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Aim: To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation‐involved defects. Materials and Methods: Fifty‐seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non‐furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI‐clustering method was also applied. Results: In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p =.01) was detected in FI compared with NF; IL‐6, MMP‐3, MMP‐8, BMP‐2, SOST, EGF and TIMP‐1 levels were increased in the GCF of FI compared with NF. Conclusions: This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI‐based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects. [ABSTRACT FROM AUTHOR]

Aim: To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years. Materials and Methods: This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non‐surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real‐time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals. Results: No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow‐up period. Conclusions: SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes. Clinical trial registration: clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates). [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of the PerioRisk prognostic tool in implementing the effect of motivational interviewing (MI) on psychological outcomes and supragingival plaque control. Materials and Methods: Participants underwent MI immediately after their first periodontal visit. According to a parallel‐arm, randomized study design, MI was performed with (RISK group) or without (CTR group) information on PerioRisk level and treatment goals based on PerioRisk output. Psychological outcomes were assessed using the Positive Affect Negative Affect Scale (PANAS) and Protection Motivation Theory (PMT). Plaque index (PI) was re‐evaluated after 8–12 weeks. Results: Significant improvements in PMT overall score and PI were observed in CTR and RISK groups, without inter‐group difference in PANAS and PMT overall scores and PI. A sub‐analysis showed that the overall PMT scores recorded immediately after MI in both CTR and RISK groups for subjects with no tooth loss due to periodontitis were higher than those recorded before MI in subjects with tooth loss due to periodontitis. Conclusions: At first periodontal visit, MI (implemented with without PerioRisk) has tangible effects on psychological outcomes and supragingival plaque control and seems to anticipate the awareness that is commonly generated by periodontitis‐related tooth loss (ClinicalTrials.gov protocol registration ID: NCT05078411). [ABSTRACT FROM AUTHOR]

Aim: The oral microenvironment contributes to microbial composition and immune equilibrium. It is considered to be influenced by dietary habits. Phenylketonuria (PKU) patients, who follow a lifelong low‐protein diet, exhibit higher prevalence of oral diseases such as periodontitis, offering a suitable model to explore the interplay between diet, oral microbiota and oral health. Materials and Methods: We conducted 16S rDNA sequencing on saliva and subgingival plaque from 109 PKU patients (ages 6–68 years) and 114 age‐matched controls and correlated oral microbial composition and dental health. Results: PKU patients exhibited worse dental health, reduced oral microbial diversity and a difference in the abundance of specific taxa, especially Actinobacteriota species, compared to controls. PKU patients with poor periodontal health exhibited higher alpha diversity than the orally healthy ones, marked by high abundance of the genus Tannerella. Notably, the observed taxonomic differences in PKU patients with normal indices of decayed/missing/filled teeth, plaque control record, gingival bleeding index and periodontal screening and recording index generally differed from microbial signatures of periodontitis. Conclusions: PKU patients' reduced microbial diversity may be due to their diet's metabolic challenges disrupting microbial and immune balance, thus increasing oral inflammation. Higher alpha diversity in PKU patients with oral inflammation is likely related to expanded microbial niches. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prevalence of gingivitis and periodontitis, and the oral hygiene status of adults with cystic fibrosis (CF) in the Republic of Ireland. Materials and Methods: A case–control study in the form of a clinical examination of 92 adults with a diagnosis of CF was carried out in the adult CF unit in Cork University Hospital. A 40‐item questionnaire was used to capture socio‐demographic variables and medical and dental information. Two calibrated examiners carried out a periodontal assessment on participants, using the WHO‐recommended CPI‐modified index, and oral hygiene status was measured using the Greene–Vermillion index. The results were compared with a population‐based control group of similar socio‐demographic profile. Results: Oral hygiene levels (plaque and calculus) were significantly worse in people with CF, with a median plaque index of 0.83 (interquartile range [IQR] 0.333–1.542) in the CF group compared with 0.5 (IQR 0.167–0.667) in the non‐CF group. Calculus index in the CF group was 0.33 (IQR 0.17–0.83) compared with 0.33 (IQR 0.125–0.33) in the non‐CF group. However, periodontal disease levels were significantly lower in the CF group. Gingivitis (bleeding on probing ≥ 10% sites) was seen in 67.4% of the CF group, compared with 83.7% of the non‐CF group, OR 0.365 (95% confidence interval [CI] 0.181–0.736), relative risk (RR) 0.779 (95% CI 0.655–0.928). Mild periodontitis (periodontal probing depth [PPD] < 5 mm) was seen in 15.2% of the CF group, compared with 31.5% of the non‐CF group, OR 0.390 (CI 0.190–0.800), RR 0.483 (95% CI 0.273–0.852). Severe periodontitis (PPD ≥ 6 mm) was seen in 0% of the CF group, compared with 9.8% of the non‐CF group. There was a tendency, albeit non‐significant, towards reduced periodontitis in PWCF who regularly took antibiotics, particularly azithromycin. Conclusions: In this study, adults with CF had poor oral hygiene practices, with high levels of plaque and calculus. Despite this finding, adults with CF had lower levels of clinical gingivitis and periodontitis than seen in a non‐CF control group. Further study is required to examine the causes of this phenomenon. [ABSTRACT FROM AUTHOR]

Aim: To investigate the associations between periodontitis and hypertension and potential mediation via systemic inflammation through a 5‐year longitudinal study. Materials and Methods: The severity and extent of periodontitis were determined using probing depth (PD). Oral hygiene was assessed using plaque scores. The associations between periodontal variables and 5‐year blood pressure changes or incident hypertension were analysed using linear or Poisson regression, adjusting for potential confounders. Mediation analysis of two systemic inflammatory biomarkers, namely white blood cell count (WBC) and C‐reactive protein (CRP) levels, was performed. Results: The study population included 901 hypertension‐free participants, aged 50–73 years. Greater mean PD, higher percentage of sites with PD ≥ 6 mm and poor oral hygiene were associated with elevated systolic blood pressure and increased hypertension risk (relative risks = 1.17 [95% confidence interval [CI]: 1.02–1.34], 1.13 [95% CI: 1.02–1.26] and 1.08 [95% CI: 1.03–1.13], respectively). Periodontitis and poor oral hygiene were associated with higher WBC and CRP levels (p <.05), which, in turn, were associated with increased hypertension risk (p <.05). WBC and CRP jointly mediated 14.1%–26.9% of the associations between periodontal variables and incident hypertension. Conclusions: Periodontitis and poor oral hygiene were associated with increased hypertension risk, and systemic inflammation was, in part, a mediator of these associations. [ABSTRACT FROM AUTHOR]

