Search

Aim: To investigate the medium-term associations of serum protein subfractions derived from proton nuclear magnetic resonance ( 1 H-NMR) spectroscopy with periodontitis and tooth loss., Materials and Methods: A total of 3031 participants of the cohort Study of Health in Pomerania (SHIP-TREND) were included. In addition to conventional serum testing, serum lipoprotein contents and subfractions were analysed by 1 H-NMR spectroscopy. Confounder-adjusted associations of lipoprotein variables with periodontitis and the number of missing teeth variables were analysed using mixed-effects models with random intercepts for time across individuals, accounting for multiple testing., Results: While only spurious associations between lipoprotein levels from conventional blood tests were found-that is, triglycerides were associated with mean clinical attachment level (CAL) and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio with the number of missing teeth - several associations emerged from serum lipoprotein subfractions derived from 1 H-NMR analysis. Specifically, elevated LDL triglycerides were associated with higher levels of mean probing depth (PD), mean CALs, and increased odds of having <20 teeth. HDL-4 cholesterol levels were inversely associated with mean PD. Systemic inflammation (C-reactive protein) might mediate the effects of LDL and HDL triglyceride contents on periodontitis severity., Conclusions: Several associations between serum lipoprotein subfractions and periodontitis were observed. As the underlying biochemical mechanisms remain unclear, further research is needed., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objective: To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up., Materials and Methods: A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities., Results: The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group., Conclusion: Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions., Trial Registration: This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO., (© 2023. The Author(s).)

Background: Recent studies have highlighted the role of low-grade systemic inflammation in linking periodontitis to cardiovascular disease (CVD) outcomes, but many aspects remain unclear. This study examines the independent and reciprocal associations of periodontitis and low-grade systemic inflammation with all-cause and CVD mortality in a large-scale cohort., Methods: A total of 3047 participants from the prospective, population-based Study of Health in Pomerania (SHIP-START) were followed for a period of 13.0 ± 2.4 years. For the association between various inflammation/periodontitis measures and mortality, hazard ratios (HRs) were obtained from covariate-adjusted Cox proportional hazards models. Interactions were analysed in joint models: on the multiplicative scale, HRs were reported and on the additive scale, relative excess risks due to interaction (RERI) were calculated. Subject and variable-specific interval records were used to account for time-varying exposures and covariates., Results: During the observation period, 380 (12.5%) individuals died from CVD (n = 125) or other causes (n = 255). All markers of periodontitis and inflammation showed apparent associations with all-cause mortality (HRs per SD-increase: mean PPD: 1.068 (95% confidence interval (CI): 0.988-1.155), mean CAL: 1.205 (95% CI: 1.097-1.323), missing teeth: 1.180 (95% CI: 1.065-1.307), periodontitis score: 1.394 (95% CI: 1.202-1.616), leukocytes: 1.264 (95% CI: 1.163-1.374), fibrinogen: 1.120 (95% CI: 1.030-1.218), CRP: 1.231 (95% CI: 1.109-1.366), inflammation score: 1.358 (95% CI: 1.210-1.523)). For CVD mortality, all PPD related variables showed significant associations. Interaction modelling revealed some variation with respect to mortality type and exposure combinations. On the additive scale, RERIs for periodontitis score and inflammation score implied 18.9% and 27.8% excess mortality risk for all-cause and CVD mortality, respectively. On the multiplicative scale, the HRs for interaction were marginal., Conclusions: Both periodontitis and inflammation were significantly associated with all-cause mortality and CVD mortality. On the additive scale, a substantial excess risk was observed due to the interaction of periodontitis and inflammation, suggesting that the greatest treatment benefit may be achieved in patients with both periodontitis and high systemic inflammation. As periodontal therapy has been reported to also reduce systemic inflammation, the possibility of a reduction in CVD mortality risk by anti-inflammatory treatments, including periodontal interventions, seems worthy of further investigation., (© 2023. The Author(s).)

Objectives: Although minimally and noninvasive caries management are advocated in pediatric dentistry, extensive caries progression often requires endodontic treatment followed by crowning of the tooth. Thus, the aim of this study was to evaluate the success of esthetic preformed zirconia crowns (PZCs) compared to the standard preformed metal crowns (PMCs) after pulpotomy in primary molars retrospectively., Method and Materials: Patients' digital records in a specialized pediatric clinic in Germany were analyzed to include 2- to 9-year-olds, who had received one or more PMCs or PZCs after a pulpotomy between 2016 and 2020. The main outcomes were success, minor failure (restoration loss, wear, or fracture), or major failure (need for extraction or pulpectomy)., Results: In total, 151 patients with 249 teeth (PMC, n = 149; PZC, n = 100) were included. The mean follow-up time was (19.9 months), with 90.4% of the crowns followed for at least 18 months. The majority of the crowns were considered successful (94.4%). The differences in the success rates between PMCs (96%) and PZCs (92%) did not reach the level of statistical significance (P = .182). All minor failures (1.6%) were in the PZC group and located in the maxilla. Independent of crown type, especially first primary molars were prone to failure (7.9%; second primary molars, 3.3%)., Conclusion: PMCs and PZCs both show high clinical success rates as restorations of primary teeth after a pulpotomy. However, there was a tendency of greater minor or major failure in the PZC group.

