Surveillance Of Periodontitis Research Articles

Estimating disease prevalence from partially-sampled clusters using the conditional linear family for multivariate Bernoulli data

In periodontal disease surveillance in human populations, full-mouth clinical examinations to classify the disease status of individuals are the gold standard for estimating periodontitis prevalence. However, conducting full-mouth exams is resource intensive, time consuming, and costly, especially in studies involving thousands of participants. Partial-recording protocols have been utilized in oral health surveys worldwide to gather correlated binary outcomes of periodontal disease on selected teeth in lieu of full-mouth exams. Since the use of partial-recording protocols tends to underestimate disease prevalence, a statistical distributional approach considering the pattern of tooth-level disease in the mouth was proposed to substantially reduce bias for the estimation of periodontitis prevalence. This approach employed multivariate Bernoulli distributions for observation (tooth)-level disease indicators to define formulae for the prevalence of disease (periodontitis) at the cluster (person)-level for various full-mouth case definitions. In turn, prevalence estimators were based on plug- in estimates of parameters from a conditional linear family for binary data gathered under partial recording protocols. Work in this article extended existing prevalence estimators for simple case definitions based on single clinical measures of tooth-level periodontal disease to a definition of severe periodontitis using two measures as defined by the Centers for Disease Control and Prevention and the American Academy of Periodontology, and later adopted by the 2017 World Workshop in Periodontology. Simulations evaluated the finite-sample performance of the proposed estimators and their confidence intervals for three established partial-recording protocols. In general, the prevalence estimators performed well relative to bias and coverage when tooth-level probabilities of disease and within-mouth correlation structures were correctly specified and even when the pattern of tooth-pair correlations was misspecified. Journal of Statistical Research 2024, Vol. 58, No. 1, pp. 3-31.

Periodontitis is associated with decreased experimental pressure pain tolerance: The Tromsø Study 2015-2016.

To assess the relationship between periodontitis and experimental pain tolerance. Participants from the population-based seventh survey of the Tromsø Study with data on periodontitis were included (n = 3666, 40-84 years old, 51.6% women). Pain tolerance was assessed through (i) pressure pain tolerance (PPT) test with a computerized cuff pressure algometry on the leg, and (ii) cold-pressor tolerance (CPT) test where one hand was placed in circulating 3°C water. Cox proportional hazard regression was used to assess the association between periodontitis and pain tolerance adjusted for age, sex, education, smoking and obesity. In the fully adjusted model using the 2012 Centers for Disease Control/American Academy of Periodntology case definitions for surveillance of periodontitis, moderate (hazard ratio [HR] = 1.09; 95% confidence interval [CI]: 1.01, 1.18) and severe (HR = 1.25, 95% CI: 1.11, 1.42) periodontitis were associated with decreased PPT. Using the 2018 classification of periodontitis, having Stage II/III/IV periodontitis was significantly associated with decreased PPT (HR = 1.09; 95% CI: 1.01, 1.18) compared with having no or stage I periodontitis. There were no significant associations between periodontitis and CPT in fully adjusted models. Moderate and severe periodontitis was associated with experimental PPT.

Association between the systemic immune inflammation index and periodontitis: a cross-sectional study

BackgroundPeriodontitis is a chronic oral inflammatory disease that seriously affects people's quality of life. The purpose of our study was to investigate the correlation between the systemic immune inflammation index (SII) and periodontitis by utilizing a large national survey. This will establish a reference for the early identification and management of periodontitis.MethodsThis study comprised the adult US population who participated in a national periodontitis surveillance project during the six years from 2009 to 2014. Through the utilization of univariate and multivariate weighted logistic regression, we investigated the correlation between the systemic immune inflammation index and periodontitis. Additionally, we employed sensitivity analyses to evaluate the robustness of our findings.ResultsThe study involved 10,366 participants with an average age of 51.00 years, of whom 49.45% were male (N = 5126) and 50.55% were female (N = 5240). The prevalence of periodontitis is estimated to be about 38.43% in the US adults aged 30 or older population. Our logistic regression models indicated a positive association between a SII higher than 978 × 109/L and periodontitis. The elder group (aged 50 or older) with SII higher than 978 × 109/L demonstrated a significant correlation with periodontitis in the fully adjusted model (Odds Ratio [OR] = 1.409, 95% Confidence Interval [CI] 1.037, 1.915, P = 0.022). However, there is no statistical difference among adults aged 30 to 50. The robustness of our findings was confirmed through sensitivity analyses.ConclusionsOur study highlights that SII is associated with periodontitis in a nationally representative sample of US adults. And the SII is significantly associated with a high risk of periodontitis in individuals aged 50 or older.

