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Periodontitis is an oral chronic inflammatory disease. Inhibiting tissue destruction and promoting tissue regeneration are important means for the treatment of periodontitis. Metformin not only has hypoglycemic effect but also has anti-inflammatory effect. Metformin has been shown to inhibit oxidative stress and activate autophagy through AMPK/mTOR pathway. High mobility group box 1 (HMGB1) has been implicated in the pathogenesis of many inflammatory diseases including periodontitis, it can participate in the induction of oxidative stress. HMGB1 is an autophagy regulator under oxidative stress, which can activate mTOR pathway. However, it is not clear whether metformin is related to HMGB1 and its mechanism in the process of periodontitis. Cell viability and expression of inflammatory cytokines were clarified by Cell Counting Kit-8, real-time PCR and enzyme-linked immunosorbent assay. Western blot and immunofluorescence were conducted to determine HMGB1 intracellular localization and expression of autophagy-associated proteins in vitro. Experimental periodontitis mice model was induced by administering a ligature. Immunohistochemistry was performed to detect the expression and localization of HMGB1 in vivo. The results of CCK-8, real-time PCR, enzyme-linked immunosorbent assay, Western blot and immunofluorescence showed lipopolysaccharide (LPS) treatment inhibited cell viability, and increased HMGB1 expression at a dose-independent manner. Metformin can reduce the effect of LPS. It also improves autophagy pathway inhibited by LPS and down-regulates mTOR expression. In addition, metformin attenuated alveolar bone resorption induced by ligation. This study provides new evidence for that metformin is a potential drug for the treatment of periodontitis and HMGB1 may be a potential target for periodontal intervention.

Objective The objective of this study was to assess characteristics of patients with mandibular osteoradionecrosis (ORN) of severity necessitating segmental mandibulectomy and osteocutaneous free flap reconstruction. Study Design This study is a retrospective review of patients who underwent free flap reconstruction of the mandible at the UCLA Medical Center between January 2016 and February 2020 secondary to ORN. Results Twenty-nine charts with detailed dental and medical records were identified. Hypertension was reported in 14 of 29 patients, diabetes in 2 of 29, osteoporosis in 2 of 29, antiresorptive use in 3 of 29, tobacco use in 15 of 29, and alcohol use in 19 of 29. Twenty-three patients initially had stage III-IV cancer. The median radiation dose was 68 Gy and median time to ORN was 5.2 years. Chemotherapy was given in 21 patients and 4 had previous mandibular surgery. Twelve of 29 patients had surgical procedures identified as the causative factor and 17 of 29 occurred spontaneously. Median decayed, missing, and filled teeth score was 17 and 17 of 29 patients had grade II-IV periodontitis. Periodontitis was present in 8 of 17 of spontaneous and 1 of 12 of surgery cases. Twenty-five of 29 cases occurred in the same oral sextant as the tumor. Conclusion Severe ORN occurred at doses >60 Gy in most cases. Location of the primary tumor was predictive of site of ORN and only molars were involved when precipitated by tooth extraction. Risk of ORN persists indefinitely.

Background: The relationship between Alzheimer’s disease (AD) and periodontitis has been recently investigated with heterogenous results. Objective: This study aims to evaluate the oral health status and its relationship with cognitive impairment of participants, enrolled in the Zabút Aging Project, a community-based cohort study performed in a rural community in Sicily, Italy. Methods: A case-control study (20 subjects with AD, 20 with amnestic mild cognitive impairment [aMCI], and 20 controls) was conducted. The protocol included a comprehensive medical and cognitive-behavioral examination. Full-mouth evaluation, microbial analysis of subgingival plaque samples (by RT-PCR analysis), and oral health-related quality of life (OHR-QoL) were evaluated. Results: The decayed, missing, and filled teeth (DMFT) total score of AD subjects was significantly higher than aMCI (p = 0.009) and controls (p = 0.001). Furthermore, the “M” component of DMFT (i.e., the number of missing teeth) was significantly higher in AD than in aMCI (p

A nine-year-old male developed severe opportunistic apical periodontitis in maxillary permanent first molars following myeloablative anticancer therapy for T cell lymphoblastic lymphoma. His developmental trajectory was characterized by limited dental care adherence, maltreatment and developmental trauma disorder, suggesting that a complex interplay between premorbid dental neglect and chemotherapy-related toxicity had exacerbated the progression of the dental infection. We would like to stress the importance of biopsychosocial assessment for severe periodontal infection to provide individualized supportive intervention, thereby improving the quality of life of patients with poor oral health literacy.

Objetivo: Este estudo teve o objetivo de avaliar a associação entre doença periodontal e obesidade. Métodos: Foi realizada uma busca nas bases PubMed, SciELO e Bireme, sendo incluídos estudos relevantes relacionados ao tema para síntese deste trabalho. Resultados: Foram selecionados treze artigos para serem incluídos nessa revisão, sendo um ensaio clínico, uma meta-análise, dois estudos de coorte, dois caso-controle, cinco estudos transversais e duas revisões sistemáticas. Conclusão: Existe uma plausibilidade biológica entre a obesidade e a doença periodontal, porém não há um consenso na literatura sobre essa associação. Desta forma, são necessários mais estudos prospectivos, laboratoriais, de coorte e meta-análises que avaliem tal associação entre as doenças.

Periodontitis could lead to periodontal destruction such as the loss of alveolar bone. The issue that how to achieve the regeneration of alveolar bone and periodontal tissues under the inflammatory environment needs to be solved urgently. Bone morphogenetic protein 9 (BMP9) is one of the most potent osteoinductive BMPs and induces osteogenic differentiation of mesenchymal stem cells. The aim of this study is to explore the possible effect of BMP9 on the osteogenic differentiation of inflammatory periodontal ligament stem cells (PDLSCs).Human PDLSCs were cultured in osteoinductive medium with 1 μg/mL lipopolysaccharide Porphyromonas gingivitis (LPS-PG). Adenoviral vector expressing system was used to overexpress target genes. In vitro expression of osteogenic markers was assessed by quantitative reverse transcription polymerase chain reaction, Western blotting, alkaline phosphatase assay, and alizarin red staining. Subcutaneous implantation nude mice models were used to evaluate the effects of BMP9 on PDLSCs in vivo. Microcomputed tomography, hematoxylineosin staining, and trichrome staining were performed to assess ectopic bone formation.In the LPS-PG induced inflammatory environment, BMP9 promoted osteogenic differentiation of PDLSCs, but upregulated the expression of inflammatory markers (P 0.05); NEL-like protein 1 (NELL1) downregulated the expression of inflammation genes in PDLSCs induced by BMP9, while augmenting BMP9-induced osteogenesis of the cells both in vitro and in vivo. In the above process, the MAPK/p38/ERK signaling pathway was triggered by NELL1.The combination use of BMP9 and NELL1 might have the potential to promote the regeneration of alveolar bone in periodontitis.

