Risk Factor For Periodontitis Research Articles

Association of Sleep Duration and BMI with Periodontitis in Nurses Working in Day and Night Shifts and Its Impact on Co-morbidities

Background: Gender imbalances persist in high-ranking leadership roles, particularly in Aim: To evaluate the association between duration of Sleep and Body-Mass Index (BMI) as potential risk factors with Periodontitis and other co morbidities in duty nurses. Methodology: An observational study was carried out on 42 duty nurses working in hospital. Two Questionnaires (PSQI) Pittsburgh Sleep Quality Index and (ESS) Epworth-Sleepiness Scale were subjectively filled. Study was conducted in 2 phases in the same duty nurses. Phase 1 Duty nurses in morning shift underwent evaluation for periodontal health, BMI and Waist -Hip ratio was recorded. Blood Samples were drawn for analysis of C-Reactive protein, lipid profile and Fasting Blood Sugar. Participants were asked to maintain sleep diary for 6 months. Phase 2: Same Duty Nurses working in Night Shift after 6 months of sleep diary maintenance underwent evaluation of same parameters as phase 1. All-the data were tabulated and sent for statistical-analysis. Results: The result showed that, the association of duration of sleep to Periodontitis was statistically significant in the morning-shift and night-shift (p=0.001), although association of Body Mass Index to periodontitis was statistically significant in the night shift with p value=0.001 than in the morning-shift. The association of Plaque Index and Gingival-Index with duration of sleep and BMI was statistically significant. The parameters taken to study the co-morbidities showed statistical significant difference between the two shifts except WHR ratio, LDL, HDL, Triglyceride, Plaque index. Conclusion: There is an association of Duration of Sleep and Body Mass Index as a potential risk factor for periodontitis and other co-morbidities (Cardiovascular disease and Diabetes) in duty nurses, however the association is much stronger in duty nurses working in night shift than morning shift.

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Healthy lifestyles ameliorate an increased risk of periodontitis associated with polycyclic aromatic hydrocarbons

The risk of chronic inflammatory diseases has been linked to exposure to polycyclic aromatic hydrocarbons (PAHs). However, limited data are available regarding their impact on periodontitis. This study aims to explore the association between PAHs and periodontitis while also evaluating the potential modifying effects of healthy lifestyles. We included 17,031 participants from the US National Health and Nutrition Examination Survey (NHANES, 2001–2004 and 2009–2014). A meta-analysis-based environment-wide association study (EWAS) was adopted to identify environmental chemicals for the mean probing pocket depth (PPD) and the mean attachment loss (AL). PAHs were further evaluated concerning the cross-sectional association with Mod/Sev periodontitis using multivariable logistic regression models. Moreover, healthy lifestyle scores were estimated to assess their modifying effect on the PAH–periodontitis association. EWAS analysis identified several urinary PAH metabolites as significant risk factors for the mean PPD and AL (false discovery rate <0.05, Q > 0.05). Periodontitis severity was positively associated with eight individual and total PAH concentrations. Stratifying the participants in terms of healthy lifestyle scores did not reveal any association in the healthy group. Moreover, the association weakened in never-smokers and individuals with sufficient physical activity and normal weight. PAH exposure was a risk factor for periodontitis. A healthier lifestyle was observed to offset the risk potentials of PAHs for periodontitis. Smoking cessation, physical activity, and weight loss might be recommended as a healthy lifestyle strategy for ameliorating PAH-related periodontitis.

Causal Relationship between Mitochondrial Biological Function and Periodontitis: Evidence from a Mendelian Randomization Study.

