Periodontitis Patients Research Articles

Elucidation of the antioxidant status in response to non-surgical periodontal therapy and post Vitamin E supplementation in patients with chronic periodontitis-a randomised controlled trial

Chronic Periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth along with the liberation of reactive oxygen species (ROS) that has deleterious effects on the periodontal tissues. This accumulated ROS is eliminated by various protective antioxidant mechanisms like Superoxide dismutase (SOD). In our study, we evaluated the cumulative effect of scaling and root planing on the levels of SOD in the gingival crevicular fluid (GCF) in chronic periodontitis (CP) patients with and without Vitamin E supplementation. Materials and Methods: This study was performed on 46 patients including 12 systemically healthy individuals with clinically healthy periodontium who served as controls (Group I), 17 patients with CP supplemented without Vitamin E (Group II) and 17 patients with CP supplemented with Vitamin E (Group III). The clinical parameters and biochemical parameters (GCF- SOD) levels were measured at baseline. All the patients were treated with (SRP) followed by an evaluation of the clinical and biochemical parameters after 6 weeks. Results: Results showed that all the clinical parameters improved after SRP in Group III and Group II, with Group III showing a higher reduction, Patients in Group III showed a greater reduction in the levels of SOD in GCF, 6 weeks post SRP when compared to Group II patients Conclusion: SRP reduced superoxide dismutase levels in the GCF of chronic periodontitis patients with significant reduction appreciated in Group III patients who recieved Vitamin E supplementation. Key Words: Antioxidant, Chronic Periodontitis, Gingival Crevicular Fluid (GCF), Reactive oxygen species, Superoxide dismutase, Tocopherols, Vitamin, Vitamin E supplementation

Estimating the salivary levels of IL-35 in smokers with periodontitis: A cross sectional study

BackgroundA refined network and integrated host immune response to bacteria are formed by anti-inflammatory cytokines and the cells that they are associated to IL-35 has been recognized as having strong suppressive activity in chronic inflammatory diseases, together with IL-10 and TGF-β. It is believed that inflammatory diseases like periodontitis trigger the inducible Treg population to express IL-35, expanding regulatory responses by increasing infection. AimThe objective is to estimate and compare the salivary IL-35 levels in Periodontally healthy subjects, smokers and non-smokers with Periodontitis in order to educate on the consequences of periodontal health among the diseased patients. Materials and MethodsTotally 42 subjects were included and they were categorized into Group 1 (n = 14) as Periodontally healthy subjects, Group 2 (n = 14) as systemically healthy non-Smokers with periodontitis and Group 3 (n = 14) as systemically healthy smokers with periodontitis. Each subject was assessed for clinical parameters such as Plaque index, Gingival index, Probing depth, clinical attachment. A polypropylene tube was used to collect unstimulated saliva and centrifuged it at 800 × g for 10 min. Supernatants were collected and stored at −80◦C. A commercially available enzyme-linked immunosorbent assay kit was used to analyse levels of human salivary IL-35. ResultsThe average age of the subjects in Group 1, Group 2 and Group 3 were 50.53, 52.93 and 52.07 years respectively. All three groups showed a statistically significant difference in clinical parameters including Plaque index, Gingival index, Probing depth and clinical attachment. The salivary IL-35 level was found to be elevated in non-smokers who have periodontitis compared to smokers with periodontitis and healthy individuals. Despite this, the salivary IL-35 levels were found to be statistically significant among three groups at P < 0.001. ConclusionThe salivary levels of IL-35 were found to increase in Periodontitis patients with/without smoking, along with increased clinical parameters. IL-35 is considered a influential biomarker for periodontal disease.

Effects of Scaling and Root Planing on Salivary Interleukine-6 Levels in Chronic Periodontitis Patients and Glycemic Controls.