Aim: To explore the epidemiology of plaque‐induced gingivitis and related factors among Chinese adolescents. Materials and Methods: This cross‐sectional survey comprised 118,601 schoolchildren in the 12–15‐year age group. Data came from the National Oral Health Survey in mainland China. The field investigation was conducted according to the World Health Organization guidelines. The new 2018 case definition for plaque‐induced gingivitis was used. Participants underwent clinical examinations and completed a structured questionnaire. Bleeding on probing (BOP) was performed on all teeth. Multinomial logistic regression was used to explore the factors related to the extent of gingivitis. Results: Nearly half of the study population (47.3%) had plaque‐induced gingivitis; 23.9% and 23.3% presented with localised and generalised gingivitis, respectively. The first molars were the most affected by BOP. Well‐established factors, such as demographic characteristics, socioeconomic status, local factors and smoking habits, were significantly associated with the extent of gingivitis. Odds ratios for localised and generalised gingivitis increased with the decrease in frequency of toothbrushing with a fluoride dentifrice. Conclusions: The study population had high plaque‐induced gingivitis prevalence. The extent of gingivitis appeared to have a dose–response relationship with the frequency of toothbrushing with a fluoride dentifrice. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of different oral irrigators on the sub‐gingival microbiome composition in patients with naturally occurring plaque‐induced gingivitis. Materials and Methods: Sub‐gingival plaque was collected from adults participating in a clinical trial assessing the efficacy of oral hygiene with two different oral irrigators (Waterpik Water Flosser [Group 1] and Oral‐B Water Flosser [Group 2]) versus dental flossing (Group 3) for microbiome analysis. Plaque samples were reflective of naturally occurring plaque‐induced gingivitis at baseline and of gingival health at the endpoint (4 weeks). Clinical measures of gingival inflammation were collected, and the sub‐gingival microbiome was analysed by 16S rRNA sequencing to identify amplicon sequence variants. Results: Oral hygiene instruction with self‐performed manual toothbrushing and water‐jet irrigation led to significant reductions in inflammation for all groups; both oral irrigators outperformed flossing in bleeding‐on‐probing reduction (p <.001). Microbiome diversity of sub‐gingival plaque remained relatively stable over time, but significant changes were noted in certain taxa, consistent with increases in the relative abundance of commensals and reductions in late colonizers and periodontal pathogens in the water‐jet groups. Conclusions: Reduction in gingival inflammation at 4 weeks within the water‐jet groups is accompanied by slight but critical changes in microbiome composition. Although biodiversity does not substantially change within 4 weeks during the resolution of naturally induced gingivitis, significant relative increases in commensal early colonizers such as Streptococcus, Veillonella and Fusobacterium were accompanied by a shift towards a less anaerobic microbiota associated with return to health. These changes were contingent upon the type of interdental hygiene, with Group 1 exhibiting more significant alterations in microbiome composition towards a periodontal‐health‐compatible community. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis is caused by dysbiosis of oral microbes and is associated with increased cognitive decline in Alzheimer's disease (AD), and recently, a potential functional link was proposed between oral microbes and AD. We compared the oral microbiomes of patients with or without AD to evaluate the association between oral microbes and AD in periodontitis. Materials and Methods: Periodontitis patients with AD (n = 15) and cognitively unimpaired periodontitis patients (CU) (n = 14) were recruited for this study. Each patient underwent an oral examination and neuropsychological evaluation. Buccal, supragingival and subgingival plaque samples were collected, and microbiomes were analysed by next‐generation sequencing. Alpha diversity, beta diversity, linear discriminant analysis effect size, analysis of variance‐like differential expression analysis and network analysis were used to compare group oral microbiomes. Results: All 29 participants had moderate to severe periodontitis. Group buccal and supragingival samples were indistinguishable, but subgingival samples demonstrated significant alpha and beta diversity differences. Differential analysis showed subgingival samples of the AD group had higher prevalence of Atopobium rimae, Dialister pneumosintes, Olsenella sp. HMT 807, Saccharibacteria (TM7) sp. HMT 348 and several species of Prevotella than the CU group. Furthermore, subgingival microbiome network analysis revealed a distinct, closely connected network in the AD group comprised of various Prevotella spp. and several anaerobic bacteria. Conclusions: A unique microbial composition was discovered in the subgingival region in the AD group. Specifically, potential periodontal pathogens were found to be more prevalent in the subgingival plaque samples of the AD group. These bacteria may possess a potential to worsen periodontitis and other systemic diseases. We recommend that AD patients receive regular, careful dental check‐ups to ensure proper oral hygiene management. [ABSTRACT FROM AUTHOR]

Aim: To identify predictors of treatment outcomes following surgical therapy of peri‐implantitis. Materials and Methods: We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft‐tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation. Results: Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD ≥6 mm and plaque at more than two sites. Conclusions: Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri‐implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft‐tissue recession. The importance of smoking cessation and patient‐performed plaque control is also underlined. [ABSTRACT FROM AUTHOR]

Aim: Consumption of free sugars has been associated with chronic non‐communicable diseases. The aim of the study was to investigate the effect of free‐sugar consumption on gingival inflammation using a systematic review and meta‐analysis based on the PICO question 'What impact does the restriction of free sugars have on the inflammation of gingival tissue?' Materials and Methods: Literature review and analyses were based on the Cochrane Handbook for Systematic Reviews of Interventions. Controlled clinical studies reporting on free‐sugar interventions and gingival inflammation were included. Risk of bias was performed with ROBINS‐I and ROB‐2, and effect sizes were estimated with robust variance meta‐regressions. Results: Of the 1777 primarily identified studies, 1768 were excluded, and 9 studies with 209 participants with gingival inflammation measures were included. Six of these studies reported on the dental plaque scores of 113 participants. Restriction of free sugars, when compared with no such restriction, was associated with statistically significantly improved gingival health scores (standard mean difference [SMD] = −0.92; 95% confidence interval [CI]: −1.43 to −0.42, p <.004; I2 [heterogeneity] = 46.8) and a trend towards lower dental plaque scores (SMD = −0.61; 95% CI: −1.28 to 0.05, p <.07; I2 = 41.3). The observed improvement of gingival inflammation scores with restricted consumption of free sugar was robust against various statistical imputations. No meta‐regression models were feasible because of the limited number of studies. The median publication year was 1982. Risk‐of‐bias analysis showed a moderate risk in all studies. Conclusion: Restriction of free sugar was shown to be associated with reduced gingival inflammation. The systematic review was registered at PROSPERO (CRD 42020157914). [ABSTRACT FROM AUTHOR]

Aim: To explore whether adjunctive antibiotics can relevantly influence long‐term microbiota changes in stage III–IV periodontitis patients. Materials and Methods: This is a secondary analysis of a randomized clinical trial on periodontal therapy with adjunctive 500 mg amoxicillin and 400 mg metronidazole or placebo thrice daily for 7 days. Subgingival plaque samples were taken before and 2, 8, 14 and 26 months after mechanical therapy. The V4‐hypervariable region of the 16S rRNA gene was sequenced with Illumina MiSeq 250 base pair paired‐end reads. Changes at the ribosomal sequence variant (RSV) level, diversity and subgingival‐microbial dysbiosis index (SMDI) were explored with a negative binomial regression model and non‐parametric tests. Results: Overall, 50.2% of all raw reads summed up to 72 RSVs (3.0%) that were generated from 163 stage III–IV periodontitis patients. Of those, 16 RSVs, including Porphyromonas gingivalis, Tannerella forsythia and Aggregatibacter actinomycetemcomitans, changed significantly over 26 months because of adjunctive systemic antibiotics. SMDI decreased significantly more in the antibiotic group at all timepoints, whereas the 2‐month differences in alpha and beta diversity between groups were not significant at 8 and 14 months, respectively. Conclusions: Mechanical periodontal therapy with adjunctive antibiotics induced a relevant and long‐term sustainable change towards an oral microbiome more associated with oral health. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether there is an association between subgingival microbial diversity and reduced respiratory function. Materials and Methods: A group of dentate 58–72‐year‐old men in Northern Ireland had a comprehensive periodontal examination including subgingival plaque sampling. DNA was extracted from plaque samples and the V1–V3 regions of the 16S rRNA gene were analysed by high‐throughput sequencing and a microbial diversity index (MDI) was derived. Spirometry measurements were made using a wedge bellows spirometer. The primary outcome variable of interest was the percentage of predicted forced expiratory volume in 1 s (% predicted FEV1). Analysis included multiple linear regression with adjustment for various confounders. Results: Five‐hundred and seven men were included in the analysis. The mean age was 63.6 years (SD = 3.1). Of these, 304 (60.0%) men had no or mild periodontitis, 105 (20.7%) had moderate periodontitis and 98 (19.3%) had severe periodontitis. Multiple linear regression analysis showed that a one unit increase in MDI was associated with a 0.71% loss (95% confidence interval: 0.06%–1.35%; p =.03) in % predicted FEV1 after adjustment for all confounders. Conclusions: In this group of dentate men from Northern Ireland, subgingival microbial diversity was associated with reduced respiratory function. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICO question: In systemically healthy humans with peri‐implant mucositis, what is the efficacy of patient‐performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow‐up? Materials and Methods: Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated. Results: Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies = 16; npatients = 650; WMD = 14.25%; 95% CI [9.06–19.45]; p <.001; I2 = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns = 5; np = 229; WMD = 22.72%; 95% CI [19.40–26.04]; p < 0.001; I2 = 94.8%), followed by probiotics (ns = 6; np = 260; WMD = 12.11%; 95% CI [3.20–21.03]; p =.008; I2 = 93.3%) and systemic antibiotics (ns = 3; np = 101; WMD = 5.97%; 95% CI [1.34–10.59]; p =.012; I2 = 58.1%). Disease resolution was scarcely reported (n = 6). Conclusions: Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient‐performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of professionally administered chemical agents as an adjunctive treatment to sub‐marginal instrumentation (SMI) in the therapy of peri‐implant mucositis. Materials and Methods: The primary outcome criteria were reduction in bleeding on probing (BOP), whereas resolution of disease, elimination of suppuration, including suppuration on probing, reduction of peri‐implant probing pocket depth, reduction of plaque, and patient‐reported outcome measures were considered as secondary outcome parameters. A literature search was performed on three electronic databases (01/1980 to 05/2022) focused on clinical studies with at least 3 months of follow‐up, and meta‐analyses were performed when appropriate. Results: From a total of 139 publications, 40 articles were identified for full‐text reading, and 5 randomized controlled clinical trials (RCTs) on antimicrobial photodynamic therapy (aPDT), 1 RCT on chlorhexidine (CHX), and 1 RCT on sodium hypochlorite (NaOCl) were included. Three studies had a low risk of bias and four had a mid‐level (some concerns) risk of bias. The application of aPDT, 0.95% NaOCl, or 0.12% CHX as an adjunctive treatment to SMI showed no difference in changes in BOP and PD compared with SMI alone (p >.05). Conclusions: Within the limitations of this review and based on a low level of evidence from seven RCTs, it is concluded that the professional adjunctive topical application of aPDT, 0.95% NaOCl, and 0.12% CHX may not be effective to improve changes for BOP and PD when compared with SMI alone. [ABSTRACT FROM AUTHOR]