A growing number of studies indicate that mitochondrial dysfunction serves as a pathological mechanism for periodontitis. Therefore, this two-sample Mendelian randomization (MR) study was carried out to explore the causal associations between mitochondrial biological function and periodontitis, because the specific nature of this causal relationship remains inconclusive in existing MR studies. Inverse variance weighting, Mendelian randomization-Egger, weighted mode, simple mode, and weighted median analyses were performed to assess the causal relationships between the exposure factors and periodontitis. The results of the present study revealed a causal association between periodontitis and medium-chain specific acyl-CoA dehydrogenase (MCAD), malonyl-CoA decarboxylase (MLYCD), glutaredoxin 2 (Grx2), oligoribonuclease (ORN), and pyruvate carboxylase (PC). Notably, MCAD and MLYCD are causally linked to periodontitis, and serve as protective factors. However, Grx2, ORN, and PC function as risk factors for periodontitis. Our study established a causal relationship between mitochondrial biological function and periodontitis, and such insights may provide a promising approach for treating periodontitis via mitochondrial regulation.

CORM-3 Inhibits the Inflammatory Response of Human Periodontal Ligament Fibroblasts Stimulated by LPS and High Glucose.

Diabetes has been recognized as an independent risk factor for periodontitis. Increasing evidences indicate that hyperglycemia aggravates inflammatory response of human periodontal ligament cells (hPDLCs). Carbon monoxide-releasing molecule-3 (CORM-3) is a water-soluble compound that can release carbon monoxide (CO) in a controllable manner. CORM-3 has been shown the anti-inflammatory effect in different cell lineages. We stimulated periodontal ligament cells with LPS and high glucose. The expression of inflammatory cytokine was detected by ELISA. RT-qPCR, Western blot and immunofluorescence were used to detect the expression of TLR2, TLR4, RAGE and the activation of NF-κB pathway. We performed silencing and overexpression treatment of RAGE targeting the role of RAGE. We performed the immunostaining of paraffin sections of the periodontitis model in diabetes rats. The results showed that CORM-3 significantly inhibited the expression of inflammatory cytokine in hPDLCs stimulated with LPS and high glucose. CORM-3 also inhibited LPS and high glucose-induced expression of RAGE/NF-κB pathway and TLR2/TLR4/NF-κB pathway. Silence of RAGE resulted in significantly decreased expression of proteins above. Overexpression of RAGE significantly enhanced the expression of these factors. CORM-3 abrogated the effect of RAGE partially. In animal model, CORM-3 suppressed the inflammatory response of periodontal tissues in experimental periodontitis of diabetic rats. Our research proved CORM-3 reduced the inflammatory response via RAGE/NF-κB pathway and TLR2/TLR4/NF-κB pathway in the process of high glucose exacerbated periodontitis. These findings demonstrated the role of RAGE in the process of high glucose exacerbated periodontitis and suggested that CORM3 be a potential therapeutic strategy for the treatment of diabetes patients with periodontitis.

Data-driven prediction model for periodontal disease based on correlational feature analysis and clinical validation

ObjectivesThis study aimed to investigate the performance and reliability of data-driven models employing correlational feature analysis and clinical validation for predicting periodontal disease. MethodsThe 7th Korea National Health and Nutrition Examination Survey (n = 10,654) was used for correlation analysis to identify significant risk factors for periodontitis. Periodontal prediction models were developed with the selected factors and database, followed by internal validation with 5-fold cross-validation and 1000 bootstrap resampling. External validation was conducted with clinical data (n = 120) collected through self-reported questionnaires, clinical periodontal parameters, and radiographic image analysis. Predictive performance was assessed for logistics regression, support vector machine, random forest, XGBoost, and neural network algorithms using the area under the receiver operating characteristic curves (AUC) and other performance metrics. ResultsCorrelation analysis identified 16 features from over 1000 potential risk factors for periodontitis. The best data-driven model (XGBoost) showed AUC values of 0.823 and 0.796 for internal and external validations, respectively. Modeling with clinical data revealed those same measures to be 0.836 and 0.649, respectively. In addition, the data-driven model could predict other clinical periodontal parameters including severe bone loss (AUC = 0.813), gingival bleeding (AUC = 0.694), and tooth loss (AUC = 0.734). A patient case study about prognostic predictions revealed that the probability of periodontitis can be reduced by 6.0 % (stop smoking) and 0.6 % (stop drinking) on average. ConclusionsData-driven models for predicting periodontitis and other periodontal parameters were developed from 16 risk factors, demonstrating enhanced prediction performance and reproducibility in internal–external validations.

