World Workshop Research Articles

Interpretation and consideration of core outcome set in clinical intervention study of oral lichen planus

Oral lichen planus (OLP), as a chronic inflammatory disease of oral mucosa, cannot be completely cured at present. OLP can develop into oral squamous cell carcinoma and reduce the life quality of patients. The development of high-quality evidence-based strategies for OLP clinical management can effectively alleviate the clinical symptoms and reduce the risk of cancerization, thus to improve the life quality of patients. However, there is a wide variety of outcomes and a lack of uniform standards in previous OLP clinical intervention studies. Therefore, evidence-based analysis of relevant studies cannot be conducted to provide more convincing guidance for clinical diagnosis and treatment. To reduce the heterogeneity of clinical intervention studies, form a data pool for meta-analysis, and provide higher quality evidence-based OLP clinical management protocols, the World Workshop on Oral Medicine Ⅷ identified a core outcome set (COS) for OLP in three steps from March 2022 to January 2023. This article introduces the process of COS formulation, interprets OLP COS, and puts forward the advantages and drawback of OLP COS in this paper. We encourage researchers to use this COS in their future OLP clinical studies for improving the clinical significance and evidence-based value of studies.

Role of oxidative stress in the occurrence of periodontitis in the background of metabolically associated diseases

Oxidative stress is an important component of slow pathological inflammation in metabolic diseases and chronic periodontitis. Periodontal diseases are interrelated with somatic pathology. This results in both local and systemic inflammatory reactions, which increases the risk of the onset and progression of somatic diseases. Psychological stress associated with oxidative stress with increased production of oxidants and oxidative damage is an important factor in the etiology of both periodontitis and metabolic disorders. Objective — to analyze the possible bond between chronic periodontitis, 8‑hydroxydeoxyguanosine (8‑OHdG), as a biomarker of oxidative stress, and cortisol in persons with metabolic‑associated diseases. Materials and methods. 68 people were surveyed, of which 47 had metabolically ‑associated diseases that were diagnosed according to domestic and international criteria. The control group consisted of systematically healthy people, representative by age and article that did not receive dental therapeutic and preventive measures for the last 6 months. The diagnosis of «chronic periodontitis» was carried out in accordance with existing recommendations provided at World Workshop on the Classification of Periodontal and Peri­Implant Diseases and Conditions (2017). The concentration of 8‑OHdG in plasma and the level of saliva cortisol were measured by the immunoenzyme method according to the manufacturer’s instructions. The arithmetic mean, standard error, and Student’s t‑test were calculated to compare the characteristics. Pearson’s correlation test was used to identify the relationship between the indicators. Results. Each of the groups had patients who had a healthy periodontium and those who had chronic periodontitis. The 8‑OHdG level in the main group was much higher (p<0.001) than in the control group, and the difference in the concentration of 8‑OHdG was also observed between those patients who had periodontal disease and those who had a healthy periodontium. The level of salivary cortisol in patients with chronic periodontitis was much higher compared to patients with clinically healthy periodontium (p=0.00). A correlation was found between cortisol levels and the presence of periodontal disease (r=0.619; p=0.00), between plasma 8OHdG levels and the epithelial attachment loss index (r=0.537; p=0.00), the hygiene index (r=0.599; p=0.00), and between 8OHdG levels and salivary cortisol concentrations (r=0.292; p=0.036). Conclusions. Oxidative stress plays an important role in delayed pathological inflammation in both metabolic diseases and chronic periodontitis. 8‑OHdG is a key and universal biomarker for the evaluation of DNA oxidative damage. There is a positive relationship between the oxidative marker, periodontitis and cortisol.

A Rose by Any Other Name: The Long Intricate History of Localized Aggressive Periodontitis.

This review addresses the recent World Workshop Consensus Conference (WWCC) decision to eliminate Localized Aggressive Periodontitis (LAgP) in young adults as a distinct form of periodontitis. A "Consensus" implies widespread, if not unanimous, agreement among participants. However, a significant number of attendees were opposed to the elimination of the LAgP classification. The substantial evidence supporting a unique diagnosis for LAgP includes the (1) incisor/molar pattern of disease, (2) young age of onset, (3) rapid progression of attachment and bone loss, (4) familial aggregation across multiple generations, and (5) defined consortium of microbiological risk factors including Aggregatibacter actinomycetemcomitans. Distinctive clinical signs and symptoms of LAgP are presented, and the microbial subgingival consortia that precede the onset of signs and symptoms are described. Using Bradford-Hill guidelines to assess causation, well-defined longitudinal studies support the unique microbial consortia, including A. actinomycetemcomitans as causative for LAgP. To determine the effects of the WWCC elimination of LAgP on research, we searched three publication databases and discovered a clear decrease in the number of new publications addressing LAgP since the new WWCC classification. The negative effects of the WWCC guidelines on both diagnosis and treatment success are presented. For example, due to the localized nature of LAgP, the practice of averaging mean pocket depth reduction or attachment gain across all teeth masks major changes in disease recovery at high-risk tooth sites. Reinstating LAgP as a distinct disease entity is proposed, and an alternative or additional way of measuring treatment success is recommended based on an assessment of the extension of the time to relapse of subgingival re-infection. The consequences of the translocation of oral microbes to distant anatomical sites due to ignoring relapse frequency are also discussed. Additional questions and future directions are also presented.

