were used to determine the differences between the two groups. The prevalence of NASH in the sample was 43% (13/30), borderline NASH 37% (11/30), while fibrosis stage 1 was most common (72%, [22/30]). Periodontitis prevalence was 67% (20/30), while all non-periodontitis patients (33%; 10/30) exhibited gingivitis. PG and NPG did not differ in NAS or NASH prevalence (p > 0.05). However, the periodontitis group showed higher C-reactive protein levels, while NPG showed higher gamma-glutamyl transpeptidase levels (p < 0.05). The study results suggest the considerable prevalence of MAFLD, periodontitis and gingivitis in obese patients with BMI >40 undergoing bariatric surgery. Patients with periodontitis had higher CRP levels, while those with gingivitis presented higher gamma-glutamyl transpeptidase levels.

IDF21-0569 Periodontal disease is associated with increased risk of Diabetes and Pre-diabetes

Background: Early diagnosis of diabetes mellitus and pre-diabetes is essential for the timely management of diabetes and its complications as well as the prevention of diabetes in individuals with pre-diabetes. Periodontal disease has also been recognized as the sixth complication of diabetes although this is still under-appreciated by endocrinologists or physicians in general. Since it has been suggested that severe periodontitis might be an early complication of diabetes, therefore periodontal disease may be a useful indicator to screen for the risk of diabetes or pre-diabetes in dental patients who otherwise do not know of their glycemic status. Aim: In this study, HbA1c levels and subsequently the prevalence of diabetes and pre-diabetes in participants with and without periodontitis of various stages were investigated. Method: From 88 mild periodontitis patients, 132 moderate periodontitis patients, 210 severe periodontitis patients and 66 patients without periodontitis (control), HbA1c values were obtained by a finger-prick blood sample taken from each participant which was then tested in a point-of-care HbA1c analyzer. Differences in mean HbA1c values and prevalence of diabetes and pre-diabetes between the different periodontitis and control groups were analyzed. Multivariate analyses were performed, correcting for known risk indicators for diabetes screening. Results: In this cohort of a total of 496 participants, 29(5.8%) and 154 (31.0%) patients were identified with HbA1c levels corresponding to the ADA guideline levels for diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%), respectively. In addition, the mean HbA1c levels increases as the stage of periodontitis increases from no periodontitis to severe periodontitis. Periodontal disease of all stages have higher proportion of hyperglycaemia as compared to non-periodontitis(control) patients. However, it is the severe periodontitis group that showed a significantly higher percentage of patients with HbA1c values in the diabetes range as compared with the mild/moderate periodontitis group (p < 0.001). The prevalence of pre-diabetes was significantly higher in patients with moderate periodontitis compared with patients without periodontitis or with patients having mild periodontitis. In the severe periodontitis group, 18 (8.6%) patients had HbA1c levels in the diabetes range and 51 (24.3%) patients could be diagnosed with prediabetes according to the ADA-guidelines, whereas in the moderate periodontitis group, 59 (44.7%) subjects had HbA1c levels in the pre-diabetes range and only 2 (1.5%) of them reached HbA1c values for diabetes diagnosis. Discussion: Periodontitis is associated with increased levels of HbA1c and subsequently with an increased prevalence of those at risk for diabetes and pre-diabetes. We suggest that severe periodontal disease may be a useful risk indicator for early diabetes or pre-diabetes. This study also demonstrates the important role that dentists can play in the early referral of their patients who may already have undiagnosed diabetes and pre-diabetes to endocrinologist so as to receive timely medical diagnosis, prevent or delay progression from pre-diabetes to overt diabetes mellitus and intervention to prevent potential diabetes complications which in turn reduces disease burden.

Assessment of Mandibular Molar Root Morphology Using Cone‑Beam Computed Tomography in Periodontitis Patients From Eastern Province: A Cross-Sectional Study