Knowledge on oral health and periodontal status among type II diabetes mellitus (DM) patients in Libya

Diabetes mellitus (DM) is one of the common diseases in the world. Its dramatic increase annually is considered a global issue to the people, in which raising awareness about the disease and its complication is crucial. It has been well documented by the literature that smoking and DM are two major risk factors for periodontal disease. Knowledge of oral health is vital for type II DM patients and is a key factor in the treatment and prevention of periodontal disease. A cross-sectional study was conducted among three hundred diabetic patients in a Benghazi diabetic treatment center. The participants were 40.3% (n = 121) male and 59.7% (n = 179) female adults whose ages ranged from 16 to 80 years. Inclusion criteria included Libyan citizens diagnosed with type II DM. The participants were questioned through a structured questionnaire and followed by the examination of their oral status. Periodontal examination was performed by two periodontists using the following indices: plaque index (PI) and periodontal disease index (PDI). Knowledge about oral health and periodontal status for Libyan patients with type II DM was tested through eight core questions using a structured questionnaire. The results showed about half of the sample had poor knowledge regarding the condition and its detrimental effect on oral and general health. Only 31% of participants provided good knowledge about type II DM and its relationship to oral health and periodontal status. The P-value showed a significant relationship between the knowledge and PI and PDI indices. Participants with poor knowledge showed higher scores in both indices. A significant relation was found between PI, PDI and knowledge. As knowledge was fair, the lower the PI and PDI scores. To lessen diabetic complications and their deleterious effects on oral and general health, raising knowledge and awareness could be a solution. Multidisciplinary cooperation between the medical and dental staff could be implemented to increase public knowledge. Key words: Oral health, Periodontal, Patients, Diabetes mellitus, Libya, Health awareness, Dentistry

Innovations in Screening and Diagnosis of Periodontal Disease in Tobacco Users: A Review.

Tobacco use is a significant risk factor for periodontal disease, a chronic inflammatory condition affecting the supporting structures of the teeth. Early detection and intervention are crucial for preventing the progression of periodontal disease and its associated complications. This review paper explores recent innovations in the screening and diagnosis of periodontal disease, with a focus on advancements in technology and methodologies for assessing periodontal health in tobacco users. By examining the latest research findings and technological developments, this paper aims to highlight the potential of novel approaches to improve the early detection and management of periodontal disease in this high-risk population. In addition, it discusses the challenges and opportunities associated with implementing these innovations in clinical practice and public health settings.

The value-for money of preventing and managing periodontitis: Opportunities and challenges.

This article gives an overview of the societal and economic aspects of periodontitis and periodontal care. Despite its largely preventable nature, periodontitis is highly prevalent worldwide and imposes a substantial health and economic burden on individuals and society as a whole. The worldwide estimated direct treatment costs and productivity losses due to periodontitis (including for periodontitis-related tooth loss)amounted to US$ 186 billion and US$ 142 billion in 2019, respectively. The burden of periodontitis is particularly evident in low and disadvantaged populations. Smoking, dietary habits, and presence of systemic diseases along with social and commercial determinants are considered as risk factors for the periodontal diseases. The cost-effectiveness of preventing and managing periodontitis has been explored in several studies but it has been highlighted that there is scope for improvement in defining the methodology and quality of reporting of such studies. A recent report by The Economist Intelligence Unit examined the cost-effectiveness of interventions to prevent and manage periodontal diseases, suggesting that prevention of periodontitis through prevention of gingivitis by means of individual home care would be more cost-efficient than four other examined approaches. Future research in this field is recommended to further decipher the economic burden of periodontitis to society and to assess the value for money of alternative approaches to address periodontitis with particular emphasis on public health preventive strategies and intersectoral care approaches that address the common risk factors of periodontitis and other non-communicable diseases simultaneously.