Objectives: Associations between saliva volumes or salivary flow rates and potentially xerogenic medication are rarely evaluated in cohorts with a wide age range. This cross-sectional cohort study investigated possible relationships between the regular consumption of potentially xerogenic medication and stimulated saliva volumes., Methods: Data from the German Studies of Health in Pomerania (SHIP-2 and SHIP-Trend-0) were pooled. Potentially xerogenic medications were identified using the Workshop on Oral Medicine VI criteria. Stimulated saliva was sampled using Salivette®, and saliva volumes expressed as μl/min were determined. Applying linear mixed models with adjustment for time point of saliva collection, associations of (a) age and sex with regularly consumed medication, (b) age and sex with saliva volumes, and (c) the number of regularly consumed xerogenic medications with saliva volumes were evaluated., Results: Six thousand seven hundred and fifty-three participants aged 20-83 years (mean 53.4 ± 14.9) were included. The average number of medications did not differ markedly between females (2.21 ± 2.46) and males (2.24 ± 2.83). Males took more potentially xerogenic medication (1.0 ± 1.3) than did females (0.9 ± 1.3). Also, males took more potentially xerogenic cardiovascular medications than did females (0.9 ± 1.2 versus 0.7 ± 1.1), while females were prescribed a higher number of potentially xerogenic medications affecting the nervous system (0.2 ± 0.5 versus 0.1 ± 0.4). The average stimulated saliva volume was 967.0 ± 433.3 µL/min. Regularly consumed and potentially xerogenic medications were associated with lower saliva volumes. Older age correlated not only with a higher number of total medications and a higher number of xerogenic medications affecting either the cardiovascular (in males) or the nervous system (in females), but also with lower saliva volumes., Conclusions: Ageing was associated with polypharmacy, especially with the intake of potentially xerogenic medication, and lower average saliva volumes. With regard to complications of dry mouth, anamnesis of medication consumption is of high importance., (This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.© 2021 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Objectives: Biofilm removal is the decisive factor for the control of peri-implantitis. Cold atmospheric pressure plasma (CAP) can become an effective aid due to its ability to destroy and to inactivate bacterial biofilm residues. This study evaluated the cleaning efficiency of CAP, and air-polishing with glycine (APG) or erythritol (APE) containing powders alone or in combination with CAP (APG + CAP, APE + CAP) on sandblasted/acid etched, and anodised titanium implant surface., Materials and Methods: On respective titanium discs, a 7-day ex vivo human biofilm was grown. Afterwards, the samples were treated with CAP, APG, APE, APG + CAP, and APE + CAP. Sterile and untreated biofilm discs were used for verification. Directly after treatment and after 5 days of incubation in medium at 37 °C, samples were prepared for examination by fluorescence microscopy. The relative biofilm fluorescence was measured for quantitative analyses., Results: Air-polishing with or without CAP removed biofilms effectively. The combination of air-polishing with CAP showed the best cleaning results compared to single treatments, even on day 5. Immediately after treatment, APE + CAP showed insignificant higher cleansing efficiency than APG + CAP., Conclusions: CAP supports mechanical cleansing and disinfection to remove and inactivate microbial biofilm on implant surfaces significantly. Here, the type of the powder was not important. The highest cleansing results were obtained on sandblasted/etched surfaces., Clinical Relevance: Microbial residuals impede wound healing and re-osseointegration after peri-implantitis treatment. Air-polishing treatment removes biofilms very effectively, but not completely. In combination with CAP, microbial free surfaces can be achieved. The tested treatment regime offers an advantage during treatment of peri-implantitis., (© 2021. The Author(s).)