Background This study aimed to examine whether modifiable risk factors can predict tooth loss over 10 years and estimate population attributable risk (PAR) for a combination of modifiable factors. Methods This longitudinal study included 1,466 participants who underwent dental examinations in 2007 and 2017 and were aged 40-79 years at baseline. Periodontal conditions were assessed using the 2018 periodontal classification. Incident tooth loss was defined as ≥4 teeth lost over a 10-year period. We calculated the partial PAR (pPAR%) for tooth loss to estimate the combined effect of modifiable risk factors. Results Incidence of tooth loss was 17.5%. Directed acyclic graphs were used to identify risk factors for tooth loss. A logistic regression model showed that baseline periodontitis, dental caries experience, no regular dental visit, periodontal treatment, smoking, and obesity were associated with tooth loss after adjusting for covariates; pPAR% was 55.5% (95% confidence interval: 31.1-73.0%) in periodontitis stage III-IV and 87.6% (50.4-97.4%) in the combination of all factors, respectively. The sex-stratified analysis showed that smoking and no regular dental visit in men and obesity in women were identified as potential risk factors for tooth loss. Conclusions Modifiable factors accounted for most cases of incident tooth loss. Risk factors for tooth loss might differ by sex, suggesting that the appropriate approach for preventing tooth loss base on sex. This article is protected by copyright. All rights reserved.

Objective: The present study aimed to establish the efficacy of sodium hypochlorite mouthwash (NaOCl-MW) compared with a control mouthwash on plaque and clinical parameters of periodontal disease. Methods: MEDLINE-PubMed, Embase and Cochrane-CENTRAL databases were searched for clinical trials on patients with gingivitis or periodontitis that assessed the effect of NaOCl-MW in comparison with a negative or positive control on plaque index (PI), gingival index (GI), and bleeding index (BI) scores and probing pocket depth (PPD). Data were extracted from the eligible studies. Results: Seven eligible papers were retrieved, which together represented six clinical trials. The studies showed considerable heterogeneity regarding methodological and clinical aspects that did not permit a meta-analysis. Two of the three studies in which NaOCl-MW was compared with a negative control showed that NaOCl-MW significantly reduced PI, GI and BI, and no effect was found on PPD. In three studies, NaOCl-MW was assessed using chlorhexidine mouthwash (CHX-MW) as a positive control; no difference was found for GI and BI. One of the three comparisons showed a statistically significant PI score favouring NaOCl-MW. One study measured PPD and found it to be significant in favour of NaOCl-MW. Conclusions: Studies with a negative control group provided very weak quality evidence for a very small beneficial effect of NaOCl-MW on PI, GI and BI scores. Studies with a positive control group provided very weak quality evidence that NaOCl-MW had a similar effect as CHX-MW on PI, GI and BI scores. The outcome for PPD was inconclusive.

This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.

There is cumulative evidence supporting the negative effects of smoking on periodontal tissues. Smoking cessation can be successfully accomplished through specific programs, including behaviour modification and medications, and has been suggested as a suitable way to reduce the risk of several diseases, including periodontitis. The aim of this review is to provide a concise overview of the current knowledge about the impact of smoking cessation on periodontal tissues and therapy, with data from studies published in the last 15 years. Literature was searched using Medline database from 2005 up to and including September 2020 using medical subject heading (MeSH) terms and other search terms, restricted to the English language. Studies were evaluated and summarised in a narrative review format. Results demonstrated that there is convincing evidence to support the benefits of tobacco cessation in reducing the risk of periodontitis and tooth loss. In addition, the harmful effects of smoking on periodontal tissues seem to be assuaged as the number of years since quitting increases. The existing current evidence, even limited, also shows that smoking cessation may result in additional benefits to the outcome of nonsurgical periodontal treatment. Periodontal care providers should not only check their patient's smoking habit for estimating risk of disease progression and predictability of periodontal therapy, but they should also help smokers improve their oral and systemic health by providing efficient and personalised tobacco-cessation counselling and treatment.

Objective The objective of this study was to assess the efficacy of a tobacco cessation intervention conducted by different dental specialists directed at a group of patients with tobacco-related oral diseases or undergoing implant treatment. Methods The study design was a multicentre, nonrandomized prospective cohort study to examine the effects of smoking cessation. The target patients were current smokers (aged ≥20 years) with an oral potentially malignant disorder or periodontitis and those seeking dental implants. A total of 74 patients were enrolled in the study. All dental specialists who participated in the trial completed an e-learning Japan Smoking Cessation Training Outreach Project (J-STOP) tobacco cessation education programme. Nicotine dependence was evaluated by the Fagerstrom Test for Nicotine Dependence. Cessation status was verified biochemically by measurement of salivary cotinine or exhaled carbon monoxide. Tobacco cessation intervention was implemented for 8 weeks with or without nicotine replacement therapy with follow-up for 12 months. Results A total of 61 patients agreed to the tobacco cessation intervention. The mean biochemically confirmed tobacco abstinence rate was 37.7% at month 3, 34.4% at month 6, and 32.8% at month 12. The highest rate of biochemically confirmed tobacco abstinence at month 12 was among patients receiving implant treatment (42.9%) followed by patients with oral potentially malignant disorder (37.1%), and those with periodontitis (21.1%). Conclusion This interventional study demonstrates the challenges encountered and the feasibility of tobacco cessation intervention among Japanese patients attending dental specialists who had completed an e-learning course on smoking cessation. Making tobacco cessation an integral part of patient management by dental specialists requires further evaluation.

La enfermedad periodontal (EP) es un proceso multifactorial y progresivo que degenera en un tiempo determinado los tejidos alrededor de los dientes; esta se clasifica según su progresión en gingivitis y periodontitis, siendo la periodontitis la última y más agravante instancia de esta enfermedad. La diabetes es una enfermedad crónica e irreversible del metabolismo que afecta los niveles de azúcar del cuerpo; se clasifica en tipo I o insulinodependiente (más común en personas jóvenes), tipo II o no insulinodependiente (más común en personas adultas), y otra variedad conocida como diabetes gestacional (o del embarazo).Se cree que factores como estado socioeconómico, genética, tabaquismo y otras condiciones sistémicas tienen influencia en el control de la enfermedad periodontal y la diabetes, y se afirma que existe una relación bidireccional entre estas dos entidades. Este artículo de revisión pretende ser una herramienta de actualización para profesionales interesados en el tema. En la relación bidireccional que existe entre estas dos patologías hay una injerencia de ciertos factores como el tabaquismo; otras condiciones sistémicas como la obesidad y el embarazo; así como también algunas interacciones medicamentosas. La diabetes mellitus constituye un factor de riesgo para la periodontitis y, al mismo tiempo, el control metabólico de estos pacientes se hace difícil en presencia de periodontitis, poniendo de relieve no solo la relación entre estas dos entidades, sino la importancia de conocerla, con el fin de poder actuar dentro de un equipo interdisciplinario que conlleve a unos mejores resultados en salud para los pacientes afectados.

D vitamine metabolites are necessary nutrients for the human body, they perform important functions. Vitamin D deficiency leads to the development of many somatic diseases, as well as diseases of the periodontal tissues. Pleiotropic effects of vitamin D on periodontal tissues include the impact on parodontopatogens, regulation of the immune response and metabolism of the skeletal system.

