Stages Of Periodontal Disease Research Articles

A Low-Cost Protocol Using the Adjunctive Action of Povidone-Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III-IV Periodontitis: A Single-Blind, Randomized Controlled Trial.

In severe stages of periodontitis, conventional periodontal therapy and maintenance care are usually insufficient due to the viral and bacterial etiology; thus, a mechanical approach alone may not be sufficient to eliminate a substantial portion of subgingival pathogens, especially in deep periodontal sites. Background and Objectives: This single-blind, randomized clinical trial aimed to compare the clinical and microbiological efficacy of a low-cost protocol using povidone-iodine and sodium hypochlorite formulations as adjuncts to non-surgical therapy for patients with stage IV periodontitis when compared with chlorhexidine, the most commonly employed substance to date for antimicrobial regimens in periodontal therapy. Materials and Methods: Forty-five patients were randomly divided into two groups: control (subgingival instrumentation, chlorhexidine-assisted) and test (antiviral medication, subgingival instrumentation with povidone-iodine, sodium hypochlorite rinsing solution, and antibiotics). Clinical measurements and microbiological analyses were performed at baseline and after three months. Results: After three months, notable differences were found in the bacterial detection scores for Porphyromonas gingivalis (a significant reduction in detection frequency was observed in the test compared to the control (p = 0.021)), and there were significant reductions in detection in the test group for Tannerella forsythia and Treponema denticola, showing undetectable levels (p < 0.0001 for both). In the test group, the pocket probing depth median value was reduced significantly (p = 0.0005); similarly, bleeding on probing showed a marked decrease (p < 0.0001). However, changes in clinical attachment loss and full-mouth plaque score were not statistically significant. Conclusions: Using the proposed protocol, substantial improvements in clinical and microbiological parameters were obtained when compared with the current antimicrobial recommendations.

“Outcome of non-surgical periodontal treatment on Gal-1 and Gal-3 GCF levels in periodontitis patients: a case-control study”

ObjectivesThis study aimed to explore the effect of nonsurgical periodontal treatment on Galectin-1 and -3 GCF levels in gingivitis and periodontitis stage III compared to periodontally healthy individuals, to determine whether they could serve as diagnostic markers / therapeutic targets for periodontitis and revealing their possible role in periodontal disease.Materials and methodsForty-five systemically healthy participants were included and equally subdivided into three groups: gingivitis, periodontitis (stage III), and a periodontally healthy control group. The clinical parameters were recorded. Galectin-1 and -3 GCF levels were evaluated (before and after non-surgical treatment for periodontitis) using an enzyme linked immune-sorbent assay (ELISA) kit. Receiver operating characteristic (ROC) curve was performed to reveal sensitivity, specificity, predictive value, and diagnostic accuracy of both markers.ResultsThe study showed statistical significance between different groups regarding Galectin-3 with higher values in periodontitis and the lowest values in healthy control. Also, Galectin-1 was significantly higher in the periodontitis/gingivitis groups than in the control group. Moreover, non-surgical periodontal treatment in periodontitis patients caused a statistical reduction in clinical parameters and biomarkers. ROC analysis revealed excellent diagnostic ability of both biomarkers in discriminating periodontitis/gingivitis against healthy individuals (100% diagnostic accuracy for Galectin-1 and 93% for Galectin-3, AUC > 0.9) and acceptable diagnostic ability between periodontitis participants against gingivitis (73% diagnostic accuracy for Gal-1 and 80% for Gal-3, AUC > 0.7).ConclusionsBoth Galectin-1 and Galectin-3 seem to have outstanding diagnostic accuracy for the identification of periodontal disease, an acceptable ability to measure periodontal disease activity and the severity of inflammatory status. Additionally, they could serve as therapeutic targets to monitor treatment efficiency.Clinicaltrial.gov registration number(NCT06038812).