Aim: To develop a simple and reproducible method for semi‐automated planimetric quantification of dental plaque. Materials and Methods: Plaque from 20 healthy volunteers was disclosed using erythrosine, and fluorescence images of the first incisors, first premolars, and first molars were recorded after 1, 7, and 14 days of de novo plaque formation. The planimetric plaque index (PPI) was determined using a semi‐automated threshold‐based image segmentation algorithm and compared with manually determined PPI and the Turesky modification of the Quigley–Hein plaque index (TM‐QHPI). The decrease of tooth autofluorescence in plaque‐covered areas was quantified as an index of plaque thickness (TI). Data were analysed by analysis of variance (ANOVA) and Pearson correlations. Results: The high contrast between teeth, disclosed plaque, and soft tissues in fluorescence images allowed for a fast threshold‐based image segmentation. Semi‐automated PPI is strongly correlated with manual planimetry (r = 0.92; p <.001) and TM‐QHPI recordings (r = 0.88; p <.001), and may exhibit a higher discriminatory power than TM‐QHPI due to its continuous scale. TI values corresponded to optically perceived plaque thickness, and no differences were observed over time (p >.05, ANOVA). Conclusions: The proposed semi‐automated planimetric analysis based on fluorescence images is a simple and efficient method for dental plaque quantification in multiple images with reduced human input. [ABSTRACT FROM AUTHOR]

Aim: To evaluate bar‐supported maxillary implant overdenture treatment when supported by either four or six implants after 10 years. Materials and Methods: Edentulous subjects with maxillary denture complaints and ample bone volume to facilitate implants in the anterior region of the maxilla were planned for implant overdenture treatment, randomized to receive either four implants (n = 25) or six implants (n = 25) and subsequently evaluated after 10 years of function. Outcome variables included peri‐implant bone‐level changes, implant and overdenture survival, complications, presence of plaque, calculus and bleeding, degree of peri‐implant inflammation, probing depth and patient satisfaction. Differences between the groups and between evaluation periods were tested with a Student's t‐test. Results: Fourteen patients with totally 72 implants were lost to follow‐up. Two patients from the six‐implant group experienced implant loss (four implants), resulting in 96.1% implant survival in this group versus 100% survival in the four‐implant group. Clinical, radiographical and patient‐reported outcome measures did not differ statistically significant between the two groups. Patients from both groups were generally quite satisfied with the result after 10 years. Conclusions: Similar and favourable outcomes are seen in bar‐supported maxillary overdentures on either four or six anteriorly placed implants after a 10‐year evaluation period. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis (PD) is the sixth most prevalent disease around the world and is involved in the development and progression of multiple systemic diseases. Previous studies have reported that PD may aggravate liver injuries. The objective of this study was to investigate whether and how PD affects liver fibrosis. Materials and Methods: Ligature‐induced PD (LIP) was induced in male C57/B6J mice, and sub‐gingival plaques (PL) from patients with PD were applied to mouse teeth. Liver fibrosis was induced by carbon tetrachloride (CCl4) injection. The mice were randomly divided into six groups: Oil, Oil+LIP, Oil+LIP+PL, CCl4, CCl4+LIP, and CCl4+LIP+PL. Alveolar bone resorption was evaluated by methylene blue staining. Hepatic function was analysed by serum alanine aminotransferase and hepatic hydroxyproline. Picrosirius red and α‐smooth muscle actin (SMA) staining were used to evaluate the fibrotic area. RNA sequencing and quantitative RT‐PCR were used to measure gene expression. Western blotting was used to measure protein levels. Flow cytometry was used to analyse the accumulation of immune cells. Mouse microbiota were analysed using 16S rRNA gene sequencing. Results: Mice in the CCl4+LIP+PL group displayed higher serum alanine aminotransferase and hepatic hydroxyproline as well as more Picrosirius red‐positive and α‐SMA‐positive areas in liver samples than those of the CCl4 group, suggesting that PD (LIP+PL) aggravated CCl4‐induced hepatic dysfunction and liver fibrosis. Consistently, the expression of fibro‐genic genes and the protein levels of transforming growth factor β were much higher in the CCl4+LIP+PL group than in the CCl4 group. Flow cytometry revealed that PD increased the accumulation of immune cells, including Kupffer cells, B cells, and Th17 cells, in the liver of mice with CCl4 treatment. PD also increased the expression of inflammatory genes and activated pro‐inflammatory nuclear factor‐kappa B pathway in the livers of CCl4‐injected mice. Moreover, PD altered both oral and liver microbiota in CCl4‐injected mice. Conclusions: PD aggravates CCl4‐induced hepatic dysfunction and fibrosis in mice, likely through the increase of inflammation and alteration of microbiota in the liver. [ABSTRACT FROM AUTHOR]

Aim: To compare the level of inflammatory markers, oral health‐related quality of life (OHRQoL), and gingival parameters 1 month after introduction of electric toothbrush and intensive oral hygiene manoeuvre adaptation (OHI) versus routine habits (no‐OHI) in patients affected by generalized gingivitis. Materials and Methods: One hundred forty subjects with generalized gingivitis were randomized to receive either OHI or no‐OHI. Full‐mouth plaque/bleeding scores (FMPS/FMBS), serum high‐sensitivity C‐reactive protein (hs‐CRP), interleukin‐6 (IL‐6), and an oral health impact profile‐14 questionnaire were collected at baseline and at 1‐month follow‐up visit. Results: In the OHI, a significant FMPS and FMBS reduction (p <.01), a significant intra‐group decrease in hs‐CRP and IL‐6 (p <.01), and a significant improvement of OHRQoL (p <.01) were noted at 1‐month follow‐up visit. In the no‐OHI, lower‐magnitude differences were noted only for oral parameters. Resolution of gingivitis varied between OHI and no‐OHI (89% vs. 7%, respectively, p <.01). A logistic multivariate regression suggested that FMBS ≤8% was associated with the odds ratio of 13, having both CRP and IL‐6 below the selected threshold for healthy young adults (p =.04). Conclusions: Gingivitis resolution determined important reductions of gingival inflammation and plaque levels, as well as systemic inflammatory markers and an improvement of quality of life (NCT03848351). [ABSTRACT FROM AUTHOR]