Introduction: We investigated the relationship between periodontal treatment and pre-clinical Alzheimer's disease (AD)., Methods: In this quasi-experimental design, 177 periodontally treated patients from the "Greifswald Approach to Individualized Medicine" cohort, which used the same protocols as the population-based Study of Health in Pomerania TREND (SHIP-TREND), and 409 untreated subjects from SHIP-TREND were analyzed. Subjects were younger than 60 years at the magnetic resonance imaging examination, with a median observation period of 7.3 years. Imaging markers for brain atrophy in late-onset AD and brain aging were used as the outcomes., Results: Robust to sensitivity analyses, periodontal treatment had a favorable effect on AD-related brain atrophy (-0.41; 95% confidence interval: -0.70 to -0.12; P = .0051), which corresponds to a shift from the 50th to the 37th percentile of the outcome distribution. For brain aging, the treatment effect was uncertain., Conclusion: Periodontitis is related to pre-clinical AD in our population., (© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

High dietary phosphorus (P), particularly soluble salts, may contribute to chronic kidney disease development in cats. The aim of the present study was to assess the safety of P supplied at 1 g/1000 kcal (4184kJ) from a highly soluble P salt in P-rich dry format feline diets. Seventy-five healthy adult cats (n 25/group) were fed either a low P control (1·4 g/1000 kcal [4184kJ]; Ca:P ratio 0·97) or one of two test diets with 4 g/1000 kcal (4184 kJ); Ca:P 1·04 or 5 g/1000 kcal (4184kJ); Ca:P 1·27, both incorporating 1 g/1000 kcal (4184 kJ) sodium tripolyphosphate (STPP) - for a period of 30 weeks in a randomised parallel-group study. Health markers in blood and urine, glomerular filtration rate, renal ultrasound and bone density were assessed at baseline and at regular time points. At the end of the test period, responses following transition to a commercial diet (total P - 2·34 g/1000 kcal [4184kJ], Ca:P 1·3) for a 4-week washout period were also assessed. No adverse effects on general, kidney or bone (skeletal) function and health were observed. P and Ca balance, some serum biochemistry parameters and regulatory hormones were increased in cats fed test diets from week 2 onwards (P ≤ 0·05). Data from the washout period suggest that increased serum creatinine and urea values observed in the two test diet groups were influenced by dietary differences during the test period, and not indicative of changes in renal function. The present data suggest no observed adverse effect level for feline diets containing 1 g P/1000 kcal (4184 kJ) from STPP and total P level of up to 5 g/1000 kcal (4184 kJ) when fed for 30 weeks.

The magnitude of forces and moments applied on teeth during orthodontic treatment is crucial to achieve the desired tooth movement. The aim of this study is to introduce a modular 3D printable orthodontic measurement apparatus (M3DOMA), which can be used for measurements of forces and moments acting on teeth during treatment with aligners. The measurement device was characterized regarding signal to noise ratio (SNR) of the sensors, repeatability of measurements, influence of thermoforming, as well as reliability. Forces and moments were evaluated for an activation range of 0.1-0.4 mm, comparing them among different activation patterns with two aligner thicknesses. The sensors exhibited a SNR from 13-33 dB. Repeatability with repeated measurements showed standard deviations ≤0.015 N and 0.769 Nmm. The influence of thermoforming represented by standard deviation of forces ranges from 0.019-0.147 N. The device showed a range of intra class correlation (ICC) for repeated measurements for all sensors from 0.932 to 0.999. Hence the reliability of the device has been proven to be excellent., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Peri-implantitis is caused by microbial contamination and biofilm formation on the implant surface. To achieve re-osseointegration, the microbes must be completely removed from the surface. Adjunctive to mechanical cleaning, chemical treatment with enzymes or other substances could optimise the treatment outcome. Therefore, we investigated the efficacy of different enzymes, a surfactant, and a chelator in destabilising dental polymicrobial biofilm. The biofilm destabilising effect of the glycosidases α-amylase, dextranase, DispersinB ® , and lysozyme, as well as the proteinase subtilisin A, and the nuclease Benzonase ® , the chelator EDTA, and the surfactant cocamidopropyl betaine were investigated on biofilms, inoculated with plaque on rough titanium discs. The test and the control solutions were incubated for 15 min at 36 °C on biofilms, and loosened biofilm mass was removed by shear stress with a shaker. Fluorescence-stained biofilms were microscopically analysed. Acceptable cell tolerability concentrations of test substances were determined by the MTT (tetrazolium dye) assay on the MG-63 cell line. A statistically significant biofilm destabilising effect of 10% was shown with lysozyme (2500 µg/ml)., (© 2021. The Author(s).)