Type 2 diabetes mellitus (DM) and periodontitis have a bidirectional relationship that is well documented in many reviews and epidemiological studies. Periodontitis has been referred to as the sixth complication of diabetes mellitus. Various studies showed improvement inInterleukin-6 levels as well as metabolic parameters after non-surgical periodontal therapy in chronic periodontitis patients with type 2 DM. Objective: To evaluate the effect of scaling and root planing (SRP) on salivary levels of IL-6 and assessment of clinical parameters in CP patients with and without T2DM. We included 50 CP patients with well-controlled T2DM (Group I), and 50 CP patients without T2DM as controls (Group II) with evident clinical inflammation, ≥ 5mm probing depth (PD) and a relative attachment level (RAL) of ≥ 5mm. Following a brief medical and dental history plaque index (PI), gingival index (GI), gingival bleeding index (BI), PD, and RAL were recorded, and an unstimulated saliva was collected.Following SRP therapy, the clinical parameters and IL-6 levels were measured after seven days, 14 days, and 30 days. Intragroup and intergroup comparisons were carried out using a paired t-test and an independent t-test. The statistical significance was set atP< 0.05. Data were analyzed using computer software, Statistical Package for Social Sciences (SPSS) v. 22.0 (IBM Corp., Armonk, NY). Intergroup comparisons of IL-6 levels at different intervals showed a significantly higher reduction in Group II than in Group I (p=0.000). While the mean difference in the GI scores from baseline to 30 days was significantly higher in Group I patients (p=0.000), the difference in the mean PI (p=0.004), mean BI (p=0.000), mean PD (p=0.000) and mean RAL scores (p=0.000) were significantly higher in Group II patients. This study indicates that scaling and root planing is effective in glycemic control and also has a role to play in the level of salivary IL-6 in periodontal healthand T2DM with chronic periodontitis. Elevated salivary IL-6 levels indicate periodontal inflammation which is further increased in T2DM patients. Hence, elevated IL-6 can be considered a marker of periodontal destruction.

Clinical diagnostic value of IL-14, 1L-16 and SAA in periodontitis.

Periodontitis is a chronic infectious disease, which leads to inflammatory destruction of periodontal supporting tissues. Interleukin 14 (IL-14), Interleukin 16 (IL-16) and serum amyloid A (SAA) have been demonstrated to be abnormally expressed in inflammatory diseases. Therefore, this study was performed to analyzed the expression and potential clinical values of IL-14, 1L-16 and SAA in periodontitis. A total of 100 periodontitis patients and 100 healthy volunteers were recruited and the saliva and serum samples were collected. Then the C-reactive protein (CRP), procalcitonin (PCT), IL-14, 1L-16 and SAA levels in the saliva and serum of periodontitis patients were measured by Elisa kits. Besides, the significance of CRP, PCT, IL-14, 1L-16 and SAA in periodontitis patients were analyzed by receiver operating characteristic (ROC) analysis. The results showed that CRP, PCT, IL-14, 1L-16 and SAA levels were significantly increased in the the saliva and serum of the periodontitis patients. Additionally, the area under the curve (AUC) of saliva CRP, PCT, IL-14, 1L-16 and SAA for the diagnosis of periodontitis were 0.9035, 0.9435, 0.9508, 0.9500 and 0.9467, respectively. The AUC of serum CRP, PCT, IL-14, 1L-16 and SAA for the diagnosis of periodontitis were 0.9035, 0.9435, 0.9508, 0.9500 and 0.9467, respectively. What's more, the diagnostic value of IL-14, 1L-16 and SAA were enhanced when combining with CRP and PCT. This study demonstrated that IL-14, IL-16 and SAA expressions were upregulated in periodontitis patients and exhibited a significant significance for periodontitis diagnosis.