Periodontitis and osteoarthritis are major public health concerns that result in decreased quality of life among middle-aged and older adults. We sought to examine whether the severity of periodontitis is related to osteoarthritis according to the presence of type 2 diabetes mellitus.This study included 3,527 participants age ≥50 years from the Korean National Health and Nutrition Examination Survey. Periodontitis was assessed using the Community Periodontal Index; severe periodontitis was defined as periodontal tissue forming deep periodontal pockets ≥6-mm depth. Osteoarthritis was defined as Kellgren/Lawrence grade ≥2 on radiographic images of the knee or hip area with joint pain. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for osteoarthritis according to the severity of periodontitis, stratified by type 2 diabetes mellitus, were calculated using multiple logistic regression analyses.Participants with type 2 diabetes mellitus were more likely to have osteoarthritis as the severity of periodontitis increased (nonsevere periodontitis OR 1.23 [95% CI 0.67-2.32]; severe periodontitis OR 3.01 [95% CI 1.51-5.84]) after adjusting for age, sex, body mass index, smoking status, alcohol consumption, regular exercise, education level, household income, hypertension, and frequent tooth-brushing. However, this positive association was not found in individuals without type 2 diabetes mellitus after adjusting for the same covariables.Severe periodontitis was positively and significantly associated with osteoarthritis in middle-aged and older individuals with type 2 diabetes mellitus. Our findings suggest that the oral inflammation manifesting in periodontitis may be at least partly involved in the pathogenesis of osteoarthritis, particularly in patients with type 2 diabetes mellitus.

Periodontitis is a disease of surrounding dental tissue with a prevalence of 74.1% in Indonesia. Many studies show periodontitis plays a role in the progression of atherosclerosis. The relationship between these two conditions shows that scaling root planing intervention can reduce the risk of atherosclerosis. This study aimed to know the efficacy of scaling root planing on changes in inflammatory biomarkers in periodontitis patients with atherosclerosis. This systematic literature review was conducted using the Rapid Review method that refers to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Electronic searches were carried out from 4 electronic databases, including the National Library of Medicine (Medline / PubMed), The Cochrane Library, EbscoHOST, and SAGE Journal. Inclusion and exclusion criteria selected 6 RCT articles to be analyzed qualitatively. Within 2 to 6 months, research in 6 RCT articles showed the results in significantly reducing CRP levels as the main biomarkers of atherosclerosis after scaling root planing intervention. Other biomarkers that were also assessed are cytokines levels, lipid profile components, WBC, and fibrinogen. Overall results showed a positive effect of scaling root planing intervention in reducing the inflammatory biomarker levels of atherosclerosis in periodontitis patients with atherosclerosis. The treatment of scaling root planing is considered effective in reducing the inflammatory biomarker levels of atherosclerosis in periodontitis patients with atherosclerosis to reduce the level of risk. KEYWORDS: scaling root planing, inflammatory biomarker, atherosclerosis

Trauma from occlusion (TFO) is a local factor that can exacerbate tissue inflammation in periodontitis cases. There have been many clinical studies on TFO, but the prevalence of patients is currently unknown. The purpose of this study was to determine the majority of TFO cases as a factor that aggravates periodontitis based on the medic records at Oral and Dental Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia in 2017-2019. This study used a comprehensive sampling approach to evaluate 10,532 medical records associated with periodontal disease, including factors such as age, sex, causes, and TFO treatment. Descriptive data analysis showed that from a total of 10,532 medical records, there were 391 medical records related to periodontia. A total of 194 samples matched the inclusion criteria. There were 79 TFO patients (40.7%), 3 TFO cases (1.5%), and 112 cases (57.7%) other periodontal diseases without TFO. The prevalence of TFO as a dominant factor aggravating chronic periodontitis at the Oral and Dental Hospital, Syiah Kuala University, Banda Aceh Indonesia in 2017-2019. Patients with elderly age and female sex predominantly experience periodontitis which is aggravated by TFO.KEYWORDS: Occlusal adjustment blocking method, periodontitis, Trauma from occlusion

Background Periodontitis is a major public health problem affecting many adults, with considerable variation in its prevalence and severity worldwide. There is little data on its prevalence or associated risk factors in Ghana making development of evidence based preventive programs challenging. This study assessed the prevalence, severity, extent and associated risk factors of periodontitis in an adult Ghanaian population. Methods A population based cross-sectional study involving adults aged 25 years and above in the Greater Accra Region (GAR) of Ghana. A random stratified two-stage sampling method was used to select participants from rural and urban communities. Data on socio-demographic and risk factors was collected using a semi-structured questionnaire. A full mouth periodontal examination was carried out to diagnose and describe the severity of periodontitis following the CDC-AAP case definition. Results A total of 729 participants were included in the study, with a mean age of 43.9 ±14.6 years and 61% being female. Majority (84.8%) presented with gingivitis, 46.7% had periodontitis with 41.8% having both, and 13.9% had severe periodontitis. The mean clinical attachment loss (CAL) was 1.36 ±0.67mm and 1.41 ±0.57mm for probing pocket depth (PPD). Factors associated with periodontitis included, increasing age, smoking and alcohol use, being Muslim provided lower odds of disease. Older people, former smoking, being underweight and not having health insurance was associated with severe periodontitis. Conclusion This study shows a high burden of periodontitis with comparatively more severe disease. Existing socio-demographic disparities in disease burden highlights the need of developing targeted population based preventive programs. This article is protected by copyright. All rights reserved.

Aim To assess the association between peri-implantitis and cardiovascular diseases (CVD). Methods 128 patients with dental implants were recruited to evaluate the prevalence of peri-implantitis in patients with or without CVD (Cases, n = 82, Controls, n = 46, respectively). Diagnosis of peri-implantitis followed the 2017 World Workshop guideline and the severity was defined as mild, moderate, and severe form when the radiographic bone loss (RBL) was 4 mm. Multivariable logistic regression was performed to test the association between two diseases. Results A trend of higher prevalence of peri-implantitis defined by detectable RBL beyond the physiologic bone remodeling was found in the "Cases" group (64.6%) when compared to the "Controls" (56.5%). A significant higher prevalence (48.8%) of moderate to severe peri-implantitis was identified in "Cases" compared to "Controls"(30.4%) with a significant crude association between moderate to severe peri-implantitis and CVD (odds ratio = 2.18, 95% CI = 1.02 to 4.67, p = 0.04). The CVD group had a trend of higher prevalence of deep pockets (≥ 7mm) and higher numbers of sites with bleeding upon probing (BOP) (> 66%) when compared to "Controls" (p> 0.05). However, after controlling for multiple confounders including age, hypertension, smoking, family history of heart attack, and periodontitis, the significant association was not found. Conclusions CVD group had significantly higher prevalence of moderate to severe peri-implantitis (RBL ≥ 2mm). The association between the two diseases did not exist after controlling multiple confounders for CVD. Future studies with a larger sample size controlling for the patient- and implant-related confounders are needed to better understand the link between peri-implantitis and cardiovascular disease. This article is protected by copyright. All rights reserved.