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.

An apically positioned flap and free gingival graft around an implant

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm. CPD/Clinical Relevance: This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

Prevalence and severity of periodontal disease in the host community and Rohingya refugees living in camps in Bangladesh.

To assess the prevalence and severity of periodontal disease of the Rohingya refugees and host community in Bangladesh. An unpublished pilot was conducted for the sample size calculation. Two-stage cluster sampling method was used to select 50 participants from refugee camps and 50 from the host community. Structured questionnaire and periodontal examination were completed. Composite measures of periodontal disease were based on the World Workshop (WW) and Centers for Disease Control and Prevention-American Academy of Periodontology. Linear regression models, for clinical attachment level and periodontal pocket depth (PPD) and ordered logistic regression models, for composite measures, were fitted to test the association of periodontal measures and refugee status. Compared to the host community, a smaller percentage of refugees reported good oral health-related behaviours. Refugees exhibited lower levels of bleeding on probing but higher PPD, hence a higher proportion had severe stages of periodontitis. As per the WW, prevalence of periodontal disease was 88% and 100% in the host and refugee groups, respectively. In the unadjusted models, refugees were three times more likely to have severe stages of periodontitis; this association was attenuated when adjusted for confounders (sociodemographic variables and oral health-related behaviours). Prevalence of periodontitis was high both in the host community and refugees. The refugees exhibited a more severe disease profile. The oral health of both groups is under-researched impacting the response of the health system. Large-scale research systematically exploring the oral health of both groups will inform the design and delivery of community-based interventions.

Ease and practicability of the 2017 classification of periodontal diseases and conditions: a study of dental electronic health records

BackgroundA new classification for Periodontal and Peri-implant Diseases and Conditions was introduced in the 2017 World Workshop. In the past the 1999 Armitage Classification was commonly used in practice. This study aimed to assess the ease and practicability of retroactively diagnosing a subset of patients formerly diagnosed using the 1999 AAP/CDC classification with the 2017 AAP/EFP disease classification.MethodsA random subset of 10% of all patients referred over a 7-year period (2011–2018) to the Post-Doctoral Periodontics Clinic at Columbia University College of Dental Medicine were reviewed by accessing the Electronic Health Records (EHRs) on axiUm. Patients diagnosed with periodontal disease based on the 1999 AAP/CDC classification (including chronic and aggressive Periodontitis) were reclassified using the 2017 classification (stage: I, II, III and grade: A, B, C).ResultsA sample of 336 patient records were examined. 132 were diagnosed with gingivitis, and 204 with periodontitis. Of these 204 patients, 68 (33.3%) were diagnosed with aggressive and 136 (66.7%) with chronic periodontitis. Patients diagnosed with aggressive periodontitis, 10% were reclassified as stage II, 47% as stage III, and 43% as stage IV periodontitis, and 100% were reclassified as grade C. Among patients with chronic periodontitis, 7% were reclassified as stage I, 65% as stage II, 21% as stage III, and 7% as stage IV; 11% of these were reclassified as grade A, 63% grade B, and 26% grade C.ConclusionsThe majority of those originally diagnosed with aggressive (90%) and chronic (80%) periodontitis were reclassified as either molar/incisor pattern stage III grade C or stage IV grade C periodontitis, and stage II or III periodontitis, respectively. The study demonstrated that it is practical to retroactively reassign a diagnosis according to the new 2017 classification using available information included in dental EHRs.