Aim: This randomized placebo‐controlled clinical trial evaluated the effects of multispecies probiotic containing Lactobacillus rhamnosus HN001™, Lactobacillus paracasei Lpc‐37®, and Bifidobacterium animalis subsp lactis HN019™ as an adjunct to mechanical debridement (MD) on changes in bleeding on probing (BOP) in edentulous patients with peri‐implant mucositis (PiM). Materials and Methods: Patients were randomly assigned to test (probiotic) or control (placebo) groups. All sites with PiM received MD and topical gel application (probiotic or placebo) at baseline and 12 weeks. After initial MD, patients consumed probiotic or placebo capsules twice a day for 12 weeks. Clinical (modified sulcus bleeding index [mSBI]; modified plaque index [mPI]; probing depth [PD]; and BOP) and immunological parameters were collected at baseline and after 12 and 24 weeks. Data were statistically analysed (p <.05). Results: Thirty‐six patients with PiM were recruited. The test group presented higher prevalence (p <.05) of cases of restored peri‐implant health at 24 weeks than did the control group (72.2% and 33.3%, respectively). No significant difference was observed between test (n = 18) and control (n = 18) groups for mPI and PD. mSBI %—score 0 was higher in the test group than in the control group at 24 weeks (p <.05). When compared with baseline, both groups presented reduced BOP at 12 and 24 weeks (p <.05). BOP was lower in the test group than in the control group at 12 (mean difference = −14.54%; 95% confidence interval [CI] = −28.87 to 0.22; p =.0163) and 24 (mean difference = −12.56%; 95% CI = −26.51 to 1.37; p =.0090) weeks. At 24 weeks, only the test group presented lower levels of interleukin (IL)‐1β, IL‐6, IL‐8, and tumour necrosis factor (TNF)‐α than those at baseline (p <.05). Conclusions: The multispecies probiotic (administered locally and systemically) containing L. rhamnosus HN001™, L. paracasei Lpc‐37®, and B. lactis HN019™ as an adjunct to repeated MD promotes additional clinical and immunological benefits in the treatment of PiM in edentulous patients (ClinicalTrials.gov NCT04187222). [ABSTRACT FROM AUTHOR]

Aim: To discover and validate differential protein biomarker expression in saliva and gingival crevicular fluid (GCF) to discriminate objectively between periodontal health and plaque‐induced periodontal disease states. Materials and Methods: One‐hundred and ninety participants were recruited from two centres (Birmingham and Newcastle upon Tyne, UK) comprising healthy, gingivitis, periodontitis, and edentulous donors. Samples from the Birmingham cohort were analysed by quantitative mass spectrometry proteomics for biomarker discovery. Shortlisted candidate proteins were then verified by enzyme‐linked immunosorbent assay in both cohorts. Leave‐one‐out cross validation logistic regression analysis was used to identify the best performing biomarker panels. Results: Ninety‐five proteins were identified in both GCF and saliva samples, and 15 candidate proteins were selected based upon differences discovered between the donor groups. The best performing panels to distinguish between: health or gingivitis and periodontitis contained matrix metalloproteinase‐9 (MMP9), S100A8, alpha‐1‐acid glycoprotein (A1AGP), pyruvate kinase, and age (area under the curve [AUC] 0.970); health and gingivitis contained MMP9, S100A8, A1AGP, and pyruvate kinase, but not age (AUC 0.768); and mild to moderate and advanced periodontitis contained MMP9, S100A8, A1AGP, pyruvate kinase, and age (AUC 0.789). Conclusions: Biomarker panels containing four proteins with and without age as a further parameter can distinguish between periodontal health and disease states. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to answer the following focused question: "In partially edentulous patients with periodontitis, are removable dental prostheses (RDPs) more efficacious than no prosthetic treatment, treatment to a shortened dental arch (SDA), or tooth‐supported fixed dental prostheses (FDPs)?" Materials and methods: A systematic literature search was performed electronically for the period 1966–2020. Two authors independently assessed the studies for eligibility according to the PRISMA guidelines. Risk assessment was performed using RoB 2.0 and the Newcastle–Ottawa Scale. Results: Two retrospective studies indicated that RDPs increased the risk of tooth loss compared to FDPs in patients with a history of periodontitis. Prospective studies found that RDPs could be maintained without any significant periodontal destruction on a long‐term basis. Owing to the heterogeneity of the data, no meta‐analysis could be performed. Several studies indicated that RDP increased plaque accumulation. RDPs had only a limited effect on masticatory efficiency and nutritional status. RDPs may improve oral‐health‐related quality of life (OHRQoL), but to a lesser extent compared with that of patients treated to an SDA. Conclusions: There is no strong evidence that RDPs per se will cause periodontal destruction including tooth loss. RDPs do not inevitably improve masticatory efficiency but improve OHRQoL, although less than for patients treated with FDPs including resin‐bonded FDPs. [ABSTRACT FROM AUTHOR]

Aim: The aim was to assess two macronutrient interventions in a 2 × 2 factorial dietary design to determine their effects on oral health. Materials and Methods: Participants (65–75 years old) with a body mass index between 20 and 35 kg/m2 of a larger randomized control trial who consented to an oral health assessment were recruited. They had ad libitum access to one of four experimental diets (omnivorous higher fat or higher carbohydrate, semi‐vegetarian higher fat or higher carbohydrate) for 4 weeks. The periodontal examination included periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing. Oral plaque and gingival crevicular fluid (GCF) were collected before and after the intervention. Results: Between baseline and follow up, the number of sites with a CAL <5 mm (mean difference [MD] −5.11 ± 9.68, p =.039) increased and the GCF amount (MD −23.42 ± 39.42 Periotron Units [PU], p =.050) decreased for the semi‐vegetarian high‐fat diet. For the mean proportion of sites with PPD reduction of >1 mm and CAL gain of >1 mm, significant differences were calculated between the diets investigated. The clinical parameters were not associated with changes in the oral microbiota. Conclusions: The results of this study provided evidence that a semi‐vegetarian high‐fat diet provides benefits to clinical parameters of periodontal health. This study is registered in ClinicalTrials.gov (ACTRN12616001606471). [ABSTRACT FROM AUTHOR]

Aim: To test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results: Three‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion: A person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effects of a 6‐week Mediterranean diet (MD) intervention on gingival inflammatory and anthropometric parameters of patients with gingivitis. Materials and methods: Forty‐two participants were allocated to MD group (MDG) or control group (CG). After a 2‐week equilibration period regarding dental care procedures, only MDG changed their diet to MD for 6 weeks, supported by a diet counselling. Gingival and anthropometric parameters were assessed at baseline (T0), Week 2 (T1, beginning of MD intervention), and Week 8 (T2). Adherence to MD was assessed by the Mediterranean Diet Adherence Screener (MEDAS); dietary behaviour was evaluated by the German Health Interview and Examination Survey for Adults Food Frequency Questionnaire (DEGS‐FFQ). Results: Plaque values remained constant in both groups. Inflammatory periodontal and anthropometric parameters decreased in the MDG only (gingival index: T1 1.51 ± 0.21, T2 1.49 ± 0.24; bleeding on probing: T1 51.00 ± 14.65, T2 39.93 ± 13.74; body weight: T1 79.01 ± 15.62, T2 77.29 ± 17.00; waist circumference: T1 84.41 ± 10.1, T2 83.17 ± 10.47 (p <.05). MEDAS revealed a sufficient diet adherence for MDG. Conclusion: Within this study, gingival inflammatory parameters were significantly reduced by MD, whereas plaque parameters remained constant. The diet counselling achieved sufficient adherence with beneficial changes in weight loss and waist circumference. [ABSTRACT FROM AUTHOR]