Evaluation of Glycosylated Hemoglobin Levels and Effect of Tobacco Smoking in Periodontally Diseased Non-Diabetic Patients

Background and Objective Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers. Methods The study was conducted with 40 patients in the age range of 20–40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups. Results The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant. Conclusion and Global Health Implications This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.

Association between biological aging and periodontitis using NHANES 2009–2014 and mendelian randomization

Aging is a recognized risk factor for periodontitis, while biological aging could provide more accurate insights into an individual's functional status. This study aimed to investigate the potential association between biological aging and periodontitis. Epidemiological data from 9803 participants in the 2009–2014 National Health and Nutrition Examination Survey were analyzed at a cross-sectional level to assess this link. Three biological ages [Klemera–Doubal method (KDM), PhenoAge, and homeostatic dysregulation (HD)] and two measures of accelerated biological aging (BioAgeAccel and PhenoAgeAccel) were set as primary exposure and were calculated. Logistic regression and restricted cubic spline regression were employed to examine the relationship between biological aging and periodontitis. Additionally, Mendelian randomization analysis was conducted to explore the causal connection between accelerated biological aging and periodontitis. After adjusting for age, gender, race, educational level, marital status, ratio of family income, and disease conditions, this study, found a significant association between subjects with older higher biological ages, accelerated biological aging, and periodontitis. Specifically, for a per year increase in the three biological ages (HD, KDM, and PhenoAge), the risk of periodontitis increases by 15%, 3%, and 4% respectively. Individuals who had positive BioAgeAccel or PhenoAgeAccel were 20% or 37% more likely to develop periodontitis compared with those who had negative BioAgeAccel or PhenoAgeAccel. Furthermore, a significant non-linear positive relationship was observed between the three biological ages, accelerated biological aging, and periodontitis. However, the Mendelian randomization analysis indicated no causal effect of accelerated biological aging on periodontitis. Our findings suggest that biological aging may contribute to the risk of periodontitis, highlighting the potential utility of preventive strategies targeting aging-related pathways in reducing periodontitis risk among older adults.

Food insecurity and periodontitis in US adults.

To determine the relationship between food insecurity and periodontitis among adults in the United States (US). Secondary analysis of the 2009-2014 National Health and Nutrition Examination Survey data. The sample included 6,108 US participants aged ≥ 30 years in a probability weighted sample. Periodontitis status was measured in full-month oral examinations at 6 sites per tooth for clinical attachment loss and periodontal probing depth. Food insecurity was assessed by the 18-item US Food Security Survey Module. Controlling for covariates, multiple logistic regression showed that periodontitis was associated with low food security (adjusted odds ratio (aOR)=1.30, 95% CI: 1.08-1.57). Risk factors for periodontitis included HbA1c ≥ 7% (aOR=1.74, 95% CI: 1.26-2.40), seeking emergency dental care (aOR=1.36, 95% CI:1.19-1.55), smoking status, racial minorities, low income, and older age. Protective factors for periodontitis were annual dental visit (aOR=0.52, 95% CI: 0.43-0.64), health insurance (aOR=0.66, 95% CI: 0.54-0.80), female gender, and college education. Food insecurity was associated with a higher risk of periodontitis among US adults. Having enough food to eat is a basic human right and would improve well-being.

Exploring the bi-directional relationship between periodontitis and dyslipidemia: a comprehensive systematic review and meta-analysis.

As periodontitis and dyslipidemia are diseases that occur with high incidence, the relationship between them has attracted much attention. Previous studies on these diseases have tended to focus on lipid parameters and periodontitis, we aimed to investigate the relationship between dyslipidemia and periodontitis. A comprehensive search to identify the studies investigating the relationship between dyslipidemia and periodontitis was performed on PubMed, Web of Science and Cochrane Library before the date of August, 2023. Studies were considered eligible if they contained data on abnormal blood lipid parameters and periodontitis. Studies that reported mean differences and 95% confidence intervals or odds ratios were used. A total of 73 publications were included in the meta-analysis. Hyper total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and lower high-density lipoprotein (HDL) levels are risk factors for periodontitis. Periodontal disease is a risk factor for high TG and low HDL levels. Three months after periodontal treatment, the levels of TC, TG and HDL were significantly improved, and statin treatment only improved gingival index (GI) levels compared to that of the dietary control. The findings reported here suggest that the mutual promotion of periodontitis and dyslipidemia can be confirmed. Non-surgical periodontal therapy may improve lipid abnormalities. It can't be demonstrated whether systematic application of statins have a better effect on the improvement in periodontal status in patients with dyslipidemia compared to that of the control.