The effect of individuals' oral hygiene habits and knowledge levels on peri-implant health and disease: a questionnaire-based observational study

BackgroundPeri-implant disease and health are associated with microbial dental plaque. Therefore, oral hygiene plays a role in preventing and treating these diseases. This study aimed to determine the relationships among knowledge of peri-implant status, oral hygiene habits, and peri-implant disease and health.MethodsA total of 144 implants in nonsmokers with controlled systemic disease were included in the study. Peri-implant disease and the conditions of the implants were determined with periodontal indices and radiographs based on the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions and The EFP S3 level clinical practice guideline. Individuals were asked 66 questions regarding demographic information, oral hygiene habits and history, and knowledge of peri-implant diseases. One-way ANOVA was used to compare the three peri-implant disease and condition categories.ResultsThere was a significant difference between groups regarding toothpaste type (p < 0.05). Gum protection toothpaste was greater in the peri-implant health group. Patients' use of interdental products was very low; often, no products were used for implant prosthesis. There was no significant difference among the groups regarding oral hygiene product use or oral hygiene habits (p > 0.05). There was a significant difference between groups regarding frequency of visit (p < 0.05). The frequency of visits to the dentist for pain was greater for individuals with peri-implantitis. There is a significant difference between the groups' answers for the causative and initiating factors of peri-implant disease (p < 0.05). The peri-implant health group answered that microbial dental plaque is the most crucial initiating factor of peri-implant diseases, and bleeding on probing is the most critical determinant of peri-implant diseases at a higher rate than the other groups.ConclusionsPatients' oral hygiene habits and knowledge levels are almost similar according to peri-implant status. Knowledge does not reflect a patient's oral hygiene behavior. Clinicians should ensure that individuals' oral hygiene practices align with their increased awareness regarding peri-implant illnesses.

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.

The effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis: A retrospective study.

The objective of this retrospective study was to evaluate the effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis. Records of 96 patients and 148 external hexagon (EH) implants with time in function ranging from 1 to 17 years were included in the study. The most recent clinical and radiographic data were collected from records and the prevalence of peri-implantitis was defined according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Marginal bone level (MBL), emergence angle (EA), emergence profile (EP), and crown/implant platform horizontal ratio (CIHR) were obtained from periapical radiographs. Dichotomous variables at the patient- and implant level were compared with association tests. Mann-Whitney U-Test was performed to compare continuous quantitative values between the studied groups. Binomial logistic regression was conducted to identify risk indicators associated with the peri-implantitis event at the patient- and implant level, with the significance level set at 5% for all tests. Nineteen patients (19.2%) and 24 implants (16.2%) with a mean time in function of 5.0 ± 4.7 years were classified as having peri-implantitis. No statistically significant differences concerning gender, mean age, implant location in the jaw, or time in function were observed between patients with or without peri-implantitis (p > 0.05). Of 24 implants with peri-implantitis 10 (41.7%) displayed EA ≤ 30° (16.4%) while 14 (58.3%) presented EA > 30° with no statistical difference between the groups (p > 0.05). No statistically significant associations were identified between EA, EP, or CIHR and the prevalence of peri-implantitis. The findings seem to indicate that the EA, EP, and CIHR of single restorations over external hexagon implants are not associated with the presence of peri-implantitis. However, prospective studies with larger samples are required to better ascertain such an association in the long term.

Effect of non-surgical periodontal therapy on salivary histone deacetylases expression: A prospective clinical study.

To evaluate the effect of non-surgical periodontal therapy (NSPT) on salivary histone deacetylases (HDACs) gene expression in patients with Stage III-IV periodontitis at baseline and at 3 and 6 months post NSPT treatment. Twenty patients completed the study. Periodontitis (as well as the corresponding staging and grading) was diagnosed according to the 2017 World Workshop Classification. Clinical measures were recorded and whole unstimulated saliva was collected at baseline and at 3 and 6 months after NSPT. The expression of 11 HDACs was determined using reverse-transcription PCR, and the respective changes over time were evaluated. Six months after NSPT, significant improvements in all clinical periodontal parameters were observed, concomitant with significant up-regulation of HDAC2, 4, 6, 8, 9 and 11 expressions. Subgroup analyses of non-responders and responders revealed no significant differences in HDACs mRNA expression between groups at any time point. This prospective clinical study identifiedlongitudinal changes in salivary HDACs expression in response to NSPT, which provides new insights into the epigenetic mechanisms underlying the pathobiology of periodontitis and creates avenues for the discovery of novel biomarkers.