Aim: To assess the microbial effects of mechanical debridement in conjunction with a mouthrinse on sites with peri‐implant mucositis and gingivitis. Materials and methods: Eighty‐nine patients with peri‐implant mucositis were included in a double‐blinded, randomized, placebo‐controlled trial with mechanical debridement and 1‐month use of either delmopinol, chlorhexidine (CHX), or a placebo mouthrinse. Submucosal and subgingival plaque samples of implants and teeth were collected at baseline and after 1 and 3 months, processed for 16S V4 rRNA gene amplicon sequencing, and analysed bioinformatically. Results: The sites with peri‐implant mucositis presented with a less diverse and less anaerobic microbiome. Exposure to delmopinol or CHX, but not to the placebo mouthrinse resulted in microbial changes after 1 month. The healthy sites around the teeth harboured a more diverse and more anaerobe‐rich microbiome than the healthy sites around the implants. Conclusions: Peri‐implant sites with mucositis harbour ecologically less complex and less anaerobic biofilms with lower biomass than patient‐matched dental sites with gingivitis while eliciting an equal inflammatory response. Adjunctive antimicrobial therapy in addition to mechanical debridement does affect both dental and peri‐implant biofilm composition in the short term, resulting in a less dysbiotic subgingival biofilm. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of a commercially available adjunctive phototherapy protocol ("Perio‐1") in treatment of periodontitis. Materials and Methods: In an examiner‐blind, randomized, controlled, split‐mouth, multicentre study, 60 periodontitis patients received root surface debridement (RSD) in sextants either alone (control sextants) or with the adjunctive phototherapy protocol (test sextants). Re‐evaluation was performed at 6, 12 and 24 weeks. Results: No statistically significant differences in mean (± standard deviation) clinical attachment level (CAL) change from baseline to week 24 were observed between test (−1.00 ± 1.16 mm) and control sextants (−0.87 ± 0.79 mm) at sites with probing pocket depths (PPDs) ≥5 mm ("deep sites") at baseline (p =.212). Comparisons between test and control sextants for all other parameters (CAL change at all sites, PPD change at deep sites/all sites, bleeding on probing, plaque scores), and for all change intervals, failed to identify any statistically significant differences. Conclusions: The phototherapy protocol did not provide any additional clinical benefits over those achieved by RSD alone. (German Clinical Trials Register DRKS00011229). [ABSTRACT FROM AUTHOR]

Aims: SARS‐CoV‐2 RNA has been recovered from different sites in the human body, including the mouth. The present study aimed to investigate the presence of SARS‐CoV‐2 RNA in the dental biofilm of symptomatic patients who tested positive in nasopharyngeal and oropharyngeal (NASO/ORO) samples. Materials & Methods: An observational clinical study of individuals with flu‐like symptoms was conducted between July and September 2020. Dental biofilm (BIO) samples were collected and analysed using real‐time quantitative polymerase chain reaction (RT‐qPCR) to determine the virus's presence. Results: Seventy participants (40 ± 9.8 years of age, 71.4% female) tested positive for SARS‐CoV‐2 RNA in NASO/ORO samples and were included in the study. Among them, 13 tested positive in BIO samples (18.6%; 95% CI: [9.5, 27.7]). The median and interquartile range of cycle quantification (Cq) for NASO/ORO and BIO samples were 15.9 [6.9] and 35.9 [4.0] (p =.001), respectively. BIO‐positive participants showed a higher virus load in NASO/ORO samples (p =.012) than those testing negative (Cq = 20.4 [6.1]). Conclusions: Dental biofilms from symptomatic COVID‐19 patients harbour SARS‐CoV‐2 RNA and might be a potential reservoir with an essential role in COVID‐19 transmission. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the correlation between bacterial dental plaque accumulation and gingival health in subjects with history of periodontitis attending a maintenance programme including personal oral hygiene measures (pOH) at short and extended intervals. This study is a secondary analysis of a randomized clinical trial. Materials and Methods: Forty‐two subjects were randomized into groups performing pOH at 12‐, 24‐ or 48‐h intervals. The Plaque Index (PlI), Gingival Index (GI) and bleeding on probing (BoP) were recorded at baseline, 30 and 90 days. For the analysis, pOH groups were collapsed into subjects performing pOH at daily (G12/24) or extended (G48) intervals. Summary statistics and Spearman correlations between plaque accumulation and gingival inflammation are presented. Results: G12/24 and G48 subjects showed significant increases in plaque scores and percentage sites with gingival inflammation over the course of study. At 90 days, G48 subjects showed significantly greater GI and BoP scores than G12/24 subjects. While PlI/GI correlations were not affected by pOH interval, PlI/BoP correlations remained unchanged with short to increase with extended pOH intervals. Conclusion: pOH interval influences the correlation between bacterial dental plaque accumulation and gingival inflammation. Subjects using extended pOH intervals exhibit an increased correlation allowing accumulation of bacterial dental plaque to the detriment of gingival health. (ClinicalTrials.gov: 50208115.9.0000.5346). Clinical Trials: ClinicalTrials.gov: NCT02684682. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the soft tissue morphology under healthy and experimental mucositis conditions comparing zirconia and titanium implants. Methods: Forty‐two patients with two adjacent missing teeth received one zirconia (Zr) and one titanium (Ti) implant, with the mesial and distal position randomized. At 3 months, half of the patients were instructed to continue (healthy; h) and the other half to omit (experimental mucositis; m) oral hygiene around the implants for 3 weeks. Clinical parameters were evaluated before and after the experimental phase, and a soft tissue biopsy was harvested. Mixed model analyses were performed to analyse the data. Results: The plaque control record increased significantly for the two mucositis groups, reaching 68.3 ± 31.9% (mean ± SD) for Zr‐m and 75.0 ± 29.4% for Ti‐m (p <.0001), being also significantly lower for Zr‐m than for Ti‐m. Bleeding on probing remained stable in group Zr‐m and amounted to 21.7 ± 23.6%, but increased significantly in group Ti‐m (p =.040), measuring 32.5 ± 27.8%. The number of inflammatory cells and the length of the junctional epithelium did not significantly differ between the groups. Conclusion: Both implants rendered similar outcomes under healthy conditions. Lower plaque and bleeding scores were detected for zirconia implants under experimental mucositis conditions. Histologically, only minimal differences were observed. [ABSTRACT FROM AUTHOR]

Aim: To determine the effects of glycine powder air‐polishing (GPAP) as an adjunct to full‐mouth scaling and root planing (SRP) on clinical, inflammatory and microbiological outcomes in patients with untreated periodontitis. Materials and Methods: Forty‐one patients were randomly assigned to the control group A (SRP) and test groups B1 (subgingival GPAP right after SRP) and B2 (subgingival GPAP right before SRP). Clinical examinations and sample collections (saliva, subgingival plaque, serum and gingival crevicular fluid) were performed at assessment visits and before therapies at clinical visits of baseline, 6‐week and 3‐month. C‐reactive protein, IL‐6 and TNF‐α were assessed in serum and gingival crevicular fluid, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were measured in saliva and subgingival plaque. Results: Patients in control and test groups did not significantly differ by age, sex and disease severity at baseline. Participants in control and intervention groups had similar improvements in clinical parameters (PD, BOP, PLI and BI). All groups had a similar percentage of sites showing PD reduction of ≥2 mm between baseline and follow‐up visits, with a few exceptions. Reduced C‐reactive protein, IL‐6 and TNF‐α in serum were found after treatments. Conclusion: Full‐mouth SRP with and without GPAP resulted in largely similar clinical, inflammatory and microbiological outcomes in the care of untreated periodontitis. [ABSTRACT FROM AUTHOR]