BackgroundThe aim of this study was to assess the root morphology of mandibular molar teeth using cone‑beam computed tomography (CBCT) in patients with periodontal disease.MethodsIn total, 88 patients were included in this study (70 patients with periodontitis and 18 patients with non-periodontitis). This cross-sectional study involved CBCT images taken for patients who visited the dental clinic of Imam Abdulrahman Bin Faisal University (IAU) from January 2019 to March 2021. The following data were analyzed on the mandibular molars: root length, number of root canals, root trunk, distance between roots, accessory canals in the furcation area (ACF), bone loss, and furcation involvement.ResultsThe mesial root was longer than the distal root in the mandibular molars of periodontitis and non-periodontitis patients. A statistically significant difference was observed between non-periodontitis and periodontitis patients regarding the number of mesial root canals of the mandibular first molar; 70% had two root canals in non-periodontitis patients, compared with 86.1% in periodontitis patients (p = 0.04). First molars of non-periodontitis patients had significantly longer root trunks than periodontitis patients (4.65 ± 0.90 compared with 4.09 ± 1.02, p = 0.007). There was a statistically significant difference in bone loss between non-periodontitis and periodontitis patients (0% and 25% for first molars, and 2.8% and 23.6% for second molars, respectively). Accessory furcation canals were 2.9 % in second molars and 7.1 % in first molars in periodontitis patients, which were higher compared with non-periodontitis patients.ConclusionsThe first molar showed a longer root trunk in non-periodontitis patients than in periodontitis patients. The mean mesial and distal root lengths were also greater in the first than the second molar. Accessory canals in the furcation area were more observed in first molars than in second molars in periodontitis patients compared with non-periodontitis patients.

Patterns of subgingival microbiota in different periodontal phenotypes

ObjectivesTo compare the subgingival microbiota of patients with aggressive (AgP) or chronic periodontitis (CP) to healthy (H), non-periodontitis patients as well as to explore their relevant associations to different host genetic variants. MethodsFollowing clinical examination, blood and subgingival plaque sampling of 471 study participants (125 AgP, 121 CP, 225 H), subgingival community analysis was performed by next generation sequencing of the 16S rRNA. Microbial data from 266 participants (75 AgP, 95 CP, 98 H) were available for analysis. SNPs in the IL6, IL6R and FTO gene were selected for genetic marker analyses. ResultsCombined periodontitis patients (AgP + CP), particularly those classified with AgP, exhibited lower alpha- and beta- diversity. Several genera (including Peptostreptococcaceae, Filifactor, Desulfobulbus, Tannerella and Lachnospiracee) and species were over-abundant in combined periodontitis vs. healthy individuals, while other genera such as Prevotella or Dialister were found to be more abundant in healthy cases. The only genus with difference in abundance between AgP and CP was Granulicatella. No associations between IL6, IL6RA and FTO genetic variants and microbial findings were detected. ConclusionThis study suggests that limited microbial differences existed between AgP and CP and challenges the current notion that periodontitis is associated with increased subgingival microbial diversity compared with periodontal health. Clinical significanceThe findings of this study cast some doubts on the notion that the dysbiosis characteristic of periodontal disease is expressed as increased microbial diversity.

Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis.

To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p>0.05). A significant CAL gain (mm) (ME=3.523; 95% CI [2.353; 4.693]; p<0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported, and objective assessment of the results on orthodontic therapy was missing. Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.

Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis.

The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4years was low (n=17 studies; weighted mean incidence (WMI)=4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI=6.9% (n=18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.

The association between periodontitis and cardiovascular risks in asymptomatic healthy patients

BackgroundPeriodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. Pathophysiological evidence suggests a possible common inflammatory background between periodontitis and cardiovascular diseases (CVD). Pathological and epidemiological associations between these two diseases have been presented, but are still debated. This study aimed to investigate the association between the inflammatory burden of periodontitis and the presence and extent of coronary calcification. Secondary aims were to study other cardiovascular parameters and cardiovascular risk predictors in relation to periodontitis and dental health. MethodsHealthy periodontitis or non-periodontitis patients 45–70 years of age were included in a prospective cross-sectional study. Full-mouth examinations were performed by a periodontist to determine their Periodontal Inflamed Surface Area (PISA) score and other dental parameters. To assess the cardiovascular conditions, Coronary Artery Calcium (CAC) scores, endothelial function assessments by the EndoPAT ™, and several physical and biochemical examinations were performed. ResultsSeventy-one patients were included. Elevated CAC scores and endothelial dysfunction were not significantly related to PISA or dental health. PISA was significantly related to the Framingham and Reynolds CVD risk predictors, but were no longer significant after correction for confounders. The same applied to the significant relations between tooth loss, dental plaque and bleeding scores and the CVD risk predictors. ConclusionsPeriodontitis is associated with increased CVD risk, but is not an independent risk factor. This link is still important to make to bridge the gap between dentistry and general medicine and to identify patients at risk for CVD in an earlier stage.