Objectives: Clear guidelines when to remove an implant are missing. The aim of this study was to evaluate the amount of peri-implant bone loss at explantation by specialists., Material and Methods: Implantology specialists were asked to provide implants explanted due to peri-implantitis with related clinical information. Early failures (survival time <12 months) were analyzed separately. Questionnaires inquired age, sex, smoking, implant location, usage of bone substitutes, and implant brand. Explants were measured and bone loss was assessed using radiographs. Covariate-adjusted mixed-effects models were evaluated for bone loss and survival time., Results: Twelve dental offices provided 192 explants from 161 patients with 99 related radiographs. Thirty-three (17.2%) explants were early failures. Excluding early failures, average survival time was 9.5 ± 5.8 years with absolute and relative bone loss of 7.0 ± 2.7 mm and 66.2 ± 23.7%, respectively. Late failures were removed at mean bone loss of 57.7% in the maxilla and 73.7% in the mandible irrespective of survival time. In fully adjusted mixed-effects models, only age at implantation (B = -0.19; 95% CI: -0.27, -0.10) remained a significant factor for survival time. Implants exhibited significantly more relative bone loss if they were positioned in the mandible (B = 17.3; 95% CI: 3.91, 30.72) or if they were shorter (B = -2.79; 95% CI: -5.50, -0.08)., Conclusions: Though the mean bone loss (66.2%) at which implants were explanted was in accordance with the literature, its wide variation and differentiation between jaws showed that the profession has no universally accepted threshold beyond which an implant cannot be preserved., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objectives: We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation., Methods: From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes)., Results: The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations., Conclusion: Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity., Clinical Relevance: Keeping systemic inflammation low in order to prevent age-related disease sequelae.

Reinfection in endodontically treated teeth is linked to the complexity of the root canal system, which is problematic to reach with conventional disinfection methods. As plasma is expected to have the ability to sanitize narrow areas, the aim of this study was to analyze the effect of cold atmospheric pressure plasma (CAP) on Candida albicans in root canals of extracted human teeth. CAP was applied as mono treatment and in combination with standard endodontic disinfectants (sodium hypochlorite, chlorhexidine and octenidine). Disinfection efficiency was evaluated as reduction of the logarithm of colony forming units per milliliter (log 10 CFU/mL) supported by scanning electron microscopy as imaging technique. Plasma alone showed the highest reduction of log 10 CFU, suggesting the best disinfection properties of all tested agents., (© 2020 The Authors. Journal of Biophotonics published by Wiley-VCH GmbH.)

Individuals responsible for decision-making during critical incidents must wrestle with uncertainty, complexity, time pressure, and accountability. Critical incidents are defined as rare events where demand outstrips resources and where there are high stakes, uncertainty, and dynamic and ever-shifting elements that frustrate clear predictions. This paper argues that critical-incident decision-making is highly complex because many critical incidents have no such analogue, and thus there is no prior experience to draw upon. Further, while prescriptive models argue for a selection of a "best" outcome, rarely in critical incidents is there a "best" outcome and, instead, more likely a "least-worst" one. Most options are high risk, most will carry negative consequences, and many will be immutable and irreversible once committed to. This paper analyzes data collected from critical decision method interviews with members of the United States Armed Forces to explore the psychological processes of making (or not making) least-worst decisions in high-consequence situations. Specifically, and based on thematic analysis of interviews with those who have made least-worst decisions while serving as part of the Armed Forces, we identify a host of exogenous (external to the incident such as resources, political agendas) and endogenous factors (features of the incident itself-size, scale, duration) that affect the decision-making process. These factors have, to date, not been factored into theoretical models of how high-stakes decisions are made under conditions of uncertainty.

Objectives: It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample., Materials and Methods: Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex., Results: Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028-1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913-0.996 and RR: 0.943; 95% confidence interval 0.894-0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed., Conclusion: Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance., Competing Interests: The authors have declared that no competing interests exist.

We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.

Aims: This study aimed to assess 11-year longitudinal effects of powered toothbrush on periodontal health, caries and tooth loss in an adult population., Materials and Methods: Participants of Study of Health in Pomerania (SHIP) cohort with dental examinations and interview data at SHIP-1, SHIP-2 or SHIP-3 examinations were included. Mixed-effects linear regression models were constructed between the exposure (manual versus powered toothbrush) and outcome variables (periodontal status using mean probing depth (PD) and mean clinical attachment loss (CAL), caries status using DMFS and DFS scores, and tooth loss), adjusting for potential baseline covariates., Results: Final baseline (SHIP-1) study sample comprised of 2,819 participants. Powered toothbrush users increased from 18.3% (SHIP-1) to 36.9% (SHIP-3); were younger; had significantly less mean PD [β: -0.09 (95% CI: -0.16; -0.02)] and mean CAL [β: -0.19 (95% CI: -0.32; -0.07)] progressions; and had 17.7% less DMFS progression and 19.5% more teeth retained than the manual toothbrushers., Conclusions: In the long-term, powered toothbrush seems to be effective in reducing mean PD and mean CAL progressions, besides increasing the number of teeth retained., (© 2019 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