Antimicrobial Sensitivity Associated with Porphyromonas gingivalis Present in Periodontitis Frameworks: An Integrative Review

Objectives: The Gram-negative anaerobic bacterium Porphyromonas gingivalis is identified as one of the most important causes of the chronic form of periodontitis. This work aimed to analyze the sensitivity of P. gingivalis to antibiotics and antimicrobial agents.&#x0D; Study Design: Integrative literature review.&#x0D; Methodology: Through a careful analysis of clinical trials published in the last 5 years. A bibliographic search was carried out in the PubMed, Scielo and Google Scholar databases. Three keywords were established and verified on the DeCs-Descritores em Ciências da Saúde website for the literary search “Antimicrobial resistance”, “Periodontal biotherapy” and “Porphyromonas gingivalis”. 66 articles were found. Of these, animal studies, studies that did not involve patients diagnosed with periodontitis according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, and studies on peri-implantitis were excluded. Studies that used only surgical therapy without association with at least one antibiotic or antimicrobial and duplicate studies were excluded.&#x0D; Results: This integrative review presents the results of 19 studies. Amoxicillin, Metronidazole and Azithromycin are the most commonly used antibiotics. Photodynamic therapy has demonstrated benefits in reducing inflammation and P. gingivalis counts. It has been demonstrated that P. gingivalis is not sensitive to Lactobacillus brevis and Lactobacillus plantarum-ProlcSan probiotic gel and tablets, as no reductions in its proportion and total count were observed. Similar results were also observed in the study that investigated the effect of administering piperacillin plus Tazobactam gel and doxycycline gel.&#x0D; Conclusion: Although most of the articles presented report the sensitivity of P. gingivalis to their protocols, microbiological reduction is not always accompanied by clinical benefit, since periodontal disease is multifactorial. Based on these findings, it is concluded that there are several antimicrobial agents capable of promoting the reduction of this key pathogen in periodontitis.

Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data.

To develop and validate an automated electronic health record (EHR)-based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions. Using material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento-enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites. Three-hundred and twenty-three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together. Our findings suggest that a rule-based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey-zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.

The Prevalence of Systemic Diseases and Its Association with Periodontal Disease among Patients Referred to a Government Periodontal Specialist Clinic in Melaka, Malaysia

Abstract Aim: The aim of the study was to identify the prevalence of systemic diseases among patients referred to a newly established government periodontal specialist clinic and to analyze the association between the severity (staging) and the rate of progression (grading) of periodontitis with the presence of these systemic diseases. Materials and Methods: Records of all new patients within the first 5 years of the clinic’s operation were reviewed, and their periodontitis status was classified according to the 2017 World Workshop Classification system. The association between the severity of periodontitis and the presence of systemic diseases was analyzed using the Chi-square test, whereas Fisher’s exact test was used to determine the association between the rate of progression and the presence of systemic diseases. Results: A total of 489 dental records were reviewed. We found that 40.1% of our patients suffered from systemic diseases. The two most common systemic diseases were cardiovascular disease (CVD) (11.4%) and diabetes mellitus (9.4%). No significant association was found between the severity of periodontitis and the presence of systemic diseases (P = 0.376). However, we found a significant association between the rate of progression of periodontitis and systemic diseases (P = 0.004). There was also a significant association between the rate of progression of periodontitis and CVDs (P = 0.001). Conclusion: The rate of progression of periodontitis is significantly associated with the presence of systemic diseases and CVDs. This highlights that periodontitis is not a stand-alone disease. Instead, it reaches across a spectrum of other noncommunicable diseases. The collaboration between medical and dental practitioners can further improve the management of this group of patients.

Prevalence of Tooth Loss due to Periodontitis in Patients Visiting Tertiary Care Hospital

Introduction: Epidemiological studies have been showing that caries is the main reason for tooth loss. But nowadays, it seems to show an increasing trend of tooth loss due to periodontal reasons rather than caries. The retention of natural teeth can improve the quality of life by maintaining the ability to chew and digest food. Thus, directly or indirectly periodontitis leading to tooth loss affects quality of life.&#x0D; Objective: To determine the prevalence of tooth loss in periodontitis patients.&#x0D; Methods: A cross-sectional study was done in Department of Periodontology and Oral Implantology from June 2023 to September 2023 after obtaining ethical clearance from institutional review committee. Study participants were patients diagnosed as periodontitis according to world workshop in periodontics 2017 classification and prevalence of tooth loss was recorded according to the history of mobile tooth. Poor prognosis and hopeless prognosis were counted as to be extracted tooth in the study. Collected data were entered into the excel sheet and further statistical analysis was done using SPSS v.20.&#x0D; Results: Mean of tooth loss due to periodontitis was found to be 3.74±3.285 and tooth to be extracted is 1.94±1.884. &#x0D; Conclusion: As the age increases number of tooth loss increases, likewise current smokers have more amount of tooth loss than that of former and nonsmokers. Likewise, mandibular anterior region was most common for prevalence for tooth loss.