Aims: T‐cells are known to have a role in periodontitis, however, the effect of periodontal therapy on peripheral memory T‐cells is unclear. This study evaluated variation in peripheral memory T‐cells and red complex bacteria in sub‐gingival plaque in patients undergoing periodontal management. Methods: Peripheral blood mononuclear cells and sub‐gingival plaque were collected from 54 periodontitis patients at baseline, 3‐, 6‐ and 12‐months post‐therapy and 40 healthy controls. Periodontitis patients were divided into treatment outcome (TxO) groups based on prevalence of sites with probing depth ≥5 mm as good (<10% of sites), moderate (10–20%) or poor (>20%) at study conclusion. Naïve (TN—CCR7+CD45RA+), central memory (TCM—CCR7+CD45RA−), effector memory (TEM—CCR7−CD45RA−) and effector memory T‐cells re‐expressing CD45RA (TEMRA—CCR7−CD45RA+) were phenotyped using flow cytometry in CD4+, CD8+, CD4+CD8+ and CD4−CD8− T‐cells and red complex bacteria were quantified using qPCR. Results: At baseline, periodontitis subjects had significantly greater mean probing depths and Porphyromonas gingivalis proportions, lower TN but higher CD4+ TCM, CD8+ TCM, CD4+CD8+ TEM and CD4−CD8− TEM cell proportions compared to health. Periodontal therapy decreased mean probing depths, P. gingivalis proportions, TEM and CD4+ and CD8+ TCM cells, but increased TN and CD4+ and CD8+ TEMRA cells. The T‐cell profile in the good TxO group showed therapy‐related changes in CD4+ TEM, and CD8+ TN and TEM cells, whereas, no changes were observed in the poor TxO group. Conclusion: Management and the reduction in red complex bacteria were associated with changes in peripheral memory T‐cells in periodontitis. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of this investigation was to analyse the periodontal microbiome in patients with aggressive periodontitis (AgP) following treatment. Methods: Sixty‐six AgP patients were recalled on average 7 years after completion of active periodontal treatment and had subgingival plaque samples collected and processed for 16S rRNA gene sequencing analyses. Results: Of 66 participants, 52 showed persistent periodontal disease, while 13 participants were considered as "successfully treated AgP" (no probing pocket depths >4 mm) and 1 was fully edentulous. Genera associated with persistent generalized disease included Actinomyces, Alloprevotella, Capnocytophaga, Filifactor, Fretibacterium, Fusobacterium, Leptotrichia, Mogibacterium, Saccharibacteria [G‐1], Selenomonas and Treponema. "Successfully treated" patients harboured higher proportions of Haemophilus, Rothia, and Lautropia and of Corynebacterium, Streptococcus and Peptidiphaga genera. Overall, patients with persistent generalized AgP (GAgP) revealed higher alpha diversity compared to persistent localized AgP (LAgP) and stable patients (p <.001). Beta diversity analyses revealed significant differences only between stable and persistent GAgP groups (p =.004). Conclusion: Patients with persistent AgP showed a more dysbiotic subgingival biofilm than those who have been successfully treated. It remains to be established whether such differences were predisposing to disease activity or were a result of a dysbiotic change associated with disease recurrence in the presence of sub‐standard supportive periodontal therapy or other patient‐related factors. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional study investigated the effect of the vitamin D receptor (VDR) FokI polymorphism and its interactions with smoking/drinking on the proportions of periodontal pathogens and periodontitis severity. Materials and Methods: FokI genotyping and bacterial quantification were performed using real‐time polymerase chain reaction. Periodontitis severity was determined using mean clinical attachment level (CAL). Regression analyses examined the associations between the FokI polymorphism (rs2228570) and bacterial proportions or periodontitis severity. Effect modification by smoking or drinking was assessed. Results: The study population comprised 1,460 individuals, aged 39–66 years. After multivariable adjustment, the FokI risk genotypes (CC + CT) were associated with elevated Porphyromonas gingivalis proportions (regression coefficient (β) =0.294 ± 0.139; p =.034) and increased mean CAL (β = 0.130 ± 0.048; p =.007). The effect of the FokI polymorphism on P. gingivalis proportions was greater in smokers (β = 0.897 ± 0.328; p =.006) compared to non‐smokers (β = 0.164 ± 0.153; p =.282) and in drinkers (β = 0.668 ± 0.242; p =.006) compared to non‐drinkers (β = 0.114 ± 0.169; p =.500). The genotype*smoking interaction for P. gingivalis proportions was significant (p =.043), whereas the genotype*drinking interaction was not (p =.061). Similar results were found for the effect of the genotype*smoking/drinking interaction on mean CAL. Conclusions: These findings suggest that the interplay between the host genotype and smoking is important in determining the subgingival microbial composition and periodontitis severity. [ABSTRACT FROM AUTHOR]

Aim: This systematic review synthesizes the available clinical evidence concerning efficacy of mechanical oral hygiene devices in periodontal maintenance patients. Material and Methods: Three databases were searched up to October 2019 for clinical trials conducted in adult patients in periodontal maintenance which evaluated the effect of toothbrushes or an interdental device on plaque removal and parameters of periodontal diseases. Descriptive analysis and network meta‐analysis (NMA) were performed. Results: Sixteen eligible publications, including 17 relevant comparisons, were retrieved. Four out of five comparisons found no clinical difference between a manual and power toothbrush. Of the interdental cleaning devices, the interdental brushes (IDBs) reduced plaque scores more effectively than a manual toothbrush alone. For the oral irrigator, two out of three comparisons indicated a positive effect on gingivitis scores, and probing pocket depth. The NMA demonstrated that for plaque removal the adjuvant use of IDBs was significantly more effective than the manual toothbrush alone. For the reduction of gingival inflammation, no product ranked higher than the manual toothbrush. Conclusion: Due to the scarcity of studies that met the inclusion criteria for each of the oral hygiene devices and the low certainty of the resultant evidence, no strong "evidence‐based" conclusion can be drawn concerning any specific oral hygiene device for patient self‐care in periodontal maintenance. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of adjunctive therapies in reducing gingivitis and plaque by means of a systematic review of randomized clinical trials (RCTs). Material and Methods: A search protocol was designed to identify 6‐month RCTs that investigated the efficacy of adjuncts to mechanical plaque control on gingivitis and plaque. Following screening, relevant information was extracted, and quality and potential risk of bias were estimated. Mean treatment differences were calculated to obtain standardized mean differences and weighted mean differences (SMD and WMD) as appropriate. Results: Meta‐analyses included 70 studies of adjunctive antiseptics. Compared with mechanical plaque control alone, adjuncts yielded statistically significant reductions in gingival index (n = 72; SMD = −1.268; 95% CI [−1.489; −1.047]; p <.001; I2 = 96.2%), bleeding (%) (n = 26, WMD=−14.62%; 95% CI [−18.01%; −11.23%]; p <.001; I2 = 95.1%), plaque index (n = 93, SMD = −1.017; 95% CI [−1.194; −0.840]; p <.001; I2 = 95.3%) and plaque (%) (n = 23; WMD = −18.20%; 95% CI [−24.00%; −12.50%]; p <.001; I2 = 96.9%). Mouthrinses resulted in greater reductions in per cent plaque compared with dentifrices (meta‐regression, coefficient = 13.80%; 95% CI [2.40%; 25.10%]; p =.020). The antiseptic agents were similarly effective in reducing gingivitis and plaque in patients with dental plaque‐induced gingivitis (intact periodontium) or previously treated periodontitis with gingival inflammation. Conclusion: Adjunctive antiseptics in mouthrinses and dentifrices provide statistically significant reductions in gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Aim: This randomized clinical trial evaluated the effect of the frequency of self‐performed mechanical plaque control (SPC) on gingival health in subjects with a history of periodontitis. Materials and Methods: Forty‐two subjects participating in a routine periodontal maintenance program were randomized to perform SPC at 12‐, 24‐ or 48‐hr intervals. Plaque index (PlI) and gingival index (GI) were evaluated at baseline, and days 15, 30 and 90 of study. Probing depths, clinical attachment levels and bleeding on probing were assessed at baseline, days 30 and 90. Mixed linear models were used for the analysis and comparison of experimental groups. Results: Mean GI at baseline remained unchanged throughout study (90 days) only in the 12‐hr group (0.7 ± 0.1 versus 0.8 ± 0.1; p <.05). At the end of study, mean GI was significantly increased in the 48‐hr group over that in the 12‐ and 24‐hr groups. When GI = 2 scores were considered, only the 48‐hr group failed to maintain gingival health throughout the study (18.8%). Conclusion: SPC performed at a 12‐ or 24‐hr frequency appears sufficient to controlling gingival inflammation whereas this clinical status was not maintained using a 48‐hr frequency in subjects with a history of periodontitis subject to a routine periodontal maintenance program (ClinicalTrials.gov: 50208115.9.0000.5346). [ABSTRACT FROM AUTHOR]