Characterization of fumarate reduction by Klebsiella pneumoniae isolated from patients with chronic periodontitis

Chronic periodontitis is oral inflammatory gum disease which affects the tissues that support the teeth. It is caused by formation of bacterial plaque consisting of bacterial species that produces various virulence factors. Oral bacterial species from the periodontitis patients include species of Fusobacterium, Porphyromonas, Prevotella, Tannerella, etc. In the present study, we isolated the Klebsiella pneumoniae strain 9A from the pockets of patients suffering from chronic periodontitis. The strain was isolated on enriched tryptic soya media containing 10 mM fumarate and identified based on Gram staining, 16S rRNA gene sequencing, biochemical tests and ability to reduce fumarate. Our study is the first report of anaerobic fumarate reduction capabilities of Klebsiella spp. isolated from chronic periodontitis patients, which may help in growth and survival of species in periodontal pockets leading to progression of the disease. In addition, experimental evidence is provided through reduction, growth, and inhibitor assays for the presence of fumarate reductase (Frd) activities. Furthermore, we detected a 400 bp frdA gene fragment in Klebsiella pneumoniae strain 9A using degenerate PCR. This fragment show similarity to fumarate reductases flavoprotein subunit (FrdA). Our findings suggest that the FrdA subunit is responsible for anaerobic fumarate respiration in Klebsiella spp. to be important in the survival of bacteria in oxygen-deprived environments in humans such as periodontal pockets, thus contributing to its pathogenicity.

Estimation of Cancellous Changes Using Fractal Analysis in Patients with Periodontitis.

Periodontal disease is a broad term given when the periodontium is affected by inflammation. There are several methods to diagnose periodontitis, but no method to quantify the cancellous bone is presently used. For this purpose, a non-invasive tool that is efficient in analyzing bone quality called fractal analysis can be employed. The objective of the study was to utilize fractal dimension (FD) to evaluate cancellous patterns of interproximal alveolar bone using a digital intraoral periapical radiograph (IOPAR) in different clinical presentations of periodontitis classified according to the latest classification by the World Workshop for Periodontal and Peri-Implant Diseases and Conditions, 2017 (WWDC, 2017). The study aimed to numerically calculate the periodontitis changes in the cancellous bone around the affected tooth on an IOPAR using fractal analysis and to provide an additional criterion for the staging of periodontitis. In this cross-sectional observational study, 75 patients were selected and equally allotted to five groups based on the staging system proposed by the WWDC, 2017. The region of interest was selected on the IOPA radiograph of the tooth with the site having the most significant clinical attachment loss, and FD was calculated using Image J analysis. The association of gender and age with stages of periodontitis was studied using the chi-square test of independence. A comparison of % bone loss and fractal dimension among stages was studied by using the non-parametric Kruskal Wallis test. The relationship between % bone loss and fractal dimension within stages and gender was studied by using the Karl Pearson correlation. A receiver operating characteristic (ROC) curve analysis was performed for FD value as a marker of periodontitis patients. We demonstrated that the FD values decreased significantly with the increase in stages (p < 0.0001). The overall relationship between % bone loss and FD showed a significantly strong negative correlation of -0.739 (p < 0.0001), except for stages III and IV. FD can be utilized as a quantitative method for detecting cancellous bone changes in different stages of periodontitis, aiding in diagnosing periodontitis.

Identifying immuno-related diagnostic genes and immune infiltration signatures for periodontitis and alopecia areata