Assessment of Sleep Quality and Duration and Its Association With Periodontitis in South Indian Population

Background and Objective Sleep deprivation is a significant issue among adults. It is on the rise in contemporary society, largely influenced by the shift towards a 24/7 lifestyle and long working hours. Lack of sufficient sleep can influence immune function causing systemic inflammation. Inflammation is a shared characteristic between chronic periodontitis and sleep deprivation. In addition, sleep deprivation can have detrimental effects on cognitive function and motor skills, which may reduce the individual’s ability to maintain proper oral hygiene further influencing periodontal health. This study aimed to examine the quality and duration of sleep and their potential association with periodontitis in the South Indian population.Methods Fifty-six subjects were diagnosed based on the criteria outlined in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Probing depth and clinical attachment loss were measured as a part of the clinical examination. The severity, complexity, and progression of periodontitis were classified based on both stage (I–IV) and grade (A–C) systems. The participants were given a questionnaire including demographic information and the Pittsburgh Sleep Quality Index.Results There was a significant association between the severity and extent of periodontitis and sleep quality and duration. The mean sleep quality was highest in Stage IV (1.57 ± 0.76) and Grade B (1.62 ± 1.28). Similarly, Stage IV (1.14 ± 0.66) and Grade B (1.38 ± 0.92) showed the highest scores for sleep duration.Conclusions Poor sleep quality and duration were significantly associated with the stage and grade of periodontitis in the South Indian population.

Is Periodontal Disease a Risk Factor for Premature Birth and Low Birth Weight

Aim: Premature birth or low birth weight has an important place in neonatal mortality and morbidity. Today, there are still cases whose etiology has not been fully elucidated. The aim of this study is to evaluate the effect of periodontal diseases on adverse pregnancy outcomes by using the current classification system accepted at the 2017 World Workshop. Materials and Methods: This study was carried out on 172 women who were followed up and delivered in the department of obstetrics and gynecology of our university’s medical faculty hospital. Demographic characteristics of all individuals were recorded and laboratory values were examined. While those with a gestational age &lt;37 weeks and/or baby birth weight &lt; 2500 g were constituted to the case group (n=85), those with a gestational age ≥ 37 weeks and/or baby birth weight ≥ 2500 g constituted the control group (n=87). Clinical periodontal and radiographic evaluations including plaque index (PI), gingival index (GI), bleeding on probing (BOP %), probing pocket depth (PPD) and clinical attachment level (CAL) values were performed for all individuals, and the diagnoses were made by the applied classification system. Analyzes were performed between the two groups to examine the relationship between periodontal disease and adverse pregnancy. Results: PI, GI, BOP %, and PPD values in the case group were significantly higher compared to the control group (p&lt;0.001). Although the CAL value was higher in the case group, the difference was not significant (p=0.058). WBC (p=0.020) and PLT (p&lt;0.001) values were significantly higher in the case group. Conclusion: According to the results of this study, periodontal diseases are associated with adverse pregnancy outcomes independent of other risk factors. Women should pay attention to their oral hygiene and dental examinations before and during pregnancy.

Association between periodontitis stages and self-reported diseases in a Norwegian population: the HUNT study

BackgroundThe relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT).Material and methodsThe fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders.ResultsCompared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema.ConclusionPeriodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis.

Evaluation of the effects of periodontal status according to 2017 classifications on oral health-related quality of life and quality of life-related to general health: A cross-sectional study.

In patients with periodontal disease, various symptoms are observed along with inflammation. The impact of local and systemic inflammation on periodontal tissue is well-known; however, the impact of periodontal disease on the individual's quality of life is unclear. This study aimed to assess oral health-related and general health-related quality of life in patients undergoing maintenance treatment following treatment for periodontitis (RP-CPH), patients with gingivitis (G) and patients with Stage I periodontitis (SI-P) and to compare this with individuals with clinical periodontal health (IP-CPH). This study was comprised of cross-sectional periodontal assessment along with questionnaires. Oral health-related quality of life and general health-related quality of life were assessed using, respectively, the Oral Health Impact Profile-14 (OHIP-14) and Short-Form-36 (SF-36) questionnaires. Study participants were classified according to the classification of periodontal and peri-implant diseases and conditions established by the 2017 World Workshop. The OHIP-14 total scores for the 166 study participants (age range: 22-57) of the G (11.61 ± 3.21) and SI-P (13.03 ± 3.47) groups were significantly higher than the OHIP-14 total scores of the IP-CPH (1.09 ± 1.58) and RP-CPH (2.95 ± 2.58) groups. SF-36 scores were found to be significantly lower in the SI-P group in all subgroups compared to the G and IP-CPH groups. A correlation was found between early-stage periodontal disease and low levels of OHRQoL and GHRQoL. The health of periodontal tissues may have a positive effect on the quality of life.

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

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