Purpose This study aimed to investigate the relationship between dental metal allergy, periodontitis, and palmoplantar pustulosis among patients from a dental metal allergy clinic over a period of 8 years. Methods This study included 436 patients who visited our dental metal allergy clinic between April 1, 2009 and March 31, 2016. Diagnoses of skin diseases, periodontal records, dental metal series patch test results, and electron probe microanalysis (EPMA) data were obtained from medical records. Relative risk (RR) values were estimated from these data. Results Of the 359 patients who underwent the patch test, 241 showed a positive reaction. Of the 187 patients who underwent EPMA, 113 had allergenic metals in their dental prostheses. These patients were suspected to have a dental metal allergy. Furthermore, 150 of the 436 patients were diagnosed with palmoplantar pustulosis (PPP). The RR of metal allergy between patients with PPP and healthy subjects was 3.88. The RR of periodontal disease between patients with PPP and PPP-negative patients in the national average was 2.54. Conclusions In this study, both dental metal allergy and periodontitis showed a high RR for PPP.

Objective: To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). Methods: The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. Results: CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. Conclusions: Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.

Background/Aim. Treatment of periodontitis undergoes several treatment phases. Non-surgical periodontal treatment (NSPT) represents the basic treatment stage, and it is applied to all the patients undergoing periodontal treatment. Adjunctive antimicrobial photodynamic therapy (aPDT) is one of several contemporary and relatively new possibilities with a role to inactivate microorganisms responsible for the occurrence and progression of the disease. The aim of this study was to comparatively analyze the clinical and microbiological effects of the NSPT alone, as well as combined with aPDT. Methods. A split-mouth method design was used in a prospective randomized controlled trial. The following clinical parameters were registered and monitored: plaque index (PI), bleeding on probing, probing depth (PD), and clinical attachment level (CAL). The presence of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola was detected by the polymerase chain reaction (PCR) method. Samples were tested before the therapy, as well as three months after the therapy. Therapeutic modalities of NSPT and NSPT with adjunct aPDT were examined. Results. All of the analyzed clinical parameters proved statistically significant improvement after the application of both treatment modalities (p < 0.001). Microbiological analyses showed that the total number of microorganisms was statistically significantly lower after the application of both methods (p < 0.001). Following the treatment, there was a statistically significantly reduced number of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola (p < 0.001). NSPT combined with aPDT led to a statistically significant improvement of both clinical parameters and microbiological status compared to NSPT applied on its own. Conclusion. The study showed improvement of all clinical indicators after the application of both treatment modalities. The total number of microorganisms was reduced as well as the number of specific microorganisms. Combining aPDT with NSPT led to a statistically significantly higher reduction in the number of microorganisms compared to NSPT alone.

Background/purpose Patients with periodontal disease have higher dental fear levels, which may have negative effects on their clinical outcome during scaling and root planing (SRP). The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, SRP pain and periodontal status. Materials and methods A total of 120 periodontitis patients were enrolled and staging according to the new classification of periodontitis. SRP was performed, and the visual analog scale (VAS) to assess pain was used with every patient after treatment. Questionnaires, including Corah's Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and subsequent visits after 6 months. The patients were grouped by DAS scores. The statistical analysis was performed using T-test, chi-square, Pearson and Spearman correlative analysis. Results Compared to pre-SRP treatment, the dental fear level on DFS was decreased in the posttreatment period for all periodontitis stages. There were no statistically significant differences in S-DAI and DAS between pretreatment and posttreatment periods in stage I and II; meanwhile, there were statistically differences in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level was significant. The proportion of high periodontitis stages was increased in high dental fear group. Conclusion SRP can reduce dental fear levels in all periodontitis stages, especially in stage III and IV. Correlations exist among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.

Current periodontal treatments aim to control bacterial infection and decrease inflammation. To optimize contemporary conventional treatments that present limitations owing to an inability to reach the lesion site, new methods are based on nanomedicine. Nanomedecine allows delivery of host-modulatory drugs or antibacterial molecules at the lesion site in an optimal concentration with decreased toxicity and risk of systemic side effects. Chitosan and polylactic-co-glycolic acid-loaded nanoparticles, carbon quantum dots, and mesoporous silicates open new perspectives in periodontitis management. The potential therapeutic impact of the main nanocarriers is discussed.

Periodontitis is a multifactorial inflammatory condition associated with an oral microbiome dysbiosis that results in gingival inflammation and clinical attachment loss. Periodontal therapies are based on scaling and root planing to disturb the bacterial biofilm mechanically and remove calculus and contaminated cementum. Research does not support the use of root modifiers for decontamination and biomodification of periodontally affected root surfaces. Standardized clinical trials in large populations, assessing biological and patient-reported outcome measures, are necessary to evaluate candidate biomaterials for decontamination and biomodification of periodontally affected root surfaces.

Background and aim Periodontitis involves a dynamic disease process, demanding the identification of biomarkers to diagnose the current state of disease activity. Therefore this study assessed the potential of “sTREM-1, IL-1β, and MMP-8” as a short panel of biomarkers of host biological process indicating the inflammatory burden in periodontium and thereby serving as a panel of diagnostic markers in periodontal disease. Methods Sixty eight patients were recruited and allotted into four groups comprising of subjects with clinically healthy gingiva and Stage III/IV Periodontitis with and without type 2 diabetes with HbA1c levels in the range of 6.5–7.9%. Periodontal parameters were measured and full mouth radiographic assessment was done. Whole saliva (unstimulated) samples were collected from all patients and estimation of the levels of markers was done employing ELISA. Results All the three biomarkers were noted to be the lowest in group I (sTREM-1: 75.63 ± 13.77; IL-1β: 15.67 ± 3.39; MMP-8: 85.83 ± 22.32) and highest in group IV (sTREM-1: 138.83 ± 14.89; IL-1β: 39.19 ± 7.20; MMP-8: 201.15 ± 50.32) with statistically significant difference. The difference observed between groups II and III for all the biomarkers assessed were statistically insignificant. The clinical parameters and HbA1c levels had positive correlation with the levels of biomarkers which was statistically significant. Conclusion This study unveils the potential of the short panel of biomarkers (“sTREM-1, IL-1β, and MMP-8”) to be used as diagnostic and possible prognostic markers for Periodontitis. It further corroborates the role of type 2 diabetes mellitus in amplifying the diverse processes that result in periodontal destruction.

Background/purpose In 1906, there was a dental treatment room established in the department of surgery of Taipei Hospital to introduce modern dental services to Taiwan. It is undoubtedly the earliest hospital dentistry in Taiwan. This study tried to assess the dental manpower and treated dental diseases in Taipei Hospital, and hence to explore the appearance of Taiwan's early hospital dentistry. Materials and methods This study utilized the secondary data analysis to evaluate the dental manpower and treated dental diseases of dental outpatients in the 27th Annual Report of Taipei Hospital (Taisho 12th year or 1923). Results Our results found that there were 3 dentists and one dental technician in the dental department of Taipei Hospital in 1923. These 3 dentists totally treated 3 inpatients and 1759 outpatients with 4511 outpatient visits (1959 for male patients and 2552 for female patients) in that year. Dental caries and retained root were the two most common dental diseases in Japanese and Taiwanese dental outpatients, and followed in a descending order by missing tooth, pulp necrosis, and pulpitis for Japanese outpatients as well as pulpitis, suppurative periodontitis, and acute or chronic periodontitis for Taiwanese outpatients. Conclusion We conclude that the dentistry of Taipei Hospital in 1923 does have a modern form of dentistry with 3 dentists and one dental technician. Its dental patients are mainly Japanese and minorly Taiwanese. Moreover, the treated dental diseases are mainly tooth diseases for Japanese outpatients and both tooth and periodontal diseases for Taiwanese outpatients.