Evaluation of the relationship between periodontal diseases and oxidative stress parameters in cats

Periodontal disease, which is defined as inflammation of the tissues and supporting structures surrounding the teeth, can be observed in cats starting from the age of 2. Periodontal diseases start with Gingivitis, which is the early stage of periodontal disease. Gingivitis can arise from inflammation of the gums due to plaque, a white or yellowish biofilm of bacteria on the tooth surface, and the toxins produced by these bacteria. It can also result from inflammation of the periodontal tissues, including dental calculus or other periodontal tissues. A total of 242 cats were brought to the clinic for surgical diseases and 14 cats (5.78%) were found to have periodontal diseases. Although there have been several studies on oxidative stress, there are very few publications investigating the relationship between oxidative stress and periodontal diseases in cats. The aim of this study is to measure serum MDA, IMA and GSH concentrations and SOD and CAT activities in cats with periodontal diseases and to evaluate the relationship between oxidant and antioxidant status, which are indicators of oxidative stress. In the study, blood samples taken from cats with periodontal disease were centrifuged and serum was removed. MDA and IMA levels of cats with periodontal disease were found to be significantly higher than in cats that recovered after treatment (P&lt;0.001). SOD, CAT and GSH levels were determined to be significantly lower cats with periodontal disease than recovered cats (P&lt;0.001). In conclusion, this study reveals that there is a relationship between periodontal diseases and oxidant/antioxidant balance in cats and it shows that the oxidative stress develop due to the increase of free radicals.

Influence of periodontal status on patients undergoing hematopoietic stem cell transplantation: A retrospective analysis

ObjectiveThis retrospective analysis aimed to evaluate the prevalence of periodontitis in patients undergoing hematopoietic stem cell transplantation, and investigate the effects of various periodontal statuses and risk factors on oral infection incidence. Study designMedical records of patients pre– and post–hematopoietic stem cell transplantation from June 2019 to October 2021were reviewed. The study examined the effort of different periodontal statuses on oral complications and infections in patients during transplantation. ResultsOf 549 transplant patients studied, 363 had periodontitis. Patients with or without periodontitis showed significant differences in mean age, male proportion, and mucositis incidence during transplantation (P < 0.05). Bacteremia rates were slightly higher in patients with periodontitis, but not significant. Male proportion, age, and hospitalization duration significantly increased with advancing periodontitis stages. Only two patients experienced periodontal complications, that were effectively managed and did not interfere in the grafting process. ConclusionPeriodontitis is prevalent in patients with hematopoietic diseases. Despite its association with oral mucositis, the occurrence of periodontal infection remains low and controllable.

Clinical effectiveness of regenerative periodontal surgery and orthodontic tooth movement with clear aligners in stage IV periodontitis: a case series.

To evaluate the clinical effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) with clear aligners in stage IV (type 2) periodontitis. Ten patients with a total of 103 intra-bony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by OT with clear aligners. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. Mean rBL gain was significant with 2.13 mm (±1.64 mm) after 1 year (T1) and 3.02 mm (±2.00mm) at final splinting (T2). Mean PPD was significantly reduced from 5.40 mm (±1.80 mm)at baseline to 3.78 mm (±1.73 mm) at T1 and remained stable with 3.73 mm (±1.70 mm)at T2. Pocket closure (PPD< 4mm) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive OT with clear aligners can lead to favorable results.

Characterization of oral microbiota in 6–8-month-old small breed dogs

BackgroundPeriodontitis is the most common oral disease in dogs, and its progression and severity are influenced by risk factors, such as age and body size. Recent studies have assessed the canine oral microbiota in relation to different stages of periodontitis and niches within the oral cavity. However, knowledge of the bacterial composition at different ages and body sizes, especially in puppies, is limited. This study aimed to characterize the oral microbiota in the healthy gingiva of small breed puppies using next-generation sequencing. Additionally, we assessed the impact of dental care practices and the presence of retained deciduous teeth on the oral microbiota.ResultsIn this study, plaque samples were collected from the gingival margin of 20 small breed puppies (age, 6.9 ± 0.6 months). The plaque samples were subjected to next-generation sequencing targeting the V3-V4 region of the 16 S rRNA. The microbiota of the plaque samples was composed mostly of gram-negative bacteria, primarily Proteobacteria (54.12%), Bacteroidetes (28.79%), and Fusobacteria (5.11%). Moraxella sp. COT-017, Capnocytophaga cynodegmi COT-254, and Bergeyella zoohelcum COT-186 were abundant in the oral cavity of the puppies. In contrast, Neisseria animaloris were not detected. The high abundance of Pasteurellaceae suggests that this genus is characteristic of the oral microbiota in puppies. Dental care practices and the presence of retained deciduous teeth showed no effects on the oral microbiota.ConclusionsIn this study, many bacterial species previously reported to be detected in the normal oral cavity of adult dogs were also detected in 6–8-month-old small breed dogs. On the other hand, some bacterial species were not detected at all, while others were detected in high abundance. These data indicate that the oral microbiota of 6–8-month-old small breed dogs is in the process of maturating in to the adult microbiota and may also have characteristics of the small dog oral microbiota.