BackgroundAlthough there have been indications that periodontitis (PD) may be susceptible to alopecia areata (AA), the underlying mechanism of its pathogenesis remains poorly understood. The objective of our study is to conduct further research into the occurrence of this complication. MethodsThe gene expression omnibus (GEO) database was the source of acquisition for both PD and AA datasets. Various methods, including the differentially expressed genes (DEGs) analysis, functional enrichment analysis, protein–protein interaction (PPI) network construction, Cytohubba algorithms, and RandomForest algorithms, were utilized to identify candidate hub immuno-related genes (IRGs) for diagnosing AA with PD. The diagnostic efficacy was assessed by constructing receiver operating characteristic (ROC) curves. To further deepen our understanding, immune cell infiltration, flow cytometry assay, and immunofluorescence techniques were employed to uncover immune cell dysregulation in PD and AA. Results899 and 803 DEGs were detected in AA and PD, respectively, with an intersection of 150 common DEGs enriched in immune regulation. Further analysis of the junction of shared DEGs and IRGs was analyzed using the PPI network, Mcode, and Cytohubba algorithms. Three hub genes (CTSS, IL2RG, and ITGAL) were subsequently selected by Cytohubba and RandomForest algorithms and were found to be promising candidate hub genes with high diagnostic values (AUC ranging from 0.776 to 0.909) for diagnosing AA with PD. Additionally, various dysregulated immune cells were observed, with mast cells potentially serving as markers for AA and plasma for PD. ConclusionThree candidate hub IRGs (CTSS, IL2RG, and ITGAL) were identified with considerable diagnostic values. Besides, mast cells could serve as markers for AA, while plasma may indicate PD. Our research has the potential to identify shared diagnostic candidate genes and immune cells for AA and PD patients.

Efficacy of a single antimicrobial photodynamic therapy session as an adjunct to non-surgical periodontal therapy on clinical outcomes for periodontitis patients. A systematic review

Background: periodontitis is a multifactorial and multi-etiological disease associated with destructive events to the periodontium. Non-surgical periodontal therapy (NSPT) is considered an efficient, gold-standard approach to treat this disease; however, several variables could hinder the success rate. Combining antimicrobial photodynamic therapy (aPDT) with NSPT showed promising results but the available literature show variations in results. Aim: whether using single episode of aPDT as adjunct to NSPT for adults affected by periodontitis can improve clinical outcomes, with a minimum 3 months follow up after terminating active treatment, as compared to conventional manual instrumentation? Methods: Three databases (PubMed, ScienceDirect, and Cochrane Library) were searched to retrieve relevant articles. The keywords matrix used for the search process consisted of the following terms: periodontitis OR periodontal disease AND photodynamic therapy OR antimicrobial photodynamic therapy OR Laser. Results: A total of 4104 articles were retrieved from the search process for the last 10 years. After removing duplicates and applying filters, 44 article were eligible for full-text reading. The last step resulted in 6 randomized controlled trials that were used for data synthesis. Conclusions: Retrieved data from this study indicated that adjunctive aPDT has a potential beneficial effect on short-term mainly reflected by improving bleeding scores and microbiological outcomes for patients with periodontitis. However, longer term advantage was not evident as compared to conventional periodontal therapy. Further studies are advised to draw a solid conclusion about using aPDT as adjunct to NSPT

Long non-coding RNA X-Inactive Specific Transcript (XIST) interacting with USF2 promotes osteogenic differentiation of periodontal ligament stem cells through regulation of WDR72 transcription.

Periodontal ligament stem cells (PDLSCs) are the most potential cells in periodontal tissue regeneration and bone tissue regeneration. Our prior work had revealed that WD repeat-containing protein 72 (WDR72) was crucial for osteogenic differentiation of PDLSCs. Here, we further elucidated its underlying mechanism in PDLSC osteogenic differentiation. Human PDLSCs, isolated and identified by flow cytometry, were prepared for osteogenic differentiation induction. Levels of WDR72, long non-coding RNA X-Inactive Specific Transcript (XIST), upstream stimulatory factor 2 (USF2), and osteogenic marker genes (Runx2, Osteocalcin, and Collagen I) in human PDLSCs and clinical specimens were detected by RT-qPCR. Protein expressions of WDR72, Runx2, Osteocalcin, and Colla1 were tested by Western blot. The interactions among the molecules were verified by RIP, RNA pull-down, ChIP, and luciferase reporter assays. Osteogenic differentiation was evaluated by alkaline phosphatase (ALP) and alizarin red staining (ARS). WDR72 was decreased in periodontal tissues of periodontitis patients, and overexpression reversed TNF-α-mediated suppressive effects on PDLSC osteogenic differentiation. Mechanically, XIST recruited the enrichment of USF2 to the WDR72 promoter region, thereby positively regulating WDR72. WDR72 silencing overturned XIST-mediated biological effects in PDLSCs. WDR72, regulated by the XIST/USF2 axis, enhances osteogenic differentiation of PDLSCs, implying a novel strategy for alleviating periodontitis.