Purpose This cross-sectional study aimed to identify impacts of depression, anxiety and stress on periodontitis severity and oral health-related quality of life (OHRQoL). Methods A total of 141 periodontitis patients were recruited. Psychological states were assessed using the Malay short-form Depression, Anxiety and Stress Scales (MDASS-21). Subjects were grouped as positive for depression, anxiety or stress (DAS) (positive-DAS), without DAS (non-DAS), stress-only and anxiety-only. OHRQoL was evaluated using the Malay short-form Oral Health Impact Profile (S-OHIP[M]). Results OHRQoL was associated with MDASS-21, probing pocket depths, recession, clinical attachment levels, number of teeth present and number of teeth with mobility. S-OHIP(M) of positive-DAS subjects was associated with clinical attachment levels, number of teeth present and presence of anxiety. Anxiety-only subjects reported higher S-OHIP(M) scores compared to the non-DAS group. Conclusion OHRQoL of all subjects was negatively impacted by periodontitis severity and tooth loss. Combinations of depression, anxiety or stress led to worse periodontal status and OHRQoL. Subjects with anxiety-only experienced poorer OHRQoL compared to those without depression, anxiety and stress regardless of periodontitis severity. Possible impacts of psychological states on periodontitis and OHRQoL highlights the importance of assessing and improving psychological factors as part of periodontal therapy and to enhance OHRQoL.

Background/purpose: Genetics plays a role in the susceptibility to periodontitis and tooth loss. Several studies examined the involvement of polymorphisms in candidate genes. We hypothesize that bone metabolism-related polymorphisms could be associated with the number of remaining teeth. Materials and methods: Participants in the Pro.V.A. longitudinal Study: 3099 Italians (aged 65+ at baseline), 2196 at follow-up 1 (5yrs), 1641 at follow-up 2 (7yrs) underwent detailed interview and clinical-instrumental examination. Subjects, grouped by remaining teeth number (0, 1–7, 8–19, 20+), were genotyped for six different bone-related polymorphisms: collagen type Iα1 (COL1A1, Sp1, Ss alleles, n = 1068), vitamin D receptor (VDR, Fok I, Ff alleles, n = 300), calcitonin receptor (CALCR, Alu I, CT alleles, n = 1430), estrogen receptor alpha (ESR1, Pvu II and Xba I, Pp and Xx alleles, n = 1335 and n = 1324). Results: COL1A1 associated with dental status: ss carriers had reduced incident tooth loss (p

INTRODUCTION: Periodontitis causes oxidative stress and reduce total antioxidant levels. The aim of this study was to determine the effect of non-surgical periodontal treatment on leptin levels and total antioxidant capacity in chronic periodontitis. MATERIALS AND METHODS: A total of 35 chronic periodontitis (ChP) patients and 35 systemically and periodontal healthy subjects were enrolled in this study. Further, the ChP group received nonsurgical periodontal therapy (NSPT). Leptin and total antioxidant capacity (TAOC) was measured in serum and saliva samples at baseline, 3 months and 6 months after non-surgical periodontal therapy. Clinical parameters measured were measured at baseline, 1, 3 and 6 months interval. RESULTS: The mean serum leptin and TAOC levels in control group were significantly higher compared to chronic periodontitis group (p

Although there is a clear relationship between the degree of obesity and periodontal disease incidence, the mechanisms that underpin the links between these conditions are not completely understood. Understanding that myeloid-derived suppressor cells (MDSCs) are expanded during obesity and operate in a context-defined manner, we addressed the potential role of MDSCs to contribute toward obesity-associated periodontal disease. Flow cytometry revealed that in the spleen of mice fed a high-fat diet (HFD), expansion in monocytic MDSCs (M-MDSCs) significantly increased when compared with mice fed a low-fat diet (LFD). In the osteoclast differentiation assay, M-MDSCs isolated from the bone marrow of HFD-fed mice showed a larger number and area of osteoclasts with a greater number of nuclei. In the M-MDSCs of HFD-fed mice, several osteoclast-related genes were significantly elevated when compared with LFD-fed mice according to a focused transcriptomic platform. In experimental periodontitis, the number and percentage of M-MDSCs were greater, with a significantly larger increase in HFD-fed mice versus LFD-fed mice. In the spleen, the percentage of M-MDSCs was significantly higher in HFD-fed periodontitis-induced (PI) mice than in LFD-PI mice. Alveolar bone volume fraction was significantly reduced in experimental periodontitis and was further decreased in HFD-PI mice as compared with LFD-PI mice. The inflammation score was significantly higher in HFD-PI mice versus LFD-PI mice, with a concomitant increase in TRAP staining for osteoclast number and area in HFD-PI mice over LFD-PI mice. These data support the concept that M-MDSC expansion during obesity to become osteoclasts during periodontitis is related to increased alveolar bone destruction, providing a more detailed mechanistic appreciation of the interconnection between obesity and periodontitis.

Dementia and Alzheimer’s disease (AD) are proposed to be comorbid with periodontitis (PD). It is unclear whether PD is associated with dementia and AD independent of confounding factors. We aimed at identifying the relationship between the longitudinal risk of developing PD in a cohort of patients with dementia and AD who did not show any signs of PD at baseline. In this retrospective cohort study, 8,640 patients with dementia without prior PD were recruited, and 8,640 individuals without dementia history were selected as propensity score–matched controls. A Cox proportional hazard model was developed to estimate the risk of developing PD over 10 y. Cumulative probability was derived to assess the time-dependent effect of dementia on PD. Of the 8,640 patients, a sensitivity test was conducted on 606 patients with AD-associated dementia and 606 non-AD propensity score–matched controls to identify the impact of AD-associated dementia on the risk for PD. Subgroup analyses on age stratification were included. Overall 2,670 patients with dementia developed PD. The relative risk of PD in these patients was significantly higher than in the nondementia group (1.825, 95% CI = 1.715 to 1.942). Cox proportional hazard models showed that patients with dementia were more likely to have PD than individuals without dementia (adjusted hazard ratio = 1.915, 95% CI = 1.766 to 2.077, P < 0.0001, log-rank test P < 0.0001). The risk of PD in patients with dementia was age dependent ( P values for all ages

The article presents modern data on the features of the oral microbiome and its medical significance when prescribing systemic antibacterial therapy for infectious and inflammatory processes in the oral cavity. The main microbial associations in normal conditions, as well as in diseases of periodontal tissues and apical periodontitis are presented. The use of antibacterial drugs in dentistry is aimed at eliminating the etiological factor of the pathogenic microflora of the oral cavity. The effectiveness of the treatment depends on how well the doctor aware of the main pathogens and microbial associations in generalized periodontitis, periodontitis, a choice of optimal antibacterial agent, compliance with indications and contraindications upon treatment., У статті наведені сучасні дані про особливості мікробіому порожнини рота та його медичне значення при призначенні системної антибактеріальної терапії інфекційно-запальних процесів порожнини рота. Наведені основні мікробні асоціації в нормі та при хворобах пародонта й апікальному періодонтиті. Використання антибактеріальних препаратів у стоматології направлене на усунення етіологічного чинника патогенної мікрофлори порожнини рота. Ефективність лікування залежить від інформованості лікаря про основні збудники та мікробні асоціації при генералізованому пародонтиті, періодонтиті, а також від вибору оптимального антибактеріального засобу, дотримання показань і протипоказань при призначенні.