Salivary Fractalkine Differentiating Periodontitis from Periodontally Healthy Subjects.

The chemokine "Fractalkine" (CX3CL1) and its corresponding receptor (CX3CR1), chemokine belonging to the CX3C family, have an essential role in developing several systemic inflammatory disorders. Accordingly, the proliferation, adhesion, and migration of inflammatory cells are all affected by it. In light of this, the present study attempts to address the following questions: (1) Is the salivary level of fractalkine and its receptor associated with periodontitis patients with different severities? (2) Is it possible to distinguish periodontitis from periodontally healthy subjects? This study included 30 individuals who had been considered controls, having healthy periodontium, and 90 patients with varying stages of periodontitis. The patients were equally divided into three groups: those with Stage I, Stage II, and Stage III. After each subject's saliva was collected, periodontal markers including bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. Enzyme-linked immunosorbent assays (ELISA) were used to detect the protein levels of salivary CX3CL1 and CX3CR1. In comparison to the control group, patients with periodontitis had statistically increased salivary concentrations of CX3CL1 and CX3CR1 (P < 0.001). Additionally, all clinical periodontal indicators (BOP, PPD, and CAL) had a strong association with salivary CX3CL1 and CX3CR1 levels. Furthermore, by using the ROC (receiver operating characteristic), both biomarkers showed a good ability to differentiate periodontitis from periodontally healthy subjects, and an excellent ability to distinguish Stage I and Stage III periodontitis from periodontally healthy subjects. The AUC for salivary CX3L1 and its receptors, CX3R, was 0.93 and 0.8, respectively, to distinguish Stage I from patients with good periodontal health. In contrast, the biomarkers' AUC for separating individuals with Stage III periodontitis from those in healthy periodontal conditions was 1. Fractalkine and its receptor are linked to periodontitis and may distinguish between periodontitis and healthy periodontal tissues, suggesting its role as a possible part of periodontal disease pathogenesis.

Exploring the Microbiome Landscape of Dental Plaque: A Cross-Sectional Analysis in Periodontal Health and Disease.

This study aimed to comprehensively analyze the microbiome of dental plaque in individuals with varying periodontal statuses, encompassing both periodontal health and disease. The primary objectives were to identify microbial markers associated with different clinical conditions, explore variations in microbial diversity, and investigate potential correlations between the oral microbiome and clinical parameters. A cross-sectional design was employed, involving 164 participants aged 18 to 65 years. Inclusion criteria comprised individuals with good oral and systemic health for the periodontal health group and those diagnosed with various stages of periodontal disease for the periodontal disease group. Dental plaque samples were meticulously collected from diverse tooth surfaces, and clinical examinations were conducted to assess periodontal health status. High-throughput sequencing of the 16S ribosomal RNA (rRNA) gene was utilized for microbiome analysis. Demographic characteristics revealed a balanced distribution between the periodontal health and disease groups. Clinical parameters, including probing depth, clinical attachment loss, and bleeding on probing, exhibited significant differences between the two groups (p < 0.001). Microbial diversity indices indicated a higher diversity in the periodontal health group compared to the disease group (p < 0.001). Analysis of relative abundance of bacterial phyla identified significant variations, with Firmicutes, Bacteroidetes, and Actinobacteria showing differential prevalence between health and disease (p < 0.05). Differentially abundant taxa analysis highlighted specific species associated with each clinical condition, including Prevotella intermedia and Porphyromonas gingivalis. Network analysis revealed complex microbial interactions within the oral microbiome. Functional predictions indicated variations in metabolic capabilities between health and disease, with potential implications for virulence and antibiotic resistance. This study provides a comprehensive analysis of the oral microbiome in periodontal health and disease, revealing significant associations between microbial composition and clinical parameters. The identification of microbial markers and functional insights enhances our understanding of the complex interplay within the oral ecosystem. These findings hold promise for advancing diagnostic and therapeutic approaches tailored to individual microbial profiles.