Strategic approaches in oral squamous cell carcinoma diagnostics using liquid biopsy.

Liquid biopsy is a noninvasive diagnostic technique used for monitoring cancer utilizing specific genetic biomarkers present in bodily fluids, such as blood, saliva, or urine. These analyses employ multiple biomolecular sources including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and exosomes (that contain DNA fragments) to detect genetic biomarkers that can predict, disclose, and/or monitor cancers. Levels of these biomarkers can inform on the presence of cancer, its genetic characteristics, and its potential treatment response and also provide predictive genetic predisposition information for specific cancers including oral squamous cell carcinomas (OSCC). Liquid biopsies can aid cancer management as they offer real-time dynamic information on the response to say chemotherapy or radiotherapy and recurrence following surgical excision. Unlike traditional tissue biopsies, which are invasive with a degree of morbidity and require specific tumor location sampling, liquid biopsies are noninvasive and can be repeated frequently. For oral squamous cell carcinoma, on which this review focuses, liquid biopsy of blood or saliva can be valuable in predicting susceptibility, providing early detection, and monitoring the disease's progression and response to therapy. This review gives a general narrative overview of the technology, its current medical usage, and advantages and disadvantages compared with current techniques and discusses a range of current potential biomarkers for disclosing OSCC and predicting its risk. Oral squamous cell carcinoma is all too often detected in the late stages. In future, liquid biopsy may provide an effective screening process such that cancers including OSCC will be detected in the early stages rather than later when prognosis is poor and morbidity and debilitation are greater. In this screening process, periodontists and hygienists have a critical role in that they are adept in examining mucosa, they see patients with shared risk factors for periodontitis and OSCC, namely smoking and poor oral hygiene, and they see patients frequently such that OSCC examinations should be a routine part of the recall visit. With this additional screening manpower, oral medicine and oral surgery colleagues will detect OSCC earlier and this coupled with new techniques such as liquid biopsy may greatly decrease global morbidity in OSCC.

MANAGEMENT OF BACTERIAL PLAQUE-INDUCED GINGIVAL ENLARGEMENT: CASE REPORT

Introduction: Gingival enlargement is a condition that we often encounter in the oral cavity. This condition can be caused by plaque accumulation, systemic disorders, and side effects of some drugs as well as genetic factors. Gingival enlargement due to the accumulation of bacterial plaque generally shows signs and symptoms of inflammation which can be a major risk factor for periodontitis. This case report aims to describe two cases of plaque-induced gingival enlargement, one of which was accompanied by the presence of granulomatous epulis. Case: The first case was a 23-year-old woman complaining that her gums often bleed when brushing her teeth since 1 year ago. Intra oral examination can see swelling of the gingiva in the anterior area of RA and RB. The second case is a 40-year-old woman with complaints of swelling of the lower right back gum since 2 years ago. An enlargement of the gingiva in the anterior area is seen accompanied by granulomatous epulis with fibrous consistency in the posterior area of RB. Treatment: In the first case, non-surgical treatment was carried out and continued with regular visits every 3 months. In the second case, non-surgical and surgical procedures were performed. Treatment begins with tooth root extraction and scaling and root planning. Furthermore, gingivectomy surgery was performed to excise the enlarged gingiva. Discussions: The treatment results look good, where it can be seen that the etiological factor can be ruled out. After the surgical treatment, the healing went well, marked by no inflammation around it. Conclusion: Gingival enlargement can affect aesthetics and interfere with the patient's masticatory function. Identification of the etiological factors is necessary for an appropriate treatment plan.