Aim: The study aim was to investigate the predictive role of obesity on clinical response following non‐surgical periodontal therapy in individuals with severe periodontitis. Methods: A total of 57 BMI obese and 58 BMI normal non‐smoker adults with periodontitis (defined as probing pocket depths (PPD) of ≥5 mm and alveolar bone loss of >30% with >50% of the teeth affected) received non‐surgical periodontal therapy. Periodontal status was based upon PPD, clinical attachment level (CAL) and full‐mouth bleeding score (FMBS). Mean PPD, percentage sites PPD >4 mm, percentage sites PPD >5 mm and FMBS at 2 and 6 months were outcome variables. Propensity score analysis was used to assess the effect of obesity on outcome variables after adjusting for confounders. Results: Statistically significant higher clinical measures (mean PPD, mean percentage of sites with PPD >4 mm, mean percentage of sites with PPD >5 mm and FMBS) were observed in the obese group than the normal group at baseline, 2 and 6 months after therapy (p <.01). At 2 and 6 months, obesity was associated with worse mean PPD (p <.05), percentage sites with PPD >4 mm (p <.05), percentage sites with PPD > 5mm (p <.05) and FMBS (p <.01), independent of age, gender, ethnicity or plaque levels. Conclusions: Obesity compared to normal BMI status was an independent predictor of poorer response following non‐surgical periodontal therapy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of smoking on the reduction of pockets >4 mm deep and a composite variable of residual pockets >4 mm and bleeding on probing (BoP) after treatment. Methods: Eligible after exclusion due to missing records were 3,535 individuals, referred for periodontal treatment between 1980 and 2015. The number of teeth (NT), probing pocket depth (PPD), proportion of plaque (PLI) and BoP were registered before treatment and 1 year after treatment. To analyse the impact of smoking on PPD reduction, a mixed model adjusted for age, sex, type of therapy, baseline PPD, reduction of PLI, BoP and NT was used. Depending on residual PPD and BoP, two categories were created: good and poor responders. Results: PLI was reduced by 20% in non‐smokers and by 18% in smokers, and BoP by 46% and 37%, respectively. In the adjusted mixed model, the mean reduction of PPD > 4 mm among smokers undergoing surgery was 14.4 versus 9.7 in non‐smokers (p <.001). The odds ratio for being a poor responder was 2.40 (95% CI 1.99–2.91, p <.001) for smokers. Conclusion: Although surgical treatment reduced PPD >4 mm in smokers more effectively than in non‐smokers, significantly more non‐smokers were good responders after periodontal therapy. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to investigate the effect of a 3‐month strict oral hygiene phase on key parameters of periodontitis: plaque, bleeding on probing (BOP) and probing pocket depth (PPD). Materials and Methods: Forty‐four patients with severe periodontal disease were randomly allocated to a test or a control group. The test group completed a 3‐month strict oral hygiene phase. The control group did not receive any instructions or motivation on oral hygiene until after the 3‐month period. Plaque, BOP and PPDs were registered on four sites of each tooth at baseline and after 3 months in both groups, as well as after the postponed hygiene phase in the control group. Results: A statistically significant and profound reduction in plaque, BOP and PPD was observed after the 3 months in the test group. No change to the better occurred in the control group. Conclusion: A 3‐month strict oral hygiene phase in patients referred for periodontal therapy reduced plaque, BOP and pocket depth to such an extent that it could affect therapy planning. [ABSTRACT FROM AUTHOR]

Aim: Few data are available regarding the long‐term impact of supportive implant therapy (SIT) on peri‐implant diseases. We present long‐term results on the possible effects of SIT on the peri‐implant tissues. Material and methods: In a private practice, 50 consecutive patients with 101 implants had attended an SIT programme for >6 years (SIT group). A second consecutive group comprised patients without SIT compliance (C group). We assessed pocket probing depth (PPD), bleeding on probing (BOP), bone loss (BL) and implant hygiene (QHI). Correlations between SIT compliance and the prevalence of peri‐implant diseases were evaluated statistically. Results: The inclusion criteria were met by 48 patients with 98 implants (SIT group) and 43 patients with 121 implants (C group). SIT group: Mucositis rate 30%; mean PPD 3.76 ± 0.86 mm; bone loss 1.02 ± 0.85 mm, peri‐implantitis rate 4%. C group: Mucositis rate 68%; mean PPD 4.07 ± 1.18 mm; bone loss 1.53 ± 1.46 mm; and peri‐implantitis rate 17%. Significant associations were found between SIT compliance and reduced peri‐implant mucositis (p =.019), reduced highest PPD (p =.038) and peri‐implantitis rates (p =.027). Conclusions: Patients under SIT were associated with lower incidence of peri‐implant diseases. Patients without regular maintenance might exhibit a 4.25‐fold increased risk for peri‐implantitis. Therefore, SIT programmes should be considered essential. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the association between liver cirrhosis and periodontitis. Methods: This case–control study included 294 individuals, 98 cases with liver cirrhosis and 196 controls. A full‐mouth periodontal examination was performed and plaque index, probing depth, clinical attachment level and bleeding on probing were recorded. The association of risk variables with periodontitis was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. Results: A high prevalence of periodontitis was observed among cases (62.2%) when compared to controls (41.8%). Individuals with cirrhosis presented a chance ~2 higher of having periodontitis than controls (OR = 2.28; 95% CI 1.39–3.78; p < .001). Significant variables associated with periodontitis in the final logistic models were as follows: (a) no/occasional alcohol use model—number of teeth up 14, age ≥45–55 years, male sex and smoking; (b) moderate and intensive alcohol use models—cirrhosis, number of teeth up 14, age ≥45–55 years, male sex and smoking. Conclusions: An important risk association between liver cirrhosis and periodontitis was observed. Additionally, the intensive alcohol use significantly increased the risk for periodontitis. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional study examined the associations between periodontitis and the serum cardiac biomarkers—soluble ST2 (sST2) and C‐reactive protein (CRP)—in systemically healthy adults. Materials and Methods: Periodontitis severity was determined using mean probing depth (PD) or clinical attachment level (CAL) and a categorical variable (no/mild, moderate, or severe). Oral hygiene was evaluated using plaque scores. Regression analyses assessed the associations between periodontal variables and sST2 or CRP levels, adjusting for age, sex, smoking, body mass index, systolic blood pressure, fasting plasma glucose, and high‐density or low‐density lipoprotein cholesterol. Results: The study population comprised 799 individuals, aged 50–73 years. After multivariable adjustment, greater mean PD/CAL, severe periodontitis, and poor oral hygiene were associated with elevated sST2 and CRP levels (p < 0.05). Greater mean PD or CAL was associated with increased odds of having sST2 in the top quintile (>22.7 μg/L) (odds ratio [OR] [95% confidence interval (CI)]: 1.7 [1.1–2.4] and 1.3 [1.1–1.7], respectively) and CRP > 3 mg/L (OR: 1.5 [1.1–2.1] and 1.3 [1.0–1.5], respectively). Individuals with poor oral hygiene were more likely to have sST2 > 22.7 μg/L (OR: 2.0 [1.0–4.0]) and CRP > 3 mg/L (OR: 2.0 [1.1–3.5]), compared to those with good oral hygiene. Conclusions: Periodontitis and poor oral hygiene were associated with elevated serum sST2 and CRP levels. [ABSTRACT FROM AUTHOR]