Comparative examination of trabecular bone structure in healthy and diabetic patients with periodontitis using fractal analysis.

Fractal analysis is a numerical method that indicates the structural patterns and complexity of the trabecular bone on radiographs. The aim of this cross-sectional study was to evaluate the trabecular bone structure in systemically healthy patients and diabetes mellitus patients with periodontitis using fractal analysis. The study included 125 mandibular first molars of nonsmoker patients. The subjects were divided into five subgroups: diabetes mellitus patients with mild-moderate periodontitis, diabetes mellitus patients with advanced periodontitis, systemically healthy individuals with mild-moderate periodontitis, systemically healthy individuals with advanced periodontitis, and systemically healthy individuals with gingivitis (control group). Clinical periodontal parameters (pocket depth, bleeding on probing, clinical attachment loss, and bone loss) were recorded. Two specific sites located in the mesial-distal regions (n = 250) of the mandibular first molars were identified using periapical radiographs captured with a parallel technique. Fractal analysis values were calculated using the box-counting method. One-way analysis of variance (ANOVA), and Pearson correlation analysis were used for statistical evaluation. The highest fractal analysis values were observed in systemically healthy with gingivitis patients (mesial fractal analysis: 1.86 ± 0.01; distal fractal analysis: 1.85 ± 0.01). Patients with periodontitis (mesial fractal analysis: 1.78 ± 0.02; distal fractal analysis: 1.79 ± 0.01) exhibited lower fractal analysis values compared to the control group. There was no significant difference in mesial and distal fractal analysis values between all periodontitis groups. No correlation was found between age, sex, clinical attachment loss, bone loss, and fractal analysis (P > .05). Although fractal analysis values were lower in the periodontitis groups compared to the control group, fractal analysis did not demonstrate any periodontitis-associated changes of bone trabeculation in diabetes at any stage of periodontitis. Furthermore, there was no significant association between fractal analysis values and age, sex, clinical attachment, and bone loss.

Clinical and Microbiological Evaluation of Diode Laser and Systemic Doxycycline as an Additive to Scaling and Root Planing for Stage II and Stage III Periodontitis Patients.

To assess and contrast the effectiveness of systemic doxycycline and diode laser as supplements to scaling and root planing (SRP) in terms of clinical and microbiological parameters. A total of 33 patients diagnosed with periodontitis stages II and III were included and randomized into group A (SRP + diode laser), group B (SRP + doxycycline), and group C (SRP alone). Selected sites were assessed for clinical and microbial parameters-plaque index (PI), gingival index (GI), pocket probing depth (PPD), relative attachment level (RAL), and colony-forming units (CFUs). Every clinical parameter was noted at baseline and after three months. The arithmetic mean, followed by the standard deviation, was calculated for the required assessment intervals. Analysis of variance (ANOVA) was used to compare all parameters between groups, and if the results of the ANOVA test were significant, post hoc analysis was performed. For intragroup comparison, student t-tests were performed. The clinical parameters significantly improved within three months for all groups. In terms of relative attachment level, a statistically significant difference (P < 0.001) was obtained at the three-month interval compared to the baseline value, with the most statistically significant difference seen in group A (3.36±0.50 to 0.64±0.50), followed by group B (3.18±0.40 to 2.18±0.40). The mean pocket probing depth observed at three months, compared to the baseline value, showed a statistically significant difference (P < 0.001) in group A (5.91±0.70 to 2.18±0.40) compared to group B (6.18±0.75 to 4.36±0.50), followed by group C (5.82±0.75 to 5.27±0.64). The use of diode laser-assisted pocket disinfection and systemic doxycycline, in addition to scaling and root planing, has proven to be efficient for treating periodontal pockets.