Rationale & Objective: Previous studies have yielded inconclusive findings regarding the relationship between periodontitis and kidney function. We sought to investigate whether periodontitis is associated with subsequent decreases in kidney function (reductions in estimated glomerular filtration rate [eGFR] and increased urinary albumin-creatinine ratio [UACR]) in the general population., Study Design: Population-based cohort study., Setting & Participants: We used baseline and 11-year follow-up data from 2,297 and 1,512 adult participants, respectively, in the Study of Health in Pomerania (SHIP). Age range was limited to 20 to 59 years to avoid the potential influence of tooth loss., Exposures: Periodontal status defined by periodontal pocket probing depth (PPD) and clinical attachment level. Mean levels and the percentage of sites ≥ 3mm was determined for either all sites (PPD) or interproximal sites (clinical attachment level). All PPDs≥4mm were summed to calculate the total PPD., Outcomes: GFR estimated from serum creatinine and serum cystatin C (eGFR cr-cys ). Moderately increased albuminuria defined as UACR>30mg/g., Analytical Approach: Adjusted linear and logistic mixed regression models., Results: At baseline and follow-up, average eGFR cr-cys was 118.3 and 105.0mL/min/1.73m 2 , respectively. Using mixed models, no consistently significant associations between periodontitis variables and eGFR cr-cys were detected. Long-term changes in UACR were inconsistently associated with periodontitis measures. After imputation of missing data, associations were either attenuated or no longer detectable., Limitations: Because periodontal assessments were performed using a partial recording protocol, periodontal disease severity estimates might have been underestimated, resulting in attenuated effect estimates., Conclusions: We found no consistent evidence for an association between periodontitis and decreased kidney function. In contrast to previous studies, these results do not support the hypothesis that periodontitis is an important risk factor for chronic kidney disease., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

This report provides a comprehensive overview of the adverse effects of hyperglycemia on the periodontium. It combines data from literature reviews of original data from two large, population-based epidemiologic studies with comprehensive periodontal health assessment. Emphasis is placed on the exploration of hitherto sparsely reported effects of prediabetes and poorly controlled (uncontrolled) diabetes, in contrast to the umbrella term "diabetes." This stems from the realization that it is not simply having a diagnosis of diabetes that may adversely affect periodontal health. Rather, it is the level (severity) of hyperglycemia that is the determining factor, not the case definition of the diagnosis of diabetes or the type of diabetes in question. Importantly, based on existing evidence this paper also attempts to estimate the improvements in periodontal probing depth and clinical attachment level that can be expected upon successful nonsurgical periodontal treatment in people with chronic periodontitis, with and without diabetes, respectively. This exploration includes the implentation of new systematic reviews and meta-analyses that allow comparison of such intervention outcomes between hyperglycemic and normoglycemic subjects. Based on both existing literature and original analyses of population-based studies, we try to answer questions such as: Is there a glycated hemoglobin concentration threshold for periodontitis risk? Does short-term periodontal probing depth reduction and clinical attachment level gain after scaling and root planing depend on glycemic control in type 2 diabetes? Are short-term scaling and root planing outcomes in people with hyperglycemia/diabetes inferior to those in people without diabetes? Do periodontitis patients with diabetes benefit more from the use of adjuvant antibiotics with nonsurgical periodontal treatment than people without diabetes? Does hyperglycemia lead to greater tooth loss in patients in long-term post-periodontal treatment maintenance programs? Throughout this review, we compare our new findings with previous data and report whether the results of these new analyses corroborate, or are in discord with, similar scientific reports in the literature. We also explore the potential role of dental health-care professionals in helping patients control the risk factors that are identical for periodontitis and diabetes. Finally, we suggest various topics that still need exploration in future research., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Research demonstrates that information sharing is facilitated by familiarity, and having a common understanding of problems, use of lexicon, and semantic meaning. These factors can be difficult to develop within extreme environments such as disasters as members of the multi-agency system that responds often have limited experience of working together. Public inquiries repeatedly highlight the impact of information sharing difficulties on public safety, but limited academic research has focused on identifying concrete behaviours that facilitate interteam information sharing within such environments. This paper presents a case study of a national disaster response exercise involving 1,000 emergency responders. Data consist of structured observations, recordings of interteam meetings, and interviews with emergency responders. Results of mixed-method analysis indicate that interteam information sharing is delayed by limited situation awareness and poor articulation. Conversely, adopting behaviours that promote common frames for understanding interteam capabilities and information requirements improves information sharing and potentially reduces cognitive effort required to process information. Findings contribute to interteam communication theory by highlighting that in complex, time-constrained environments, having a shared understanding of responsibilities and information requirement is important for minimizing redundant deliberation and improving relevance and speed., Practitioner Points: Facilitating the exchange and interpretation of relevant information is important for improving situation assessment, decision-making, and the implementation of appropriate actions for addressing risks.Interteam information sharing can be particularly challenging when teams are comprised of members from across different organizations with different language and cultures that must form ad hoc to rapidly respond to problems in extreme environments.Adopting communication strategies that develop common frames-of-reference can facilitate information sharing and interteam responses to disasters.