The human body contains more than 100 trillion microorganisms, including the oral cavity, the skin, and the gastrointestinal tract. After the gastrointestinal tract, the oral cavity harbors one of the most diverse microbial communities within the human body and harbors more than 770 species of bacteria. The composition of the oral and gut microbiomes is quite different, but there may be a microbiological link between the two mucosal sites during the course of disease. More studies indicate that oral bacteria can disseminate to the distal gut via enteral or hematogenous routes. This is mostly obvious in periodontitis, where specific bacteria, such as Fusobacterium nucleatum and Porphyromonas gingivalis, show this pathogenic feature. The translocation of oral microbes to the gut may give rise to a variety of gastrointestinal diseases, including colorectal cancer. However, the precise role that oral microbe play in colorectal cancer has not been fully illustrated. Here, we summarize the current researches on possible pathways of ectopic gut colonization by oral bacteria and their possible contribution to the pathogenesis of colorectal cancer. Understanding the correlation of the oral-to-gut microbial axis in the pathogenesis of colorectal cancer will contribute to precise diagnosis and effective treatment.

AIM To determine the bidirectional link between periodontitis and fibromyalgia. MATERIALS AND METHODS In this cohort study, 196,428 periodontitis patients and 196,428 propensity score-matched non-periodontitis controls were enrolled. A Cox proportional hazard model was utilized to estimate the risk of fibromyalgia and survival analysis was adopted to assess the time-dependent effect of periodontitis on fibromyalgia. Subgroup analyses stratified by age, sex, and tracking period were conducted to identify susceptible populations. A parallel and symmetrical cohort that recruited 141,439 fibromyalgia patients and 141,439 propensity score-matched non-fibromyalgia controls ascertained the inverse effect of fibromyalgia on incident periodontitis. RESULTS Patients with periodontitis were more likely to develop fibromyalgia than non-periodontitis controls (HR = 1.42, 95% CI = 1.39-1.44, P < 0.001), which persisted in the survival analysis (log-rank test P < 0.0001). This effect was significant in both sexes and all age subgroups, and was particularly evident in males (HR = 1.52, 95% CI = 1.48-1.56, P < 0.001) and younger periodontitis patients (HR = 1.55, 95% CI = 1.50-1.60, P < 0.001). Fibromyalgia patients who never had periodontitis presented with greater risk for periodontitis over time (HR = 1.43, 95% CI = 1.40 - 1.45, P < 0.001; log-rank test P < 0.0001). CONCLUSIONS Patients of both sexes and all age subgroups with periodontitis presented with a greater risk of fibromyalgia. Subgroups that were the most susceptible to periodontitis-associated fibromyalgia were periodontitis patients that were males and below 30 years old. Risks of periodontitis were also greater in fibromyalgia patients who never had periodontitis. This article is protected by copyright. All rights reserved.

Treatment of periodontitis plays an important role in preventing tooth loss. Over the years, various treatment modalities have been proposed, researched and applied in the dental practice. The non-surgical periodontal therapy of cleaning the root surfaces is still the golden standard in treatment of periodontitis. If pockets of ≥ 6 mm remain after the non-surgical therapy, surgical periodontal therapy could be considered. People with periodontal disease should agree with lifelong periodontal therapy, because after the 'active' (non-surgical and surgical) periodontal therapy, lifelong periodontal maintenance is the most important thing to guarantee periodontal health and stability. The ultimate goal of periodontal therapy is preservation of the natural dentition. Many studies have shown that this goal can be achieved, providing the following circumstances are met: a good oral hygiene and high patient motivation, optimal periodontal treatment, and smoking cessation.Behandeling van parodontitis is essentieel in het voorkomen van tandverlies. Verschillende behandelmodaliteiten zijn in de loop der jaren voorgesteld, onderzocht en in de praktijk toegepast. De niet-chirurgische parodontale behandeling bestaande uit reiniging van de worteloppervlakken is nog altijd de gouden standaard. Indien er daarna pockets van ≥ 6 mm resteren is een chirurgische parodontale behandeling te overwegen. Mensen met parodontitis gaan een ‘levenslange behandelovereenkomst’ aan met de behandelaar, omdat na ‘actieve’ (niet-chirurgische en chirurgische) parodontale behandeling levenslange parodontale nazorg belangrijk is om parodontale gezondheid en stabiliteit te kunnen borgen. Het ultieme doel van de parodontale behandeling is het behouden van de eigen dentitie. Vele onderzoeken hebben inmiddels aangetoond dat dat doel behaald kan worden, mits er aan de volgende voorwaarden wordt voldaan: een goede mondhygiëne en motivatie van de patiënt, een optimale parodontale behandeling en stoppen met roken.

The use of stimulants, an improperly composed diet, lack of exercise, metabolic and mental stress, as well as overweight increase the risk of periodontitis. These lifestyle choices have an (in)direct influence on the immune system and can initiate inflammatory reactions at the level of the periodontium. Ultimately, this increases the susceptibility to gingivitis and periodontitis. A complete diet in terms of macro- (proteins, omega-3 fatty acids) and micro-nutrients (vitamins), as well as physical activity and sufficient relaxation appear to be essential for a healthy periodontium. A healthy weight, but especially a waist circumference within the normal range, also contribute to a reduction in the risk of periodontitis: directly, through the release of pro-inflammatory cytokines via the adipocytes, and indirectly, through obesity-related disorders. An unhealthy lifestyle thus increases the susceptibility to periodontal disease. Lifestyle advice should therefore be part of periodontal care.Het gebruik van genotsmiddelen, een onjuist samengestelde voeding, bewegingsarmoede, metabole en mentale stress evenals overgewicht verhogen het risico op parodontitis. De genoemde leefstijlkeuzes zijn (in)direct van invloed op het immuunsysteem en kunnen ontstekingsreacties ter hoogte van het parodontium initiëren. Dit verhoogt uiteindelijk de vatbaar­heid voor gingivitis en parodontitis. Een volwaardige voeding in termen van macro- (eiwitten, omega 3-vetzuren) en micronutriënten (vitamines) evenals fysieke activiteit en voldoende ontspanning blijken essentieel voor een gezond parodontium. Een gezond gewicht maar vooral een buikomvang binnen de normale range, dragen eveneens bij aan risicoreductie op parodontitis. Direct door het vrijmaken van pro-inflammatoire cytokines via de adipocyten en indirect door met overgewicht samenhangende aandoeningen. Een ongezonde leefstijl leidt dus tot een grotere vatbaarheid voor parodontale aandoeningen. Adviezen ten aanzien van leefstijl vormen derhalve een onderdeel van de parodontale zorg.