Perception of patients regarding periodontal disease and its management

Objective: To assess the perception of patients regarding periodontal diseases and their management coming to University Dental Hospital, the University of Lahore. Methodology: This study was descriptive correctional in nature. Data was collected with the help of a questionnaire. A pilot study with the sample size of 100 participants was conducted in University Dental hospital, University of Lahore. Results: 42% participants reported that they had any treatment for gum disease such as scaling and root planning (deep cleaning). 58% participants reported that experience as unpleasant. The reason for this as per the participants was the cost of dental treatment in the last visit (44%). 84% participants perceived that scaling as cleaning of teeth. 66% participants reported that scaling can cause sensitivity. Majority of patients (52%) reported their oral health as fair. Conclusion: A modified self-report questionnaire represents a valuable and adequate tool for the screening and surveillance of periodontitis at the population level.

Evidence-based Recommendations on Periodontal Practice and the Management of Periodontal Patients During and After the COVID-19 Era: Challenging Infectious Diseases Spread by Airborne Transmission

Background: Periodontal care, which was completely suspended during the peak of the SARS-Cov-2 pandemic and was delayed and recurrently discontinued during the succeeding waves, must be safely provided in the COVID-19 era. Objectives: The study aimed to provide recommendations on periodontal practice, optimizing safety, ergonomics, and economic resources, and the management of periodontal patients, ensuring continuity, timing, and effectiveness of periodontal care in the COVID-19 era. Methods: Reported protocols for the dental practice in the context of the COVID-19 and current evidence on periodontitis treatment and prevention were reviewed. Results: Evidence-based recommendations on contamination control and ergonomic improvements for periodontal practice and the management of periodontal patients challenging COVID-19 and airborne infectious diseases have been provided. Conclusion: Due to the economic, ergonomic, and ethical concerns raised by limited periodontal care due to the SARS-Cov-2 pandemic, and awareness of other emerging airborne transmitted infections, the periodontal practice should integrate measures minimizing airborne cross-infections and optimizing time-space and economic resources. The management of periodontal patients in the COVID-19 era should comprise less complex treatments and more comprehensive and definitive approaches, reducing emergencies, session length and number, and, concurrently, extending the recall and maintenance intervals. Moreover, it should implement prevention strategies through teledentistry tools and apps, improving periodontal awareness and self-care, and also through the self-reporting of periodontitis and periodontal risk assessment tools, performing both “population-based” and “high-risk” surveillance of periodontitis. Finally, it should enhance inter-professional collaboration, through telehealth networks, especially targeting subjects at high-risk of both periodontitis and systemic disorders, each of the two variously linked to COVID-19 onset and worsening.

Investigation of direct and indirect association of ultra-processed food intake and periodontitis.

Ultra-processed foods are associated with both sugar intake and non-communicable diseases. We aimed to assess whether the intake of ultra-processed food is associated with periodontal disease and whether this association, if present, is dependent on non-communicable diseases. This analysis used data from cycles 2009 to 2010, 2011 to 2012, and 2013 to 2014 of the National Health and Nutrition Examination Survey (NHANES), including participants aged 30 years or older. Dietary recalls were categorized according to the NOVA classification, and total contribution of ultra-processed foods to daily energy intake (%E) was calculated. Cases of periodontitis were defined as moderate or severe according to the CDC working group criteria for use in population surveillance of periodontitis. Adjustment variables to estimate total and direct associations were defined with directed acyclic graphs. Odds ratios were estimated with logistic regression for moderate/severe periodontitis and severe periodontitis, and ordinal logistic regression for the trichotomized outcome. Analyses were performed using NHANES fasting subsample weights. Sample participants numbered 4809 (52.2% female), with a mean age of 52.1 years (SE, 0.3). The prevalence of periodontal disease was 27.8% for moderate and 6.5% for severe cases. Mean %E from ultra-processed foods was 54.4 (SE, 0.5). No significant crude, direct, or total association between ultra-processed %E and periodontal disease was found. Intake of ultra-processed foods is not associated with periodontal disease in US non-institutionalized adults over 30 years old, whether directly or by mediation.

