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Objectives. We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. Methods. Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results. There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions. Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes

Endothelial dysfunction is a key triggering event in atherosclerosis. Following the entry of lipoproteins into the vessel wall, their rapid modification results in the generation of advanced glycation endproduct epitopes and subsequent infiltration of inflammatory cells. These inflammatory cells release receptor for advanced glycation endproduct (RAGE) ligands, specifically S100/calgranulins and high-mobility group box 1, which sustain vascular injury. Here, we demonstrate critical roles for RAGE and its ligands in vascular inflammation, endothelial dysfunction, and atherosclerotic plaque development in a mouse model of atherosclerosis, apoE-/- mice. Experiments in primary aortic endothelial cells isolated from mice and in cultured human aortic endothelial cells revealed the central role of JNK signaling in transducing the impact of RAGE ligands on inflammation. These data highlight unifying mechanisms whereby endothelial RAGE and its ligands mediate vascular and inflammatory stresses that culminate in atherosclerosis in the vulnerable vessel wall., Introduction The metabolic and biochemical milieu generated upon entry of lipid into the vessel wall drives the generation of ligands of the receptor for advanced glycation endproduct (RAGE), including advanced [...]

Objectives. We measured and contrasted general dentists' and periodontists' involvement in 3 areas of managing diabetic patients--assessment of health status, discussion of pertinent issues, and active management of patients--and identified and contrasted predictors of active management of diabetic patients. Methods. We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%). Results. Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists ([R.sup.2]=0.46, P Conclusions. Our findings permitted us to assess and compare general dentists' and periodontists' behavior in 3 realms--assessment of diabetic patients' health status, discussion of pertinent issues, and active management of diabetic patients--and to identify components of potentially effective targeted interventions aimed at increasing specialists' and generalist dentists' involvement in the active management of diabetic patients. doi:10.2105/AJPH.2006.086496

A survey was conducted on general practitioners (GPs) in northeastern United States, on smoking-cessation. The survey reveals that dentists should change their attitude and demeanor towards patients suffering from diabetes besides educating them of smoking hazards. Diabetes mellitus, the disease that is of a concern to United States, is also discussed.

Objectives. We explored the association between diabetes mellitus and oral disease in a low-socioeconomic status urban population. Methods. Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results. There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions. Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes (Am J Public Health. 2004;94: 755-758)

Author(s): Akihiko Taguchi [1]; David C. Blood [1]; Gustavo del Toro [1]; Anthony Canet [1]; Daniel C. Lee [1]; Wu Qu [1]; Nozomu Tanji [1]; Yan Lu [1]; Evanthia Lalla [...]

Aim: Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non‐surgical periodontal therapy. Materials and Methods: Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non‐smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non‐surgical periodontal therapy. Meta‐regressions were conducted to evaluate correlations between outcomes and other contributing factors. Results: Seventeen studies were included. The post‐treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: −0.33 mm, 95% confidence interval (CI): [−0.49, −0.17], p <.01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: −0.20 mm, CI: [−0.39, −0.02], p <.01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups. Conclusions: Smoking negatively impacts clinical responses to non‐surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non‐smokers. [ABSTRACT FROM AUTHOR]

Aims: We conducted a randomized controlled trial to assess the clinical outcomes of two loading protocols involving either immediate or delayed prosthetic temporization of single implants placed at posterior, healed sites. Materials and Methods: Forty‐nine patients in need of single implants at premolar or molar sites were randomized to receive a temporary crown either immediately after implant placement or 3 months later. Randomization was stratified by sex, implant location (premolar/molar) and arch (maxilla/mandible). Final implant screw‐retained zirconia crowns with angulated screw channels were delivered at 5 months after surgery. Radiographic bone levels (primary outcome), peri‐implant mucosal margin levels and peri‐implant probing depths were recorded at baseline, 6 and 12 months after surgery. Results: Both treatment arms showed similar patterns of soft tissue and bone re‐modelling from the implant platform over 12 months [mean bone level change 1.6 mm (SD 1.0 mm) in the delayed, and 1.2 mm (SD 1.3 mm) in the immediate temporization group], with the majority of changes occurring within the first 6 months. Conclusions: Immediate or delayed temporization of single implants placed at posterior healed sites resulted in largely similar 1‐year outcomes with respect to peri‐implant bone levels and soft tissue changes. [ABSTRACT FROM AUTHOR]