Aim: To investigate the relation between oral health status and microcirculation, we analysed the association between periodontitis and number of teeth with retinal vessel diameters in a population-based study., Methods: We analysed data from the Study of Health in Pomerania-TREND (SHIP-TREND). All subjects (3,183 for number of teeth, 3,013 for mean probing depth and 2,894 for mean attachment level) underwent nonmydriatic funduscopy and dental examination. We measured central retinal arteriolar (CRAE), venular (CRVE) vessel diameters and calculated arterio-venous ratio (AVR) from static vessel analysis (SVA). Periodontal status was assessed using the case definition of the Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Data were analysed by linear (CRAE, CRVE, AVR) and logistic regression (AVR < 0.8) adjusted for age, sex, smoking status, alcohol consumption, body mass index, systolic blood pressure, hsCRP and type-2-diabetes mellitus., Results: Only in men, significant associations were found between periodontal and retinal conditions. Severe periodontitis [β = -0.0120 (-0.0218; -0.0007 95%-CI)] and mean probing depth [β = -0.0054 (-0.0105; -0.0002 95%-CI)] were inversely associated with AVR; severe periodontitis [β = 3.80 (0.61; 6.98 95%-CI)], mean probing depth [β = 1.86 (0.23; 3.49 95%-CI)] and mean attachment level [β = 1.31 (0.34; 2.27 95%-CI)] with CRVE and mean attachment level with CRAE [β = 0.91 (0.14; 1.69 95%-CI)]., Conclusions: Our results point towards an association between periodontal conditions and AVR in men. Periodontitis may impact microvascular endothelium function. Improving oral health to reduce periodontitis might lead to reduced risk for other age-related diseases., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To demonstrate how data collected using the computerized planimetric method (CPM) can be analyzed by providing an example in which the amount of plaque accumulation and the efficacy of the rotating needles device (RND) in cleaning specific parts of partial removable dental prostheses (PRDPs) were estimated., Materials and Methods: Thirty-four participants wearing a total of 41 double-crown-retained PRDPs with veneered secondary crowns were included in this study. The PRDPs underwent the following steps: preparing the PRDP for photography, photography of the PRDP, cleaning the PRDP with the RND, and re-photography. One trained examiner used a tested CPM to analyze 98 images (49 before/49 after). Each participant was considered as a statistical unit; thus, if the participant had two PRDPs, one was randomly selected for analysis. Reliability was tested using intraclass correlation coefficients (ICCs [1, 2] ), and nonparametric Wilcoxon signed rank test was used for all comparisons., Results: The intraclass correlation coefficients (images before/after) for both the base and veneer were > 0.9. Wilcoxon signed rank test P value was < .001 for the comparison of plaque accumulation on the base and veneer, estimating the RND's efficacy on both PRDP parts (before/after) and comparing the RND's efficacy on the base and the RND's efficacy on the veneer., Conclusions: There are different ways to analyze data collected via CPM; thus, it is advisable to provide an explanation for the choice of modeling. Plaque accumulation was significantly greater on the double-crown veneer than on the base. The RND efficacy in cleaning the veneer and the base is significant, but more substantial in cleaning the base.

Aim: We aimed to assess the association between furcation involvement (FI) and tooth loss for subjects not undergoing regular periodontal treatment., Materials and Methods: Data from 2333 subjects participating in the baseline and 11-year follow-up of the Study of Health in Pomerania (SHIP) were used. All subjects had half-mouth periodontal examinations, including FI in one upper and one lower molar, at baseline. A total of 1897 subjects and 3267 molars were included in the final analysis., Results: In total, 375 subjects (19.8%) lost molars during the follow-up period. Respectively, 5.6%, 12.7%, 34.0% and 55.6% of molars without FI, degree I FI, degree II FI and degree III FI were lost. Initial probing pocket depth (PPD) and clinical attachment level (CAL) were associated with molar loss (p < .001). Baseline degree I FI was associated with a 1.73 IRR (incidence rate ratio) (95% CI=1.34-2.23, p < .001) of tooth loss while degree II-III was associated with a 3.88 IRR (95% CI=2.94-5.11, p < .001) of tooth loss compared to molars without FI at baseline., Conclusion: This study provides evidence for an increased risk of molar loss affected by periodontal furcation involvement in a general population not undergoing regular periodontal care., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Whole saliva is gaining more and more attention as a diagnostic tool to study disease-specific changes in human subjects. Prior to the actual disease-related analyses, it is important to understand the influence of various demographic variables and coupled phenotypes on salivary protein signatures. In a cross-sectional approach, we analyzed the influence of age, sex, body mass index (BMI), smoking, and education on salivary protein signatures in whole saliva samples of 187 individuals. Subjects were randomly selected from the population-based Study of Health in Pomerania (SHIP-Trend). Stimulated whole saliva was collected, and proteins were precipitated and proteolytically digested. Samples were analyzed by label-free tandem mass spectrometry. Of the 602 human proteins identified in at least 40% of the saliva samples, we used 304 proteins, which could be identified with at least two unique peptides, for statistical analyses. Univariate and multivariate linear models were used to reveal associations with the phenotypes. The largest number of proteins was associated with smoking status. Moreover, age had a distinct influence on the salivary protein composition. The study discloses the influence of common phenotypes on the salivary protein pattern of human subjects. These results should be considered when studying disease-related proteome signatures in saliva.