Periodontal disease and risk of atrial fibrillation or atrial flutter: A systematic review and meta-analysis.

We conducted a study to evaluate the risk of atrial fibrillation (AF) and atrial flutter (AFL) in periodontal disease (PD) patients. Cohort studies that evaluate the risk of AF or AFL in PD patients were included. The risk was expressed in the pooled odd ratio (OR) with 95% confidence interval (CI). A total of four cohort studies were included. We found that patients with PD have a significantly higher risk of AF/AFL compared to those without PD with the pooled OR of 1.33 (95% CI 1.29-1.38; p = 0.357, I 2 = 3.0%). PD increases the risk of AF and AFL.

The association between periodontitis patients' chief complaints and the stage of periodontitis: A clinical retrospective study.

The purposes of this retrospective study were to investigate the prevalence of various periodontal chief complaints (pCCs) of patients, diagnosed with periodontitis, as well as to identify the association between pCCs and periodontal parameters or periodontitis staging according to AAP/EFP 2017 classification. Five hundred eighty-nine patients, applied to the clinic with pCCs, were screened. The demographic characteristics, smoking status, brushing behaviors, history of periodontal therapy, medical data, and periodontal parameters were obtained. A multinomial logistic regression analysis was performed to determine the most common pCCs and co-variables among the indicators of Stage III and IV periodontitis. In Stage IV periodontitis, patients with pCC of mobility were observed the most (26.8%), and pCC of halitosis were the least (7.3%). Among all pCCs of patients, those with the pCC of gingival enlargement and tooth mobility had the highest percentage of sites with PPD ≥ 4mm and CAL ≥ 5mm, respectively (p < .001). According to regression analysis, those with pCC of gingival bleeding, recession and mobility were more likely to be in Stage IV than those in Stage I/II. Among pCCs, only patients with pCCs of mobility, gingival recession and bleeding are related to periodontitis staging. Moreover, the extent of periodontal pockets in patients with pCC of gingival enlargement, and the extent of attachment loss in patients with pCC of mobility are greater than other patients. New machine-learning technology models can be developed with the aim of classifying the patients based on their chief complaints, to support diagnosing the severity of periodontal diseases.

Ferritin was involved in interleukin-17A enhanced osteogenesis through autophagy activation

Periodontitis is a prevalent inflammatory immune disease that involves tissue inflammation and excessive bone loss. In murine periodontitis models and periodontitis patients, upregulated interleukin-17A (IL-17A) expression was observed, and its level seemed to correlate with the disease severity. In this study, we intended to investigate the specific role of ferritin, a critical iron storage protein, in IL-17A enhanced osteogenic differentiation as well as the underlying mechanism. Under osteogenic induction, IL-17A stimulation promoted differentiation and mineralization of murine calvarial osteoblasts. In addition, increased iron accumulation and ferritin expression were detected in osteoblasts treated with IL-17A, indicating an alteration in iron metabolism during osteogenesis. Administration of iron chelator deferoxamine (DFO) and transfection with small interfering RNA (siRNA) targeting ferritin heavy chain (FTH) further revealed that ferritin suppression consequently inhibited osteoblast differentiation. Autophagy activation was also found upon IL-17A stimulation, which played a positive role in osteogenic differentiation and was subsequently suppressed by DFO or siRNA targeting FTH. In conclusion, IL-17A induced ferritin expression in osteoblasts, which further enhanced osteogenic differentiation via autophagy activation. These findings may provide further insight into the role of IL-17A in osteoblast differentiation and demonstrate ferritin as a potential target in modulating alveolar bone homeostasis.