Monocytes and macrophages are major cellular components of the innate immunity that play essential roles in tissue homeostasis. The contribution of different subsets of monocytes/macrophages to periodontal health and disease has not been fully elucidated. Type 2 diabetes mellitus (T2DM) is a risk factor for periodontitis. We hypothesized that the monocyte/macrophage signaling is perturbed in periodontitis-affected sites versus periodontally healthy sites and that this perturbation plays a critical role in the pathogenesis of periodontitis. Pairs of gingival tissue samples (each from a periodontally healthy and a periodontitis-affected site of the same patient) were harvested from 27 periodontitis patients, with and without T2DM. Each sample was processed to form a single-cell suspension, and a flow-cytometry panel was designed and validated to study monocyte and macrophage phenotypes. In separate experiments, the transcriptional changes associated with a pro-inflammatory phenotype were also examined in monocyte/macrophage subsets obtained from peripheral blood of patients with T2DM versus diabetes-free controls. A significantly higher proportion of intermediate (CD14+CD16+) monocytes was observed in periodontitis-affected tissues compared to healthy tissues. These monocytes overexpressed HLA-DR and PDL1 molecules, suggesting their activated inflammatory status. PDL1 increase was specific to intermediate monocytes. The ratio of M1/M2 macrophages was also significantly higher in periodontally affected sites, signifying an imbalance between inflammatory and repair mechanisms. We found a significantly higher expression of PDL1 in overall monocytes and M1 macrophages in periodontitis-affected sites compared to controls. Importantly, we identified a subpopulation of M1 macrophages present in periodontally affected tissues which expressed high levels of CD47, a glycoprotein of the immunoglobulin family that plays a critical role in self-recognition and impairment of phagocytosis. Analysis of the transcriptional landscape of monocytes/macrophages in gingival tissue of T2DM patients with periodontitis revealed a significant disruption in homeostasis toward a proinflammatory phenotype, elevation of pro-inflammatory transcription factors STAT1 and IRF1, and repression of anti-inflammatory JMJD3 in circulating monocytes. Taken together, our results demonstrate disruption of myeloid-derived cell homeostasis in periodontitis, with or without T2DM, and highlight a potentially significant role of these cell types in its pathogenesis. The impact of macrophage and monocyte signaling pathways on the pathobiology of periodontitis should be further evaluated. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare thick versus thin connective tissue grafts (CTG) for the treatment of gingival recession, over a 3-month period.Methods: Forty-two CTG procedures were performed on single tooth Miller Class I or II recession defects at either premolar or anterior sites in 30 individuals. Procedures were randomized (1:1 ratio) to CTG thickness of 1 or 2 mm (parallel group design). Primary outcomes were the change in the width of the zone of keratinized tissue and the amount of root coverage achieved 3 months postoperatively at the recipient site. Secondary outcomes included change in the thickness of keratinized tissue at 3 months and patient-reported outcomes, such as pain, bleeding, and swelling at both the recipient and donor sites at 1 week, 2 weeks, 1 month, and 3 months.Results: No significant differences were found between the two groups for any of the primary or secondary outcomes. Mean root coverage achieved was 2.1 ± 0.2 mm in the 1-mm thick group and 2.5 ± 0.2 mm in the 2-mm thick group (P = 0.33). Keratinized tissue width was increased by 2.2 ± 0.2 mm in the 1-mm thick group and by 2.7 ± 0.3 mm in the 2-mm thick group (P = 0.18). Keratinized tissue thickness was increased by 1.0 ± 0.1 mm and by 1.2 ± 0.1 mm in the 1- and 2-mm thick groups, respectively (P = 0.09).Conclusion: Within the current study limitations, our results suggest that similar root coverage and increase in the width and thickness of keratinized tissue can be achieved at 3 months whether a 1- or 2-mm thick CTG is used. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aimed to evaluate the impact of diabetes mellitus on clinical outcomes of non‐surgical periodontal therapy. Materials and Methods: Searches were conducted in electronic databases to screen studies published from January 1960 to August 2018. The included studies had at least two groups of patients: chronic periodontitis only (P) or both diabetes and chronic periodontitis (DMP). Outcomes of interest included the difference between the two groups in probing depth (PD) reduction and clinical attachment level (CAL) gain following non‐surgical periodontal therapy. Meta‐regression was conducted to evaluate the correlation between the outcomes of interest and contributing factors. Results: A total of 12 studies with a follow‐up period up to 6 months were included. There was no significant difference in PD reduction (p = 0.55) or CAL gain (p = 0.65) between the two groups. A positive association between PD reduction and baseline PD difference (p = 0.03), and a negative association between PD reduction and age (p = 0.04) were found. The level of HbA1c at baseline did not significantly affect the difference in PD reduction (p = 0.39) or CAL gain (p = 0.44) between two groups. Conclusions: Recognizing the study's limitations, we conclude that diabetes mellitus (HbA1c ≤ 8.5%) does not appear to significantly affect short‐term clinical periodontal outcomes of non‐surgical periodontal treatment. [ABSTRACT FROM AUTHOR]