Association Between Periodontal Disease And Inflammation: Influence Of Sociobehavioral Factors

Increasing epidemiological evidence indicates that periodontitis causes an increased risk for future atherosclerotic cardiovascular disease (CVD). The purported mechanism involved in the increased risk for CVD, include bacteremia and the associated inflammatory sequelae resulting in an inflammatory milieu. PURPOSE: To examine the association between periodontal disease (PD) and a marker of systemic inflammation, white blood cell (WBC) count, and the modifying effects of sociobehavorial factors, using the 2013-2014 dataset from The National Health and Nutrition Examination Survey. METHODS: Full mouth periodontal assessment was carried out by trained licensed dentists, on 3624 participants (Age range: 30 to 80 years), using periodontal probes and mirrors. PD was classified according to the CDC–AAP case definitions for surveillance of periodontitis. Of the total pool of participants, 3252 were used for these analyses, of which 1412 (43%) had PD. RESULTS: Univariate logistic regression models revealed those classified as having PD had significant higher WBC counts (OR: 1.12 (95% CI: 1.07-1.16), p < 0.001), were male, > 50 years, Hispanic or Blacks, from lower income (ratio of family income to poverty guidelines (FIPR) < 1.3) and education (High School or less) groups, and over 1 year since a last dental visit. Behavioral factors associated with PD included smoking, abnormal glucose levels (Hemoglobin A1c > 6.5%), and increased TV-time (> 2 hours/day). In the adjusted (controlled for gender, age, race, social determinants and A1c, smoking, dental visits, and TV time) model WBC (OR: 1.11 (95% CI: 1.07-1.15, p < 0.001) remained a significant contributor to PD. Further analyses revealed contributions of sociobehavioral factors on PD were population specific. Specifically, TV-time was a significant modifier of PD for whites with high incomes (OR: 1.50 (95% CI: 1.02-2.22, p < 0.04), but not for other racial or economic distinctions. CONCLUSION: These data support recommendations to advise patients with periodontitis regarding their risk of systemic inflammation, and its consequences. Social determinants of health and behavior contribute significantly to oral health disparities. Recognizing population specific factors associated with PD may assist dental teams in providing appropriate strategies for care.

Evaluation of the FDI Chairside Guide for Assessment of Periodontal Conditions: A Multicentre Observational Study

ObjectiveThere is a need to develop easy-to-use tools to screen for periodontal conditions in daily practice. This study aimed to evaluate the FDI World Dental Federation “Chairside Guide” (FDI-CG) developed by the Task Team of the FDI Global Periodontal Health Project (GPHP) as a potential tool for screening. MethodsDatabases from 3 centres in Germany, Hong Kong, and Spain (n = 519) were used to evaluate the association of the FDI-CG and its individual items with the periodontitis case definitions proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) for population-based surveillance of periodontitis. ResultsStatistically significant differences were observed among the databases for the prevalence of periodontitis and the items included in the FDI-CG. The FDI-CG score and its individual components were significantly associated with the periodontal status in the individual databases and the total sample, with bleeding on probing showing the strongest association with severe periodontitis (odds ratio [OR] = 12.9, 95% CI [5.9; 28.0], P < .001, for those presenting bleeding on probing >50%), followed by age (OR = 4.8, 95% CI [1.7; 4.2], P = .004, for those older than 65 years of age). Those subjects with a FDI-CG score >10 had an OR of 54.0 (95% CI [23.5; 124.2], P < .001) and presented with severe periodontitis. A significant correlation was found between the different FDI-CG scoring categories (mild, moderate, and severe) and the categories for mild, moderate, and severe periodontitis using the Centers for Disease Control and Prevention and the American Academy of Periodontology criteria (r = 0.57, Spearman rank correlation test, P < .001). ConclusionThe FDI Chairside Guide may represent a suitable tool for screening the periodontal condition by general practitioners in daily dental practice.