Periodontal bacterial bioflm causes an innate and adaptive immune response of the host mucosa, leading to inflammation and destruction of the tissues supporting the periodontal. The progression of periodontitis depends not only on bacteria, since an inadequate immune response to microorganisms can accelerate the development of periodontitis. However, the exact mechanisms of the development of immune reactions remain unclear. Recent studies emphasize the existence of a typical innate response of resident and extravasated immune cells.Objective. To investigate the quantitative composition of non-resident subpopulations of lymphocytes in salivary fluid and to study the mechanisms of interaction of the cellular link of the innate and adaptive immune system in chronic generalized periodontitis of varying severity.Materials and methods. 49 people aged 26–67 years of both sexes were examined with a diagnosis of chronic periodontitis. The comparison group consisted of 17 people aged 26–44 years with no periodontal diseases. The state of the cellular link of the adaptive and local immune system of the oral cavity was assessed by the following phenotypes: CD3–CD16+56+; CD3+CD16+56+; CD3+; CD3+HLA-DR+; CD19+, CD19+HLA-DR+; CD19+CD5+CD27–; CD19+CD5–СD 27–; CD19+СD5–CD27+.Results. The number of T-NK cells decreased with a mild degree of periodontitis and increased with a severe degree. Similarly, CD3+HLA-DR+ decreased with mild periodontitis [Me = 0.148 cells/µl] and increased with moderate [Me = 0.247 cells/µl] and severe [Me = 0.448 cells/µl]. The number of B-lymphocytes with the CD19+, CD19+CD5+, CD19+CD5–CD27+ phenotype decreased to single cells per microliter during the development of the disease.Conclusion. The imbalance of the immune system caused by pathogenic colonization of the periodontium, at different degrees of severity, is an important factor in the occurrence and development of periodontitis, in which various subsets of B cells of the adaptive immune system play a certain role, closely interacting with the cellular link of the innate mucosal immune system

Objectives: The management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics. Materials and methods: Periapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ2 test was used to compare the responses of the participants. Results: The survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups. Conclusions: This survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.

Periodontitis is a common disorder affecting >40% of adults in the United States. Globally, the severe form of the disease has a prevalence of 11%. In advanced cases, periodontitis leads to tooth loss and reduced quality of life. The aetiology of periodontitis is multifactorial. Subgingival dental biofilm elicits a host inflammatory and immune response, ultimately leading to irreversible destruction of the periodontium (i.e. alveolar bone and periodontal ligament) in a susceptible host. In order to successfully manage periodontitis, dental professionals must understand the pathogenesis, primary aetiology, risk factors, contributing factors and treatment protocols. Careful diagnosis, elimination of the causes and reduction of modifiable risk factors are paramount for successful prevention and treatment of periodontitis. Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing. For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilised. Thereafter, periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth. The aim of this review is to provide current concepts of diagnosis, prevention and treatment of periodontitis. Both clinical and biological rationales will be discussed.

Objective The intent was to analyse the association of periodontitis with the development of rheumatoid arthritis (RA) using a representative population-based cohort and longitudinal matched-cohort design. Methods Participants were 40 years of age or older and had not been diagnosed with RA between 2002 and 2006. Among the participants, those who were newly diagnosed with periodontitis between 2004 and 2006 (excluding cases that had already been diagnosed with periodontitis between 2002 and 2003) were allotted to the periodontitis group. Among the participants, those who had never been diagnosed with periodontitis between 2002 and 2006 formed the control group, matched by sex, age, and household income at a 1:1 ratio. From 2007 to 2018, the 2 groups (n = 691,506) were followed to monitor the development of RA. The t-test and χ2 test compared the general characteristics and health-related variables of both groups. The Kaplan-Meier method with a log-rank test was conducted to compare the incidence of RA in both groups. The hazard ratio (HR) and adjusted hazard ratio (aHR) were calculated using a Cox proportional hazard regression analysis to evaluate the risk of subsequent RA. Results Univariate analysis revealed that the periodontitis group was more likely to develop RA than the control group (hazard ratio 1.10), and multivariate analysis also revealed a higher incidence risk of RA (adjusted hazard ratio 1.09) in the periodontitis group. Conclusions Our findings demonstrate that periodontitis is associated with an increased risk of developing RA.

Background/Purpose Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population. Methods The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions. Results The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population. Conclusion The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.

Objective The objective of this systematic review was to evaluate the efficacy of non-surgical periodontal therapy on rheumatoid arthritis activity. Material and methods Articles published until April 2019 were electronically searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). This study was recorded in the international PROSPERO database (CRD42019132205). The PICO question (population, intervention, comparison, results) was: in adult patients with rheumatoid arthritis and periodontitis (P), does non-surgical periodontal treatment (I), as compared to no treatment (C), provides better outcomes in rheumatoid arthritis activity (O). Results After searching the databases, seven articles were selected for qualitative and five for quantitative analysis. The total number of participants included was 292, with an average age of 50.5 years. All patients had rheumatoid arthritis and periodontal disease. Non-surgical periodontal treatment significantly reduced Disease Activity Score 28 (P = 0.004; I2 = 92%) and erythrocyte sedimentation rate (P = 0.01; I2 = 78%), but with no significant effect on C-reactive protein (P = 0.34; I2 = 92%). Conclusions It can be concluded that non-surgical periodontal treatment can benefit patients with rheumatoid arthritis.

Introduction The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment. Methods hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%. Results VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P Conclusions Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.

Background As the global aging population is rapidly advancing, recognizing the full potential of periodontal disease (PD) in the onset or progression of Alzheimer's disease (AD) is important for reducing geriatric morbidity. This review explores the possible role of PD in the pathogenesis of AD, as the pathological mechanisms underlying AD are the most well-studied among all types of dementia. The investigation was conducted using the electronic academic databases PubMed and ScienceDirect, employing a combination of keywords “periodontal disease,” “periodontitis,” “Alzheimer's disease,” “dementia,” and “Porphyromonas gingivalis.” After applying the selection and eligibility criteria and removing overlaps, from an initial search finding of 5933 studies, 11 were finally included for qualitative analysis. Highlight The inflammatory reaction induced by oral pathogenic bacteria related to PD, through complex pathways, may exacerbate inflammation in the central nervous system, thereby contributing to the progression of AD. Conclusion Maintenance of adequate oral hygiene in patients diagnosed with AD is significant because they suffer from a gradual loss of manual dexterity as the disease advances. Additionally, the evidence presents the potential of systemic inflammation from PD-induced pathogenic bacteria, illustrating the grave cyclical progression of AD.