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non‐carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon‐Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm‐induced inflammation (such as neoplastic diseases); 2) diabetes‐associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking – now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues – is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non‐carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm‐induced gingival inflammation and loss of periodontal supporting tissues. Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented. [ABSTRACT FROM AUTHOR]

Multiple studies over many decades have demonstrated that diabetes mellitus and periodontitis are closely linked and may amplify one another. This review provides a different look at the complex association between these two common, chronic conditions and discusses decision-making in the management of affected individuals. [ABSTRACT FROM AUTHOR]

Aim Soluble CD163 ( sCD163) has been implicated as a new biomarker in inflammatory conditions. The aim of this cross-sectional study was to assess CD163 levels systemically and locally in patients with chronic periodontitis. Methods sCD163 levels were measured by ELISA in serum samples from 70 periodontitis and 70 periodontally healthy subjects, and in saliva samples in a subset of the population. Two gingival biopsies were harvested per subject from 20 periodontitis patients: one from a periodontally affected site, the other from a healthy site, and the relative expression of CD163 mRNA was assessed by real-time PCR. Results Serum sCD163 was significantly higher in periodontitis patients compared to periodontally healthy subjects (720.0 ± 330.6 ng/ ml versus 510.7 ± 219.6 ng/ ml, respectively; p < .001). Similarly, sCD163 levels in saliva were significantly increased in periodontitis compared to healthy subjects (3.01 ± 5.07 ng/ ml versus 1.98 ± 4.95 ng/ ml, respectively; p = .009). Serum and saliva sCD163 levels showed a positive correlation (Kendall's tau .27, p = .018). Importantly, CD163 gene expression was significantly higher in affected sites compared to unaffected sites in periodontitis patients, with a mean fold upregulation of 9.9 ( STD: 15.3, p = .010). Conclusion Our findings suggest that CD163 may be involved in the pathogenesis of periodontitis and its link with systemic conditions. [ABSTRACT FROM AUTHOR]

doi:10.1111/j.1741-2358.2009.00311.x Oral disease experience of older adults seeking oral health services Objective: The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community-dwelling older adults who regularly utilize dental services in New York City. Background: Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well-documented, the dental care needs of older adults who access dental services are not well documented. Materials and Methods: Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross-sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine. Results: Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth. Conclusions: While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that periodontal disease may be a source of systemic inflammation that impacts overall health. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease and adverse outcomes in diabetes mellitus and pregnancy. With the aim of assessing oral health knowledge and orientations of physicians in training, we surveyed incoming internal medicine trainees about their general knowledge, attitudes, and behaviors/practices about periodontal health and disease. Methods: A 16-question survey was distributed during orientation to incoming internal medicine trainees at a single urban teaching hospital in New York City in 2007 and 2008. Questions aimed to assess the knowledge levels of the subjects about periodontal disease and their attitudes toward discussing/evaluating the periodontal status of their patients. The study was approved by the Montefiore Institutional Review Board. Results: Of 125 incoming medical trainees queried, 115 responded (92% response rate). Of the 115 responders, 96% were medical interns. The median age of the trainees was 27 years (interquartile range: 26 to 29 years), and 61% were female. Overall, 34% of the trainees answered all five true/false general knowledge questions correctly, 82% reported that they never asked patients if they were diagnosed with periodontal disease, 90% reported not receiving any training about periodontal disease during medical school, 69% reported that they were not comfortable at all performing a simple periodontal examination, 17% agreed that patients expect physicians to discuss/screen for periodontal disease, 46% felt that discussing/evaluating the periodontal status of their patients was peripheral to their role as physicians, 76% reported never screening patients for periodontal disease, and 23% stated that they never referred patients to dentists. Conclusions: In this study, incoming internal medicine trainees had inadequate knowledge regarding periodontal disease. They were also generally uncomfortable with performing a simple periodontal examination. Oral health training in medical school and the medical postgraduate setting is recommended. [ABSTRACT FROM AUTHOR]

Objective: The progression of diabetes is associated with profound endothelial dysfunction. We tested the hypothesis that cellular stress would be detectable in ECs retrieved from arterial and venous vessels of diabetic mice.Method: We describe a method for direct isolation of well-characterised aortic and venous ECs from mice in which cells are not subjected to propagation in culture.Results: Gene expression profiling, confirmed by real-time PCR, revealed a progressive increase in markers of injury within two main gene families, EC activation and EC apoptosis, in aortic and venous ECs recovered from diabetic versus non-diabetic mice. In short-term diabetes, Il1b mRNA transcripts were higher in aortic and venous ECs of diabetic mice versus controls. In long-term diabetes, casp-1 mRNA transcripts were higher in aortic and venous ECs of diabetic mice versus controls.Conclusion: These data suggest that diabetes imparts diffuse endothelial perturbation in the arterial and venous endothelium. [ABSTRACT FROM PUBLISHER]