IMPACT OF AGING AND STRESS ON THE PERIODONTAL HEALTH OF THE GERIATRIC POPULATION BEFORE AND AFTER PERIODONTAL TREATMENT IN OLD HOMES OF KARACHI, PAKISTAN

Age and stress-related periodontal diseases are prevalent in the geriatric population and continue to provide a significant epidemiological concern. Objective: To assess the impact of ageing and stress on the periodontal health of the senior population before and after periodontal treatment Method: A cross-sectional study was conducted between February and October 2023. Twenty-two senior patients aged 55 to 77 were selected through purposeful random sampling, excluding those unwilling or unable to participate. A semi-structured questionnaire, translated into the native language, assessed periodontal health using the Basic Periodontal Examination (BPE). Informed consent was obtained from participants, who were assured confidentiality and the right to withdraw. Data analysis was performed using SPSS version 23, employing mean and standard deviation for continuous data and frequency tables for categorized data. Cross-tabulation and significance testing were utilized to demonstrate associations. Results: The results of the prevailing cross-sectional study reveal that there exists an association between moderate to elevated levels of perceived stress and the manifestation of severe instances of periodontal disease. As per the study findings, periodontitis tends to afflict individuals across older adult age demographics. Conclusion: The study emphasised that stress and ageing are key risk factors for periodontal diseases, underlining the importance of addressing them during therapy. Consistent oral hygiene can prevent periodontitis in older adults.

Periodontitis: A Plausible Modifiable Risk Factor for Neurodegenerative Diseases? A Comprehensive Review.

The aim of this comprehensive review is to summarize recent literature on associations between periodontitis and neurodegenerative diseases, explore the bidirectionality and provide insights into the plausible pathogenesis. For this purpose, systematic reviews and meta-analyses from PubMed, Medline and EMBASE were considered. Out of 33 retrieved papers, 6 articles complying with the inclusion criteria were selected and discussed. Additional relevant papers for bidirectionality and pathogenesis were included. Results show an association between periodontitis and Alzheimer's disease, with odds ratios of 3 to 5. A bidirectional relationship is suspected. For Parkinson's disease (PD), current evidence for an association appears to be weak, although poor oral health and PD seem to be correlated. A huge knowledge gap was identified. The plausible mechanistic link for the association between periodontitis and neurodegenerative diseases is the interplay between periodontal inflammation and neuroinflammation. Three pathways are hypothesized in the literature, i.e., humoral, neuronal and cellular, with a clear role of periodontal pathogens, such as Porphyromonas gingivalis. Age, gender, race, smoking, alcohol intake, nutrition, physical activity, socioeconomic status, stress, medical comorbidities and genetics were identified as common risk factors for periodontitis and neurodegenerative diseases. Future research with main emphasis on the collaboration between neurologists and dentists is encouraged.

Immunological Implications in Diabetes: A Review on Various Diseases and Conditions