Enamel Matrix Derivative Suppresses Chemokine Expression in Oral Epithelial Cells.

Epithelial cells in periodontitis patients increasingly express chemokines, suggesting their active involvement in the inflammatory process. Enamel matrix derivative (EMD) is an extract of porcine fetal tooth germs clinically applied to support the regrowth of periodontal tissues. Periodontal regeneration might benefit from the potential anti-inflammatory activity of EMD for epithelial cells. Our aim was, therefore, to set up a bioassay where chemokine expression is initiated in the HSC2 oral squamous carcinoma cell line and then test EMD for its capacity to lower the inflammatory response. To establish the bioassay, HSC2 cells being exposed to TNFα and LPS from E. coli (Escherichia coli) or P. gingivalis (Porphyromonas gingivalis) were subjected to RNAseq. Here, TNFα but not LPS caused a robust increase of chemokines, including CXCL1, CXCL2, CXCL8, CCL5, and CCL20 in HSC2 cells. Polymerase chain reaction confirmed the increased expression of the respective chemokines in cells exposed to TNFα and IL-1β. Under these conditions, EMD reduced the expression of all chemokines at the transcriptional level and CXCL8 by immunoassay. The TGF-β receptor type I kinase-inhibitor SB431542 reversed the anti-inflammatory activity. Moreover, EMD-activated TGF-β-canonical signaling was visualized by phosphorylation of smad3 and nuclear translocation of smad2/3 in HSC2 cells and blocked by SB431542. This observation was confirmed with primary oral epithelial cells where EMD significantly lowered the SB431542-dependent expression of CXCL8. In summary, our findings suggest that TGF-β signaling mediates the effects of EMD to lower the forced expression of chemokines in oral epithelial cells.

Clinical and immunological parameters of dental status in children with type 1 diabetes mellitus

BACKGROUND: Destructive processes in the pancreas in type 1 diabetes mellitus alter oral homeostasis. The first signs of a change in dental health in type 1 diabetes mellitus are pastosity of the oral mucosa and hyposalivation, which causes dental plaque formation. Many researchers note the high prevalence of periodontal disease in patients with type 1 diabetes mellitus.&#x0D; AIM: To examine the dental status, cytokine profile, and specific factors of oral immunological protection in children with type 1 diabetes mellitus.&#x0D; MATERIALS AND METHODS: Two groups of children aged 617 years were examined. The main group (n=53) included patients with type 1 diabetes mellitus, whereas the comparison group (n=30) included children without somatic pathologies. The study analyzed the results of a clinical examination of patients, including an assessment of the intensity of caries, oral hygiene, and periodontal status, and results of an immunological examination of the oral fluid, including the level of cytokines (interleukin (IL)-1, tumor necrosis factor-, IL-4, and IL-10) and immunoglobulins (IgA, IgG, and IgM).&#x0D; RESULTS: Both groups had satisfactory levels of oral hygiene, and the extent of plaque formation on the proximal surfaces of the teeth was unacceptable. The prevalence of chronic catarrhal gingivitis was higher in the main group. An immunological study showed that both groups had pro-inflammatory cytokine imbalance in the oral fluid, and the levels of these cytokines are higher in the main group. The levels of immunoglobulins in the oral fluid were also different: the levels of IgA and IgM in the saliva of the main group were 1.1 and 1.2 times higher, and the IgG level was 1.25 times lower.&#x0D; CONCLUSION: The high prevalence of periodontal disease in children with type 1 diabetes mellitus was associated with poor oral hygiene and carbohydrate metabolism. Patients with type 1 diabetes mellitus showed a pronounced imbalance of oral immunological protection factors. With worsening compensation of carbohydrate metabolism, immunological changes in the oral cavity became more pronounced.

Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: A meta-analysis of prospective studies.