Public Health Aspects of Periodontitis: Recent Advances and Contributions by Dr. Robert J. Genco.

This review provides an overview of the objectives, activities and accomplishments of the CDC-AAP collaboration on public health aspects of periodontitis focusing mostly on surveillance. Dr. Robert Genco was co-chair of this effort. This initiative developed new standard periodontitis case definitions for surveillance and implemented for the first time a full-mouth periodontal examination protocol for NHANES 2009 -2014. Measurements from this survey resulted in significantly greater estimate for the national prevalence of periodontitis in US adults and our understanding of population risk factors associations with periodontitis. Notably, this initiative also developed, and validated field-testing a battery of eight questions for multivariable modeling of self-report measures for predicting periodontitis in populations. This Initiative resulted in significant improvements of surveillance of periodontitis and produced unique findings with important implications for advancing our understanding of population aspects of periodontitis in US adults at the national, state, and local levels.

Diagnostic Potential of Salivary Biomarker Profiles in Epidemiological Survey of Periodontitis

Objective: To assess the diagnostic value of salivary biomarker profiles in determining the prevalence of periodontitis in the adult population using the case definition for population-based surveillance of periodontitis (CDC/AAP) criteria. &#x0D; Methods: Eighty subjects with healthy periodontium, mild, moderate, and severe periodontitis were recruited (20 in each group) using CDC/AAP criteria. Clinical parameters of probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PI), and bleeding index (BI) were recorded. Salivary samples were analyzed to determine levels of matrix metalloproteinase-8 (MMP8), interleukin 1β (IL-1β), and total protein (TP). ANOVA and Kruskal-Wallis tests were used to compare clinical and salivary parameters. Multinomial regression analysis was used to identify each examined group.&#x0D; Results: Clinical parameters were significantly higher in periodontitis groups compared to the healthy group (p&lt; 0.0001) except in PPD and PI. Both MMP8 and IL-1β were significantly higher in the moderate and severe periodontitis groups compared to the healthy group. No statistically significant differences in TP levels were found between examined groups (p=0.9). Multinomial regression analysis showed that the combination of MMP8, IL-1β, and age could accurately identify health, mild, moderate, and severe periodontitis groups with the certainty of 90%, 65%, 60%, 70%, respectively.&#x0D; Conclusions: This study suggests that age, salivary MMP8, and IL-1β levels offer a way to determine the prevalence of periodontitis using CDC/AAP criteria.

Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination.

In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.

Validity of a self-reported questionnaire for periodontitis in a Spanish population.

Clinical examination is the gold-standard approach for surveillance of periodontitis; however, it requires large resources. Several self-reported measures have been developed and tested in diverse scenarios with results suggesting that it may be a useful tool for screening periodontal disease in different populations; yet they have not being tested in Spanish population. We aimed to assess the validity of a self-reported questionnaire for periodontitis in a Spanish population from Barcelona during 2018. One hundred and twelve participants were enrolled in the study and, in one appointment; a dentist performed the self-reported questionnaire and a full-mouth periodontal examination. Periodontitis was defined as at least mild periodontitis according to three criterion of classification. Receiver-operating characteristics curve analyses were used to test the discriminatory capability, sensitivity and specificity of the self-reported questionnaire and logistic regression models were adjusted to estimate the minimal-set of questions associated with periodontitis. The self-reported questionnaire had a useful discriminative capability for detecting individuals with periodontitis (area under the curve [AUC]=0.85 95% CI 0.78-0.92) and its moderate/severe form (AUC=0.86 95% CI 0.79-0.04) with sensitivity and specificity of 77% and 74% and 73% and 87%, respectively; representing moderate validity. The combination of four-specific questions had high accuracy (AUC=0.88 95% CI 0.81-0.94) and validity (sensitivity=92.2%) and was strongly associated with moderate/severe periodontitis after adjusting by socio-demographic factors. The use of several self-reported questions proved to have a good performance for screening periodontitis in the population under study; specifically, those related with tooth mobility and gum migration. Large community-based studies are needed to test its validity and predictive capability.

Recent epidemiologic trends in periodontitis in the USA.