Aim: To investigate the effects of a combined biofilm removal with an optimized air polishing and a cold plasma device on cells in vitro., Materials and Methods: A 7-day-old biofilm was removed from rough titanium discs with an air-polishing device with erythritol powder (AP) or with a cold atmospheric pressure argon plasma (CAP) device or in combination of both (AP + CAP). The removal efficacy was evaluated by subsequent cell seeding of osteoblast-like cells (MG-63). The cell spreading was analysed after 5 days of incubation by scanning electron microscopy. Separately, the surface hydrophilicity was analysed by measuring the water contact angle (WCA) of the disc for each treatment method., Results: The mechanical plaque removal with AP rendered specimen conducive for cell growth, 85% of the surface was covered with cells. An advantage of the combination of AP + CAP was not detectable compared to AP (cell coverage ranged from 57% up to 75%). After sole CAP treatment, microorganisms re-grew and destroyed all cells. The WCA was reduced by all treatment methods., Conclusion: An AP treatment has the potential to remove biofilm from rough implant surfaces completely. In contrast to our hypothesis, the combination of plasma and AP treatment did not enhance osteoblast spreading., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lifespan is a complex trait, and longitudinal data for humans are naturally scarce. We report the results of Cox regression and Pearson correlation analyses using data of the Study of Health in Pomerania (SHIP), with mortality data of 1518 participants (113 of which died), over a time span of more than 10 years. We found that in the Cox regression model based on the Bayesian information criterion, apart from chronological age of the participant, six baseline variables were considerably associated with higher mortality rates: smoking, mean attachment loss (i.e. loss of tooth supporting tissue), fibrinogen concentration, albumin/creatinine ratio, treated gastritis, and medication during the last 7 days. Except for smoking, the causative contribution of these variables to mortality was deemed inconclusive. In turn, four variables were found to be associated with decreased mortality rates: treatment of benign prostatic hypertrophy, treatment of dyslipidemia, IGF-1 and being female. Here, being female was an undisputed causative variable, the causal role of IFG-1 was deemed inconclusive, and the treatment effects were deemed protective to the degree that treated subjects feature better survival than respective controls. Using Cox modeling based on the Akaike information criterion, diabetes, mean corpuscular hemoglobin concentration, red blood cell count and serum calcium were also associated with mortality. The latter two, together with albumin and fibrinogen, aligned with an"integrated albunemia" model of aging proposed recently.