Objectives Medical professionals should advise their patients to visit a dentist if necessary. Due to the lack of time and knowledge, screening for periodontitis is often not done. To alleviate this problem, a screening model for total (own teeth/gum health, gum treatment, loose teeth, mouthwash use, and age)/severe periodontitis (gum treatment, loose teeth, tooth appearance, mouthwash use, age, and sex) in a medical care setting was developed in the Academic Center of Dentistry Amsterdam (ACTA) [1]. The purpose of the present study was to externally validate this tool in an outpatient medical setting. Materials and methods Patients were requited in an outpatient medical setting as the validation cohort. The self-reported oral health questionnaire was conducted, demographic data were collected, and periodontal examination was performed. Algorithm discrimination was expressed as the area under the receiver operating characteristic curve (AUROCC). Sensitivity, specificity, and positive and negative predictive values were calculated. Calibration plots were made. Results For predicting total periodontitis, the AUROCC was 0.59 with a sensitivity of 49% and specificity of 68%. The PPV was 57% and the NPV scored 55%. For predicting severe periodontitis, the AUROCC was 0.73 with a sensitivity of 71% and specificity of 63%. The PPV was 39% and the NPV 87%. Conclusions The performance of the algorithm for severe periodontitis is found to be sufficient in the current medical study population. Further external validation of periodontitis algorithms in non-dental school populations is recommended. Clinical relevance Because general physicians are obligated to screen patients for periodontitis, it is our general goal that they can use a prediction model in medical settings without an oral examination.

Highlights • Periapical lesions promotes higher T-bet expression and lower GATA3 and FOXP3 expression. • Periapical lesion promotes increased GATA3 and decreased FOXP3 expression in the group with 4 periapical lesions (4PL) • The adaptive immune system, with a predominance of the Th1 polarization, may be involved in the development of insulin resistance in rats with Periapical lesions., Objective Apical periodontitis (AP) is a chronic or acute inflammatory disease usually developed from endodontic infections, predominantly due to gram-negative anaerobic bacteria invading the dental pulp. This study aimed to evaluate lymphocyte markers to assess the involvement of adaptive immunity in insulin resistance (IR) in a rat model of AP. Design. Forty-five male Wistar albino rats were divided into 3 groups (control, 1AP and 4AP). AP was induced in the upper right first molar (1AP), and in the first and second upper and lower right molars (4AP). The spleen was collected to evaluate the expression of transcription factors involved in lymphocyte polarization, including T-bet (Th1), GATA3 (Th2), and FOXP3 (Treg). Blood samples were assessed for serum cytokine levels transcribed by the respective lymphocyte polarizations, INF-γ (Th1), IL-4 (Th2) and TGF-β (Treg). In addition, glucose and insulin levels were measured to evaluate IR by the HOMA-IR method. Results The results showed higher T-bet expression on AP groups, along with lower GATA3 and FOXP3 expression in the 1AP, in addition to increased GATA3 and decreased FOXP3 expression in the 4AP group compared to the CN group. There was no difference in the INF-γ levels, while IL-4 was decreased in the AP groups. Taken together, these results suggest that the adaptive immune system, with a predominance of the Th1 polarization, may be involved in the development of IR in rats with AP. Conclusions AP promotes increase in the expression of T-bet (4AP) and decrease of FOXP3 expressions and IL-4 levels (1AP and 4AP). However, depending on the number of lesions (1 or 4 lesions), the expression of GATA3 appears differently. Thus, innate immunity and adaptive immunity may contribute to the IR observed in rats with AP.

Objective With this cross-sectional study, we aimed to evaluate factors associated with moderate and high risk of periodontal disease (PD) progression in the Saudi population. Methods We reviewed 281 patients’ clinical charts from predoctoral periodontal clinics at the dental teaching hospital in the College of Dentistry (COD) at Imam Abdulrahman Bin Faisal University (IAU) in Dammam, Saudi Arabia. After obtaining ethical approval, we determined the Periodontal Risk Assessment (PRA) of the included patients based on the modified criteria developed by Lang and Tonetti (2003) . We used logistic regression on stratified data and divided the results into two categories (low-moderate and high risk) to assess the effect modifier for potential risk factors. We used SPSS version 22 for data analysis, and considered a P-value ≤ 0.05 to be statistically significant. Results Out of the 281 patients, 104 (37.0%) were male and 177 (63.0%) were female, with a mean age of 39.9 ± 14.0 years; 78.1% were Saudi nationals, 77% were married, and 44.6% were in the age group of 30 to 49. The PRA revealed 86 (30.5%) to represent high risk, 108 (38.3%) denoted moderate risk, and 88 (31.2%) signaled low risk for periodontitis. Logistic regression analysis showed that males were three times more likely to have high PRA (OR = 3.24) and to be married (OR = 2.77), as well as to be active smokers (OR = 8.87). The highest predictive factors of high PRA were 8 or more pockets ≥ 5 mm (OR = 29.0), those with active diabetes mellitus (DM; OR = 10.2), and those with 8 or more missing teeth (OR = 9.15). Conclusion Saudi males who are married and have residual periodontal pockets, are actively diabetic, and with missing teeth are at high risk of PD. Further research is needed with a larger sample size comparing the general population with and without PD.

Introduction Poor oral health can negatively affect general health and quality of life of kidney transplant recipients. The study aimed to investigate the association between chronic oral disease burden, serum biomarkers, and comorbidities in kidney transplant recipients. Design A cross-sectional comparative study was conducted with 44 patients after kidney transplant. The burden of chronic oral disease was composed of the following observable variables: moderate periodontitis and presence of dental caries. Serum biomarkers and comorbidities data were collected. The chi-square or Fisher's exact tests for categorical variables and Student's t-test or Mann–Whitney test for continuous variables were used. Robust Poisson regression was used to model the association. Results Higher levels of mean uric acid ( P = .01) and creatinine ( P = .03) were observed in the group of patients with oral disease burden, while the highest level of high-density lipoprotein was observed in the group without oral disease. Higher values of uric acid were associated with the occurrence of chronic oral disease burden (Adjusted PR = 1.24, 95% CI: 1.03-1.48, P = .019). There was no statistical difference between the groups with and without oral disease burden in comorbidities present. Conclusion The findings suggest that chronic oral diseases burden can be associated with uric acid and creatinine levels in kidney transplant recipients.

Introduction The association between periodontitis and certain systemic diseases is well established; however, there is a distinct lack of research available on its awareness among medical students in the United Kingdom. Aims To determine the awareness of fourth-year undergraduate medical students concerning periodontitis including its risk factors, relationship with systemic health and students' attitudes towards oral diseases and further education. Methods We delivered an online survey via a weekly email news bulletin to 299 fourth-year medical students and received 101 completed responses. Results Medical students were largely aware of the most common features of periodontitis and recognised that systemic diseases may affect the periodontium. There was less awareness of the associations between certain systemic diseases and periodontitis and there appeared to be confusion with tooth decay. Perceived knowledge was generally reported to be poor and most students believed that further teaching would improve their medical practice. Conclusions Increased teaching on periodontitis within the medical curriculum would benefit students. This may be achieved using an integrated teaching approach. Future doctors should graduate with an adequate education on the interdisciplinary links and should be capable of signposting or referring patients early to the appropriate services where indicated to improve patient care.