Abstract:: Diabetes Mellitus (DM) is a long-term metabolic condition that has significant social, health, and economic consequences. There are various forms of diabetes mellitus, but the two most common varieties are type I and type II. Insulin-dependent diabetes (IDDM) is one of the most wellknown autoimmune illnesses that cause insulin insufficiency and hyperglycemia by either damaging or destroying Langerhans' beta cells. Available scientific data evidenced the greatest genetic contribution of Human Leukocyte Antigen class II in the IDDM. Hyperglycemia and individual components of the insulin resistance (metabolic) syndrome put people with type II diabetes at increased risk for microvascular consequences (retinopathy, nephropathy, and neuropathy) as well as macrovascular issues (cardiovascular comorbidities). A number of pathophysiological abnormalities, including obesity, poor diet, and physical inactivity, as well as genetic variables, are involved in the disturbed glucose homeostasis associated with type II diabetes. Diseases like lipid abnormalities contribute to the progression of diabetes, whereas obesity and its related medical disorders (such as hypertension, diabetes, insulin resistance, and sleep apnea syndrome) are eventually linked to an elevated cardiovascular risk. Diabetes raises the incidence, intensity, and duration of peri-densities in people with diabetes compared to healthy persons, making it a risk factor for periodontal disease. Diabetes conditions in patients concurrently also increase the progression or risk of other diseases, i.e., cardiovascular- related diseases (hypertension, oxidative stress, hyperlipidemia), nervous system-related diseases, and COVID-19, by increasing the overall infection rate. There is widespread evidence that correlates the direct connection between diabetes and other diseases, including immunity disorders, CVS disorders, etc. This review provides a correlation between diabetes and another disease with an overall impact on the progression of cardiovascular diseases, neurological diseases, COVID-19, and periodontal diseases. This current review focuses on the collation of some plants that show antidiabetic activity, including plant part, family, chemical constituent, mechanism of action, and chemical used for extraction. Studies on the role, causes, clinical management, prevention, and treatment of diabetes heavily rely on epidemiological evidence. This review also explains different factors responsible for diabetes, like genetic factors, environmental factors, and viral infections.

Evaluation of CD44 antigen in type 2 diabetic patients with periodontitis: An immunohistochemical study.

Type 2 diabetes mellitus (DM) is a known systemic risk factor for periodontitis. An increased expression of CD44 has been suggested in type 2 diabetics and periodontitis patients. The present study aimed to assess the expression of CD44 antigen in patients with chronic periodontitis (CP) and type 2 DM in a South Indian urban population. Additionally, the relationships between the expression of CD44 antigen in gingival tissues, periodontal clinical parameters, and the random blood sugar (RBS) and glycated hemoglobin (HbA1c) levels were assessed. A total of 63 subjects were divided into 3 groups: systemically and periodontally healthy controls (group H); CP patients, otherwise healthy (group CP); and CP patients with type 2 DM (group CP+DM). Periodontal parameters were recorded for all groups, and additionally the RBS and HbA1c levels for group CP+DM. Gingival tissue samples were obtained and subjected to immunohistochemical analysis for CD44. The expression of CD44 was significantly higher in the diseased groups. Epithelial CD44 expression was significantly stronger in group CP+DM as compared to groups CP and H (p < 0.001), whereas connective tissue CD44 expression was similar in groups CP and CP+DM (p = 0.657). Furthermore, an inverse relationship was observed between blood glucose parameters and CD44 expression in the epithelium and connective tissue. The expression of CD44 increased with the severity of periodontal disease. Additionally, glycemic control in patients with CP and type 2 DM had an impact on CD44 expression. Our findings indicate a possible destructive role of CD44 in the pathogenesis of periodontal diseases in individuals with type 2 DM.

Obesity and Oral Health: The Link Between Adipokines and Periodontitis.

Periodontitis is a chronic inflammatory disease of the periodontium, or the supportive tissues around the tooth. This disease has been related to different risk factors, such as the presence of plaque and calculus, tobacco smoking, low socioeconomic status, and the immune state of the host. Importantly, the chronic inflammatory environment generated by periodontitis may lead to tooth loss and diverse systemic complications, such as cardiovascular disease, osteoarthritis and metabolic disease. Recent investigations have supported the role of obesity as a risk factor for periodontitis. Furthermore, studies have found obesity to compromise healing after periodontal therapy; however, the mechanisms underlying this association are not well understood. Proteins called 'adipokines' could be the factor linking obesity to periodontitis. Adipokines are bioactive molecules with hormonal properties and a structure similar to cytokines produced by the adipose tissue. Although adipokines have both pro-and anti-inflammatory effects, the shift towards pro-inflammatory actions occurs when the adipose tissue becomes pathological, as observe in the progression of conditions such as obesity or adiposopathy. This article reviews the role of adipokines in the pathophysiology and progression of periodontitis by focusing on their impact on inflammation and the molecular mechanisms through which adipokines contribute to the onset and development of periodontitis.