Background: The prevalence of diabetes in New Zealand is reaching epidemic proportions, with serious implications for oral health. We investigated the attitudes, beliefs, and practices of New Zealand (NZ) general dental practitioners (GDPs) with respect to the management of patients with diabetes and contrasted the NZ findings with those from a similar survey of GDPs in the Northeast United States (NE US) conducted in 2002. Methods: A nationwide postal survey was conducted of NZ dentists. A random sample was selected from the 2005 New Zealand Dental Register. Responses were received from 437 dentists (response rate: 64.5%). Results: The sample was representative. Most GDPs participated in the assessment and discussion phases of managing patients with diabetes, but the prevalence of more hands-on activities (such as testing) was considerably lower. Three-quarters of dentists asked new patients about their type of diabetes. Just over two in five respondents believed that their evaluation and/or management of the patient with diabetes were hindered by the lack of continuing education opportunities. Almost one-third of dentists were unwilling to screen for diabetes using a finger-stick test, and only 2.6% overall had ever done so. There were only minor differences between NZ and NE US dentists. Conclusion: Given the increasing numbers of patients with diabetes (known and unknown), there is a need for NZ and US dentists to be more involved in their active management. [ABSTRACT FROM AUTHOR]

Porphyromonas gingivalis is a periodontal pathogen that promotes a proatherogenic response in endothelial cells. Cell death responses of human aortic endothelial cells to P. gingivalis at various multiplicities of infection (MOI) were investigated by assessment of cell detachment, histone-associated DNA fragmentation, lactate dehydrogenase release and ADP:ATP ratio. Porphyromonas gingivalis at MOI 1 : 10–1 : 100 did not have a cytotoxic effect, but induced apoptotic cell death at MOI 1 : 500 and 1 : 1000. Monocyte chemoattractant protein-1 production was significantly enhanced by P. gingivalis at MOI 1 : 100. At higher MOI, at least in vitro, P. gingivalis mediates endothelial apoptosis, thereby potentially amplifying proatherogenic mechanisms in the perturbed vasculature. [ABSTRACT FROM AUTHOR]

Background: Approaches to patient care consistent with a greater emphasis on the importance of risk factors associated with periodontal disease should include measures to reduce risk. In this article, we investigate the extent to which periodontists' and general practice dentists' (GPs) behaviors and attitudes reflect current understanding of the most important environmental risk factor for periodontitis (smoking) and the most important systemic disease risk factor for periodontitis (diabetes mellitus). Methods; A mail survey of active periodontists and GPs in the Northeastern United States was conducted during the fall of 2002. Random samples of periodontists and GPs listed in the designated Northeastern states were drawn from the 2002 American Academy of Periodontology Directory and the 2001 American Dental Directory, respectively. Responses were received from 103 periodontists (for a response rate of 73%) and from 105 GPs (for a response rate of 80%). Results: Although periodontists generally perform risk identification and management behaviors for patients who smoke or who have diabetes more frequently than GPs, both groups tend to engage in activities that inquire, discuss, and inform more than they tend to undertake measures to control or manage these risk factors. Rates of proactive patient management activities are quite low in both clinician groups. Conclusions: There is a need to increase periodontists' and GPs' involvement in the active management of the patient who smokes and in the diabetic patient. Such actions can be expected to result in improved periodontal and general health outcomes. [ABSTRACT FROM AUTHOR]

The Receptor for Advanced Glycation End Products (RAGE) is a multiligand member of the immunoglobulin superfamily. RAGE interacts with AGEs, the products of nonenzymatic glycation/oxidation of proteins and lipids that accumulate in diverse settings, such as diabetes, inflammation, renal failure, pro-oxidant states and natural aging. In addition, RAGE is also a receptor for amyloid-β peptide and β-sheet fibril species. Recent studies underscore the premise that RAGE interacts with pro-inflammatory molecules, including S100/calgranulins and amphoterin, the latter also known as high mobility group box 1 (HMGB1). In chronic neurodegenerative disorders as well as in nerve tissue upon acute injury, evidence points to upregulation of both RAGE and these ligand families. In this review, we will discuss the implications of transient/self-limited upregulation of RAGE and its ligands, vs sustained/chronic upregulation of this axis in neurodegeneration vs repair in both the central and peripheral nervous systems. Experimental evidence supports the premise that RAGE bears both homeostatic and injurious properties in the nervous system, thereby highlighting "yin/yang" features of this receptor and its ligand families. [ABSTRACT FROM AUTHOR]