Studies reported periodontal disease (PD) periodontal disease is associated with many systemic diseases, including cardiovascular outcomes and all-cause mortality. However, the precise mechanistic link for these relationship remained unclear. We therefore performed a meta-analysis of cohort studies to investigate the association of PD with the risk of cardiovascular outcomes and all-cause mortality. We systematically searched the databases of PubMed, EmBase, and the Cochrane library to identify eligible studies until April 2023. The investigated outcomes included major adverse cardiovascular events (MACEs), coronary heart disease (CHD), myocardial infarction (MI), stroke, cardiac death, and all-cause mortality. The summary relative risk (RR) with 95% confidence interval (CI) were calculated using the random-effects model. Thirty-nine cohort studies with 4,389,263 individuals were selected for final meta-analysis. We noted PD were associated with elevated risk of MACEs (RR: 1.24; 95%CI: 1.15-1.34; P<0.001), CHD (RR: 1.20; 95%CI: 1.12-1.29; P<0.001), MI (RR: 1.14; 95%CI: 1.06-1.22; P = 0.001), stroke (RR: 1.26; 95%CI: 1.15-1.37; P<0.001), cardiac death (RR: 1.42; 95%CI: 1.10-1.84; P = 0.007), and all-cause mortality (RR: 1.31; 95%CI: 1.07-1.61; P = 0.010). Sensitivity analyses indicated the pooled conclusions for cardiovascular outcomes and all-cause mortality are robustness. The associations of PD with the risk of ardiovascular outcomes and all-cause mortality could affected by region, study design, PD definition, follow-up duration, and study quality. This study found the risk of cardiovascular outcomes and all-cause mortality were elevated in PD patients, and the intervention for PD should be applied to prevent the risk of cardiovascular outcomes.

Role of Macrophage Colony-Stimulating Factor for Staphylococcal Infection in the Oral Cavity.

There are few valid indicators of oral infection owing to the complexity of pathogenic factors in oral diseases. Salivary markers are very useful for scrutinizing the symptoms of disease. To provide a reliable and useful predictive indicator of infection for opportunistic pathogens in individuals with compromised immune systems, such as those with periodontal diseases and Human Immunodeficiency Virus (HIV), this study examines opportunistic pathogens such as C. albicans and staphylococci and macrophage colony-stimulating factor (M-CSF) and CA125/MUC16 in saliva. The aim was to explore the correlations investigated among these factors. Samples were divided into two groups (based on patient sex, the absence and presence of dentures in elderly, or HIV-positive patients and healthy subjects), and the correlation was analyzed in two groups of elderly patients with periodontal disease (64.5 ± 11.2 years old) and HIV-infected patients (41.9 ± 8.4 years old). Healthy subjects (33.8 ± 9.1 years old) were also analyzed as a control. Levels of C. albicans, staphylococci, and M-CSF, which is an immunological factor for the differentiation of macrophage, and CA125/MUC16, which provides a protective lubricating barrier against infection, were investigated. A significant and positive correlation between the levels of M-CSF and staphylococci was found in elderly individuals and HIV-positive patients treated with antiretroviral therapy. A significant and positive correlation between the levels of M-CSF and CD125/MUC16 was also found in both patients. These correlations were enhanced in both patients as compared with healthy subjects. Salivary M-CSF might be useful as a new indicator of opportunistic infection caused by staphylococci and a defense against infection in immunocompromised hosts.