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial-mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full-mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6years of National Health and Nutrition Examination Surveys from 2009-2014, yielding complete data for 10683 dentate community-dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009-2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%-15% in all age groups of 40years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self-reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state-based surveys. These items were also included in the 2009-2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30-79years is better understood because of application of valid periodontitis case definitions to full-mouth periodontal examination, in combination with reliable information on demographic and health-related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.

Validity of self-reported measures for periodontitis surveillance in a rural sample.

To evaluate the predictive performance of self-reported questions for periodontitis screening in a representative sample of a rural population. Nine questions were compared with gold standard clinical examinations (probing six sites/tooth, full-mouth). Case definition for severe periodontitis was defined according to World Workshop (2017-WW) and Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Diagnostic tests such as sensitivity (SN), specificity (SP), positive and negative predictive values were performed for all questions alone and grouped into models. Binary logistic regression modeling was used to derive parameter estimates for all variables in a given model and the area under ROC curve was calculated. Clinical examinations showed a prevalence of periodontitis in the sample (n=585) of 99.4% and 86.3%, being 40.3% and 33.8% of severe disease according to 2017-WW and CDC/AAP case definitions, respectively. Individually, only the questions regarding the self-perception of teeth/gum health and loose and lost teeth were valid to predict severe periodontitis. The best logistic regression models combined sociodemographic variables and risk-factors with the self-reported measures of self-perception of gum disease, teeth/gum health, loose teeth and history of tooth loss. Predictive performance of these self-reported questions presented herein support its potential use for surveillance of severe periodontitis in rural populations with high periodontitis prevalence.

Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study

BackgroundThe co-occurrence of caries and periodontitis and a possible association is still a matter of debate. Thus, the aim of the study was to determine the co-occurrence of caries and periodontitis in Chilean adults.MethodsEvaluation of periodontal and dental status in 994 adults (35–44 years old) based on the First Chilean National Examination Survey 2007–2008. The prevalence of caries was defined as the percentage of participants with one or more teeth with untreated caries by using the D component of the DMFT index (DT ≠ 0). The prevalence of periodontitis was determined using standard case definitions for population-based surveillance of periodontitis described by the CDC–AAP.ResultsIndividuals with caries had an approximately 40% higher prevalence of severe (29.3% vs 20.8%, p < 0.05) and a 13% higher prevalence of total periodontitis (89.3% vs 78.4%, p < 0.05) than those without caries. Ordinal logistic regression revealed a positive association between periodontitis and the number of teeth with caries (DT ≠ 0; 3 or 4 teeth with caries: OR 1.74; CI = 1.12–2.29 p < 0.05; 5 or more teeth with caries: OR 2.47; CI = 1.66–3.67 p < 0.01).ConclusionDental caries is associated with the severity and prevalence of periodontitis in Chilean adults. Individuals with 3 or more teeth with untreated caries are more likely to suffer from periodontal disease.

Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014

BackgroundThis report presents weighted average estimates of the prevalence of periodontitis in the adult US population during the 6 years 2009-2014 and highlights key findings of a national periodontitis surveillance project. MethodsEstimates were derived for dentate adults 30 years or older from the civilian noninstitutionalized population whose periodontitis status was assessed by means of a full-mouth periodontal examination at 6 sites per tooth on all non–third molar teeth. Results are reported according to a standard format by applying the Centers for Disease Control and Prevention/American Academy of Periodontology periodontitis case definitions for surveillance, as well as various thresholds of clinical attachment loss and periodontal probing depth. ResultsAn estimated 42% of dentate US adults 30 years or older had periodontitis, with 7.8% having severe periodontitis. Overall, 3.3% of all periodontally probed sites (9.1% of all teeth) had periodontal probing depth of 4 millimeters or greater, and 19.0% of sites (37.1% of teeth) had clinical attachment loss of 3 mm or greater. Severe periodontitis was most prevalent among adults 65 years or older, Mexican Americans, non-Hispanic blacks, and smokers. ConclusionsThis nationally representative study shows that periodontitis is a highly prevalent oral disease among US adults. Practical ImplicationsDental practitioners should be aware of the high prevalence of periodontitis in US adults and may provide preventive care and counselling for periodontitis. General dentists who encounter patients with periodontitis may refer these patients to see a periodontist for specialty care.