Aim: The aim of this network meta‐analysis (NMA) was to compare the efficacy of different oral hygiene products for chemical biofilm control, in 6‐month home‐use, randomized clinical trials (RCTs), in terms of changes in gingival index (GI). Material and Methods: Six‐month RCTs assessing GI were identified and screened for inclusion. Relevant information was extracted, and quality and potential risk of bias were estimated. Mean differences between baseline and end were calculated to obtain standardized mean differences (SMDs). NMA protocols were applied to assess direct and indirect comparisons among products using Löe & Silness GI, modified GI and gingival severity index. Results: Fifty‐three papers were included, 19 studies for mouth rinses, 32 for dentifrices, comprising data from 5,775 and 2,682 subjects, respectively. When ranking treatments, similar results were observed for all tested dentifrices, with the lowest effect observed for sanguinarine and baking soda. For mouth rinses, essential oils, triclosan–copolymer, chlorhexidine (at concentrations ≥ 0.10%) and cetylpyridinium chloride (>0.05%) demonstrated the greatest effect. Conclusion: Although NMA revealed significant differences when comparing placebo versus some active agents, when comparing among active agents, no differences were found for dentifrices, while mouth rinses containing essential oils showed the greatest effect on GI scores. [ABSTRACT FROM AUTHOR]

Aim: To evaluate periodontal status in first‐degree relatives of patients with rheumatoid arthritis (FDR‐RA) and detect correlation with the presence of anti‐citrullinated protein antibodies (ACPAs). Materials and Methods: Rheumatologic status and periodontal status were evaluated in a nested case–control study of FDR‐RA with no diagnosis of RA at enrolment. The following parameters were assessed in 34 ACPA‐positive (ACPA+) and 65 ACPA‐negative (ACPA−) subjects: gingival index (GI), plaque index (PI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL). We compared the two groups using conditional logistic regression. Results: In ACPA+ individuals, the mean, PD, BOP, CAL and number of sites per person with PD > 4 mm and BOP were significantly higher compared to the ACPA‐ group. All ACPA+ subjects had periodontitis: 44.1% presenting moderate and 47.1% severe periodontitis. ACPA‐ subjects had mainly mild (30.8%) and moderate (27%) periodontitis, differences being significantly different for both moderate periodontitis (p = 0.001) and severe periodontitis (p < 0.001). In multivariable analyses, ACPA status (p = 0.04) and age (p = 0.002) were significantly and independently associated with periodontal conditions. Conclusion: High prevalence and severity of periodontitis in FDR‐RA was associated with seropositivity to ACPAs. This further strengthens the hypothesis that periodontitis may be a risk factor in the development of RA. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the sequential and differential expression of a variety of antimicrobial peptides (AMPs) during the development of an experimentally induced gingivitis in humans. Material and methods: In twenty healthy volunteers, gingival inflammation was induced by abstention from oral hygiene at 6 teeth. Bleeding on probing (BOP) and plaque index (PI) were assessed, and gingival biopsies and gingival crevicular fluid (GCF) were collected at 8 different time points (t0‐t35). Gingival epithelial cells (GECs) were stimulated with various receptor agonists. In biopsies and GECs, mRNA expression of human beta‐defensins (hBD‐2, hBD‐3), CC‐chemokine ligand 20 (CCL20), S100A7/psoriasin (S100A7), and calgranulin A/B (S100A8, S100A9) was evaluated using real‐time PCR, and protein profiles were measured by ELISA. Statistical analysis was performed using non‐parametric tests. Results: The clinical parameters BOP, PI and GCF increased over time (p < 0.0001). Tissue AMP mRNA expression was elevated, but at different and AMP‐specific time points (p < 0.05). Protein analysis revealed a similar expression pattern for hBD‐2 and CCL20 in GCF (p < 0.05). In GECs, multiple receptor stimulation was required to induce AMP gene expression (p < 0.0001). Conclusions: For the first time, this study showed the sequential and differential expression of AMPs during a developing inflammation in vivo providing further evidence for their role as guardians of a healthy periodontium. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of mobile applications and text messages, compared with conventional oral hygiene instructions, for improving oral health knowledge and/or reducing gingival inflammation, when delivered to adolescents, adults and mothers of young children. Methods: Randomized clinical trials evaluating the use of mobile applications or text messages related to oral hygiene and/or oral health education were screened. A search was performed in the Medline‐PubMed, Scopus and Embase databases and the grey literature. The eligible studies comprised those related to plaque, gingival bleeding and/or oral health knowledge as outcomes. The risk of bias was assessed with the Cochrane tool and the GRADE system. Two meta‐analyses were carried out. Results: Among the fifteen studies selected, twelve (80%) used text messages and thirteen (87%) showed better results when mobile technology was used. The pooled SMD for the dental plaque index (n = 10 studies) was −9.43 (95% CI −14.36 to −4.495; I2 = 99%, p < 0.001), and that of gingival bleeding (n = 7 studies) was −8.54 (95% CI −13.16 to −3.91; I2 = 99%, p < 0.001), indicating significant improvement in dental plaque control and gingival bleeding for groups that received the mobile health (mHealth) strategy. Conclusion: mHealth can be used as an adjunct component in managing gingivitis, acquiring oral health knowledge and improving oral hygiene. [ABSTRACT FROM AUTHOR]

Aim: (a) To investigate the influence of the keratinized mucosa (KM) on peri‐implant health or disease and (b) to identify a threshold value for the width of KM for peri‐implant health. Materials and Methods: The total dataset was subsampled, that is one implant was randomly chosen per patient. In 87 patients, data were extracted at baseline (prosthesis insertion) and 5 years including the width of mid‐buccal KM, bleeding on probing, probing depth, plaque index and marginal bone level (MB). Spearman correlations with Holm adjustment for multiple testing were used for potential associations. Results: Depending on the definition of peri‐implant diseases, the prevalence of peri‐implantitis ranged from 9.2% (bleeding on probing threshold: <50% or ≥50%) to 24.1% (threshold: absence or the presence). The prevalence of peri‐implant mucositis was similar, irrespective of the definition (54%–55.2%). The width of KM and parameters for peri‐implant diseases demonstrated negligible (Spearman correlation coefficients: −0.2 < ρ < 0.2). No threshold value was detected for the width of mid‐buccal KM in relation to peri‐implant health. Conclusion: The width of KM around dental implants correlated to a negligible extent with parameters for peri‐implant diseases. No threshold value for the width of KM to maintain peri‐implant health could be identified. [ABSTRACT FROM AUTHOR]

Objective: Periodontal disease is a possible contributing factor to preterm delivery. The aim of this study was to compare the periodontal status of women with preterm prelabour rupture of membranes (PPROM) and women with uncomplicated singleton pregnancies. Patients and Methods: Seventy‐eight women with PPROM at gestational ages between 24 + 0 and 36 + 6 weeks and 77 healthy women with uncomplicated pregnancies, matched for gestational age at sampling without preterm birth, were included in this study. All women underwent evaluation of periodontal and oral hygiene status. Results: Women with PPROM had higher gingival and plaque indexes in crude analysis (gingival index: median 0.80 versus 0.20; p < 0.0001; plaque index: median 0.80 versus 0.10; p < 0.0001), even after adjustment for smoking status (p < 0.0001 and p < 0.0001). Mean clinical attachment loss (CAL) and probing pocket depth (PPD) values were higher in women with PPROM in the crude analysis (CAL: median 2.3 mm versus 1.8 mm; p < 0.0001; PPD: median 2.3 mm versus 1.8; p < 0.0001), as well as after adjustment for smoking status (p < 0.0001 and p < 0.0001). Conclusions: Pregnant women with PPROM residing in central Europe had worse periodontal status than women with uncomplicated pregnancies. [ABSTRACT FROM AUTHOR]