Variability of salivary analytes under daily conditions and their implications for periodontitis biomarkers

IntroductionRecent studies have identified inflammatory mediators as potential biomarkers for monitoring or diagnosing periodontitis. However, the brief half-life of these mediators, coupled with their variability among different individuals and across different stages of periodontal disease, may limit their reliability as biomarkers.MethodsIn this study, we assessed the concentration profile of salivary biomarkers (IL-6, IL-8, and total protein) through repeated measurements within the same day and across different days in 79 patients exhibiting various states of periodontal health: intact periodontium, stable periodontitis, and active periodontitis. Additionally, we explored how daily variations, such as the interval between toothbrushing and eating, impact the levels of these salivary biomarkers and their diagnostic efficacy for periodontitis activity.ResultsOur results showed high salivary levels of IL-6 and total proteins in periodontitis patients (p &amp;lt; 0.001), with detection ability reflected by an Area Under the Receiver Operating Characteristic Curve (AUC-ROC) ranging between 0.709 and 0.852. Conversely, IL-8 levels were higher in patients with intact periodontium (p &amp;lt; 0.001), with an AUC-ROC for periodontitis detection between 0.671 and 0.815. Daily activities such as toothbrushing and eating influenced the levels of specific analytes, particularly total proteins (p &amp;lt; 0.001), but this did not affect their ability to detect periodontal disease activity. The highest measurement agreement, assessed by Intraclass Correlation Coefficients (ICC), was found for IL-6, with no significant differences in agreement between same-day and different-day measurements.ConclusionsOur study demonstrated consistency in the repeated measurements of salivary analytes, both within the same day and across different days, except for salivary total protein levels. These analytes exhibited variability within a range that did not undermine their effectiveness as biomarkers for periodontal disease.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study

ObjectivesThe recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis. MethodsThis retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation. ResultsThe incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively. ConclusionThis study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease. Clinical significanceThis study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

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

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

Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation.

Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP). In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8)chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP),and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38),or adherent CPAP (n = 34) groups. The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages. Hypertensive patients with obstructive sleep apnea(OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

Effectiveness of Ultrasonic and Manual Instrumentation in Nonsurgical Periodontal Therapy: Are Additional Therapies More Effective? A Systematic Review

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers).

Convolutional neural networks combined with classification algorithms for the diagnosis of periodontitis.

We aim to develop a deep learning model based on a convolutional neural network (CNN) combined with a classification algorithm (CA) to assist dentists in quickly and accurately diagnosing the stage of periodontitis. Periapical radiographs (PERs) and clinical data were collected. The CNNs including Alexnet, VGG16, and ResNet18 were trained on PER to establish the PER-CNN models for no periodontal bone loss (PBL) and PBL. The CAs including random forest (RF), support vector machine (SVM), naive Bayes (NB), logistic regression (LR), and k-nearest neighbor (KNN) were added to the PER-CNN model for control, stage I, stage II and stage III/IV periodontitis. Heat map was produced using a gradient-weighted class activation mapping method to visualize the regions of interest of the PER-Alexnet model. Clustering analysis was performed based on the ten PER-CNN scores and the clinical characteristics. The accuracy of the PER-Alexnet and PER-VGG16 models with the higher performance was 0.872 and 0.853, respectively. The accuracy of the PER-Alexnet + RF model with the highest performance for control, stage I, stage II and stage III/IV was 0.968, 0.960, 0.835 and 0.842, respectively. Heat map showed that the regions of interest predicted by the model were periodontitis bone lesions. We found that age and smoking were significantly related to periodontitis based on the PER-Alexnet scores. The PER-Alexnet + RF model has reached high performance for whole-case periodontal diagnosis. The CNN models combined with CA can assist dentists in quickly and accurately diagnosing the stage of periodontitis.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function.

Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database. Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups. Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.

Periodontal disease severity in patients with long COVID and non-COVID-19

Background: Previous research studies have found the persistence of various COVID-19 symptoms even after the patient tested negative on a PCR test; this incident is now known as long COVID. These long COVID symptoms are reported to appear in the oral cavity including long COVID effects on periodontal disease, as both long COVID and periodontal disease release similar proinflammatory cytokines such as Acute phase proteins, CRP, TNF-α, IL-1β, IL-2, IL-6, and IFN-g. Purpose: This study aims to show periodontal-disease severity-frequency distribution in COVID-19 survivors with long COVID and in non-COVID-19 patients. Methods: Patients’ secondary data in the Periodontics Clinic Faculty of Dentistry at Trisakti University Dental Hospital (n=40) consisted of 20 samples from COVID-19 survivors who experienced long COVID and 20 samples from the non-COVID-19 group selected according to the inclusion criteria. Afterward, the data was recapitulated and processed into a research report. Results: The distribution percentage of generalized gingivitis was highest in non-COVID-19 patients, while generalized periodontitis was highest in COVID-19 survivors with long COVID. Based on periodontitis staging and grading methods, it is not proven that long COVID increases the severity of the periodontitis. Conclusion: This research shows that the distribution of gingivitis in COVID-19 survivors with long COVID has not increased. Meanwhile, the distribution of general periodontitis increased in survivors with long COVID. However, there was no increased severity of periodontitis based on the staging and grading method of periodontitis in the COVID-19 survivors with long COVID.

Prevalence and Association of Calcified Pulp Stones with Periodontitis: A Cone-Beam Computed Tomography Study in Saudi Arabian Population

ABSTRACT This study aimed to identify the prevalence and association of periodontitis and pulp stone (PS) along with the clinical variables. This study assessed the cone-beam computed tomography (CBCT) records to identify the presence of PS and clinical periodontitis records were used to determine the stages of periodontitis. The Chi-square test was used to evaluate the relationship between study parameters. Logistic regression was used to determine the association between PS and periodontitis. A total of 228 CBCT records were conveniently selected for this study based on the inclusion and exclusion criteria. Cohen’s kappa analysis showed near to perfect scores for both examiners. The Chi-square test showed that CBCT records from the age range 41–50 years, male patients, and stage II of periodontitis prevalently showed pulp stones; however, there were no significant differences observed between the PS and clinical variables. However, gender, involvement of tooth, and stages of periodontitis showed significant distribution of the PS. Logistic regression showed that the stages of periodontitis showed no significant association with PS in patients with periodontitis. Moreover, multivariate odds ratio adjustment did not alter the outcome. Periodontitis is not associated with the presence of PS in the current population.

Succession of the oral microbiome with the increasing severity of periodontitis

AbstractPeriodontitis development is strongly associated with the succession of the oral microbiome. However, the knowledge about the succession of the oral microbiome in the development of periodontitis remains insufficient. In the present study, an analysis was conducted on the succession of tongue back, the saliva (Sal) microbiome, and gingival crevicular fluid (GCF) from healthy individuals and patients with mild (CPL), moderate (CPM), severe chronic (CPH), and generalized aggressive periodontitis (GAgP). The composition and structure of the oral microbiome gradually changed with the increasing severity of periodontitis, among which GCF showed the highest correlation with periodontitis. With an ecological preference, pathogens in the mouth varied with the development of periodontitis. In healthy and CPL patients, Sal‐derived microorganisms accounted for a large proportion of GCF but exhibited a decrease in patients with CPM, CPH, and GAgP. Permutation and time course sequencing analysis revealed that a variety of microorganisms changed with the severity of periodontitis. A majority of these microorganisms are closely related to clinical periodontal indices. Ecological analysis suggested that the composition of oral microbial communities at different stages of periodontitis is controlled by random processes. The comparison of microbial interaction networks demonstrated that a series of key microorganisms drive oral health to severe periodontitis. In this study, the relationship between the succession process of the oral microbiota and the development of periodontitis was revealed.