PR153: Critical review of the CDC/AAP case definitions for surveillance of periodontitis

PR153: Critical review of the CDC/AAP case definitions for surveillance of periodontitis

B cell subset distribution is altered in patients with severe periodontitis

Several studies have recently highlighted the implication of B cells in physiopathogenesis of periodontal disease by showing that a B cell deficiency leads to improved periodontal parameters. However, the detailed profiles of circulating B cell subsets have not yet been investigated in patients with severe periodontitis (SP). We hypothesised that an abnormal distribution of B cell subsets could be detected in the blood of patients with severe periodontal lesions, as already reported for patients with chronic inflammatory diseases as systemic autoimmune diseases. Fifteen subjects with SP and 13 subjects without periodontitis, according to the definition proposed by the CDC periodontal disease surveillance work group, were enrolled in this pilot observational study. Two flow cytometry panels were designed to analyse the circulating B and B1 cell subset distribution in association with the RANKL expression. A significantly higher percentage of CD27+ memory B cells was observed in patients with SP. Among these CD27+ B cells, the proportion of the switched memory subset was significantly higher. At the same time, human B1 cells, which were previously associated with a regulatory function (CD20+CD69-CD43+CD27+CD11b+), decreased in SP patients. The RANKL expression increased in every B cell subset from the SP patients and was significantly greater in activated B cells than in the subjects without periodontitis. These preliminary results demonstrate the altered distribution of B cells in the context of severe periodontitis. Further investigations with a larger cohort of patients can elucidate if the analysis of the B cell compartment distribution can reflect the periodontal disease activity and be a reliable marker for its prognosis (clinical trial registration number: NCT02833285, B cell functions in periodontitis).

Abstract P242: Periodontal Disease and Incident Venous Thromboembolism: the Atherosclerosis Risk in the Community (ARIC) Study

Background and Purpose: Previous research has identified an association between periodontal disease (PD) and atherosclerotic cardiovascular disease, but the relationship between PD and venous thromboembolism (VTE) has not been studied. PD may trigger VTE through activating inflammatory, coagulation, and fibrinolysis processes associated with thrombosis. We hypothesize an independent association between PD and increased risk of VTE. Methods: PD was assessed among ARIC participants at visit 4 (1996-1998) using self-reported tooth loss due to gum disease and clinical PD definitions based on ARIC dental exams. PD case definitions from the CDC Periodontal Disease Surveillance workgroup in collaboration with the American Academy of Periodontology (CDC/AAP) and the biofilm-gingival interface (BGI) index were used. The outcome of interest was validated VTE, including all cases of deep vein thrombosis occurring in the leg and pulmonary embolism. Follow- up time was from visit 4 to the first VTE hospitalization, dropping out of the study, death, or else, December 31, 2011. Multivariate-adjusted Cox proportional hazards regression models were used. Results: There were a total of 424 VTE events among the 10,651 ARIC participants who provided baseline self-reported PD data and 314 VTE events among the 8,119 participants who were edentulous at visit 4 or who completed the dental exam from which baseline clinical PD data were obtained. Compared to those without periodontal disease, self-reported history of tooth loss due to gum disease was associated with higher VTE risk (HR = 1.42 (1.11, 1.82)), as was being edentulous at exam 4 [1.51 (1.07, 2.14)] using the CDC/AAP PD definition. No other statistically significant associations were observed between clinical levels of PD and VTE risk. Conclusions: These results suggest that individuals who are edentulous or have experienced tooth loss due to PD may be at higher VTE risk.

State of the art diagnostic criteria of severe periodontitis

Periodontitis could be categorized as mild, moderate, and severe according to the severity of the disease. This categorizing system could also be used together with other classification systems. The present article introduced the status about the case definition of severe periodontitis, including the standard of case definitions for surveillance of periodontitis reported by the Centers for Disease Control and Prevention (CDC) in partnership with the American Academy of Periodontology (AAP) and the consensus report on the definition of periodontitis case for use in risk factor research by Europe workshop. A consensus on the state of the art definition of severe periodontitis for use in clinical work was gained base on the expertise of Chinese Society of Periodontology, Chinese Association of Stomatology. The background of this consensus and the significance of the criteria for the case definition were discussed.