Enhancing Periodontitis Treatment: A Comprehensive Literature Review of Locally Delivered Antibiotics as an Adjunctive Therapy

Background: Periodontitis is a prevalent and persistent infection that can significantly affect overall health. While scaling and root planing are effective treatments, they may not fully remove bacterial biofilms in difficult-to-reach areas, such as furcations and deep pockets. Therefore, numerous studies have demonstrated that supplementing mechanical debridement with locally delivered antibiotics can improve clinical outcomes. Objective: This study aims to review the effectiveness of different types of locally delivered antibiotics as adjunctive therapy to scaling and root planing in treating periodontitis. Methods: Pubmed, Scopus and Google Scholar were utilized to obtain papers addressing locally delivered antibiotics in periodontitis patients, antibiotics in periodontitis, or antimicrobial agents in periodontitis up to February 1, 2023. Results: Treatment with locally delivered antibiotics led to notable improvements in clinical outcomes. These improvements encompassed reductions in probing depths, gingival inflammation, and bleeding on probing. Additionally, enhancements in clinical attachment level and periodontal pocket depth reduction were consistently observed in the included studies. Conclusion: Based on individual antimicrobial agent analyses, we are unable to determine which local antibiotic is the best. It is challenging to accurately assess the use of sustained or released local antimicrobials due to the unique features of each product. Local medication administration into the periodontal pocket could be an effective therapy adjunct to mechanical instruments.

Deep learning for the early identification of periodontitis: a retrospective, multicentre study

To develop a deep-learning model to help general dental practitioners diagnose periodontitis accurately and at an early stage. First, the panoramic radiographs (PARs) from the Second Affiliated Hospital of Nanchang University were input into the convolutional neural network (CNN) architecture to establish the PAR-CNN model for healthy controls and periodontitis patients. Then, the PARs from the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were included in the second testing set to validate the effectiveness of the model with data from two centres. Heat maps were produced using a gradient-weighted class activation mapping method to visualise the regions of interest of the model. The accuracy and time required to read the PARs were compared between the model, periodontal experts, and general dental practitioners. Areas under the receiver operating characteristic curve (AUCs) were used to evaluate the performance of the model. The AUC of the PAR-CNN model was 0.843, and the AUC of the second test set was 0.793. The heat map showed that the regions of interest predicted by the model were periodontitis bone lesions. The accuracy of the model, periodontal experts, and general dental practitioners was 0.800, 0.813, and 0.693, respectively. The time required to read each PAR by periodontal experts (6.042±1.148 seconds) and general dental practitioners (13.105±3.153 seconds), which was significantly longer than the time required by the model (0.027±0.002 seconds). The ability of the CNN model to diagnose periodontitis approached the level of periodontal experts. Deep-learning methods can assist general dental practitioners to diagnose periodontitis quickly and accurately.

Periodontitis is associated with multimorbidity in a large dental school population.

To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.

Evaluation of salivary glycated albumin in periodontitis patients with and without type 2 diabetes mellitus and its changes with non-surgical periodontal therapy.

Bidirectional relationship exists between diabetes mellitus and periodontitis. Glycated albumin is an emerging biomarker to assess intermediate glycemic control. Salivary glycated albumin has not been evaluated in periodontitis. The aim of the study was to compare salivary glycated albumin in periodontitis patients with and without diabetes mellitus before and after periodontal therapy. This comparative cross-sectional study was conducted in the Department of Periodontics. Ninety subjects (mean age 41.8 ± 6.82) were categorized into three groups. Clinical examination and saliva sample collection were done at baseline and 4 weeks after scaling and root debridement. Salivary glycated albumin levels were estimated using an enzyme-linked immunosorbent assay. One-way analysis of variance with post hoc test and paired t-test was done for inter- and intra-group comparison. The optimal cut-off value was calculated using the receiver operating characteristic curve and by maximization of the Youden index. Mean salivary glycated albumin was the highest in diabetic patients followed by non-diabetic periodontitis patients and least in healthy controls. All the intergroup comparisons were significant. A cut-off value of 72.19 ng/ml of salivary glycated albumin could predict diabetic status with a sensitivity and specificity of 75%. Salivary glycated albumin was significantly reduced in a similar manner in both groups after periodontal therapy (19.4% and 18.5%). Periodontitis patients with diabetes mellitus were presented with the highest salivary glycated albumin. Non-surgical periodontal therapy resulted in a similar reduction of salivary glycated albumin in periodontitis with and without diabetes mellitus.