Objectives: Evidence on possible associations between facial morphology, attachment loss and gingival recession is lacking. We analysed whether the facial type, which can be described by the ratio of facial width and length (facial index), is related to periodontal loss of attachment, hypothesizing that a broad face might be associated with less gingival recession (GR) and less clinical attachment loss (CAL) than a long face., Materials and Methods: Data from the 11-year follow-up of the population-based Study of Health in Pomerania were used. Periodontal loss of attachment was assessed by GR and CAL. Linear regression models, adjusted for age and gender, were used to assess associations between specific landmark based distances extracted from magnetic resonance imaging head scans and clinically assessed GR or CAL (N = 556)., Results: Analysing all teeth, a higher maximum cranial width was associated with a lower mean GR (B = -0.016, 95% CI: -0.030; -0.003, p = 0.02) and a lower mean CAL (B = -0.023, 95% CI: -0.040; -0.005, p = 0.01). Moreover, a long narrow face was significantly associated with increased mean GR and CAL (facial index, P for trend = 0.02 and p = 0.01, respectively). Observed associations were more pronounced for incisors and canines than for premolars and molars., Conclusion: This study revealed craniofacial morphology, specifically the cranial width and the facial index, as a putative risk factor for periodontal loss of attachment., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Muscle strength declines and gums recede with increasing age across the life course. Possible associations exist between handgrip strength as an indicator of physical fitness and periodontitis and number of teeth., Material and Methods: Handgrip strength (GS), anthropometric measures, clinical attachment loss, number of teeth, C-reactive protein and glycated haemoglobin were assessed in 2089 participants of the Study of Health in Pomerania (SHIP-2). Linear regression including interaction with age was used to estimate the association between clinical attachment level, number of teeth and GS., Results: In multiple regression adjusted for age, body mass index (BMI) and waist-to-hip ratio (WHR) each mm of diminished periodontal attachment was associated with reduction in GS by 1.47 kg (95% CI -2.29 to -0.65) and 0.38 kg (-0.89 to 0.14) in men and women respectively. Correspondingly, each additional remaining tooth was significantly associated with higher GS. Using handgrip strength relative to BMI as outcome, these relationships become even more apparent. Indicators of obesity such as BMI and WHR associated with both GS and periodontitis modulate the relationship between GS and periodontitis with a different impact between the sexes., Conclusion: Periodontitis is associated with GS modified mainly by anthropometric measures related to adiposity and inflammation. Putative mechanisms encompass interactions of factors declining with increasing age., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Systemic low-grade inflammation represents a central hallmark of chronic diseases and has been proposed as the underlying mechanism linking factors like obesity or diabetes with periodontitis. However, the impact of inflammatory markers on periodontitis has not yet been investigated., Materials and Methods: The study population comprised 1784 subjects from the Study of Health in Pomerania with complete 11-year follow-up. Fibrinogen and white blood cell (WBC) counts were measured as markers of inflammation. Periodontitis was assessed by probing depth (PD), clinical attachment loss (CAL) and the CDC/AAP case definition., Results: Multilevel regression analyses revealed significant coefficients for the impact of both inflammation markers on the percentage of sites with PD/CAL ≥ 3 mm. Increases in fibrinogen about 1 g/l were associated with 3.0% and 2.7% more sites with PD/CAL ≥ 3 mm respectively. Consistent associations were found using mean values of PD/CAL but not using missing teeth or caries. Regarding the CDC/AAP case definition, 11-year changes in fibrinogen and WBC counts were significantly associated with ≥1 category progression (OR: 1.36 and 1.11)., Conclusions: Fibrinogen levels and WBC counts showed consistent long-term associations with PD, CAL and the CDC/AAP case definition. Results indicate that systemic low-grade inflammation might indeed represent one possible pathway for effects of obesity, diabetes or other chronic inflammatory conditions on periodontitis., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This paper demonstrates a combined approach for separating an active pharmaceutical ingredient (API) from a heavily contaminated waste stream. The approach uses organic solvent nanofiltration (OSN) to improve the application of counter-current chromatography (CCC) in an industrial process. OSN provides an efficient route for exchanging solutes from the process solvent into the desired mobile phase for CCC, generating a CCC feed containing less than 0.01% (area % by GC) of the original process solvents. The high solvent burden of CCC was additionally reduced through recovery of mobile phase using OSN, with the recovered solvent containing less than 1% (area % by HPLC) impurities. The recovered solvent was then successfully recycled into a subsequent CCC run with no indication of impurity build-up. Coupling OSN with CCC improved the mass-intensity of the CCC process, reducing the solvent use by 56%. OSN can be a useful tool in facilitating the application of CCC to pharmaceutical process streams., (Copyright © 2012 Elsevier B.V. All rights reserved.)

In the approaches or models which aim to understand and/or predict how the functioning of ecosystems may be affected by perturbations or disturbances, little attention is generally given to microorganisms. Even when they are taken into account as indicators, variables which are poorly informative about the changes in the microbial functioning (microbial biomass or diversity or total number of microorganisms) are often used. To be able to estimate, in complex environments, the quantity of enzymes involved in key ecosystem processes may constitute a useful complementary tool. Here, we describe an immunological method for detecting and quantifying, in complex environments, the nitrite oxidoreductase (NOR), responsible for the oxidation of nitrite to nitrate. The alpha-catalytic subunit of the enzyme was purified from Nitrobacter hamburgensis and used for the production of polyclonal antibodies. These antibodies were used to detect and quantify the NOR by a chemifluorescence technique on Western blots after separation of total proteins from pure cultures and soil samples. They recognized the alpha-NOR of all the Nitrobacter species described to date, but no reaction was observed with members of other nitrite-oxidizing genera. The detection threshold and reproducibility of the proposed method were evaluated. The feasibility of its use to quantify NOR in a soil was tested.

A series of copper(II) complexes with substituted phenanthroline ligands has been synthesized and characterized electronically and structurally. The compounds that have been prepared include the monosubstituted ligand complexes of the general formula [Cu(5-R-phen)(2)(CH(3)CN)](BF(4))(2), where R = NO(2), Cl, H, or Me, and the disubstituted ligand complex [Cu(5,6-Me(2)-phen)(2)(CH(3)CN)](BF(4))(2). The complexes [Cu(5-NO(2)-phen)(2)(CH(3)CN](BF(4))(2) (1), [Cu(5-Cl-phen)(2)(CH(3)CN)](BF(4))(2) (2), [Cu(o-phen)(2)(CH(3)CN)](BF(4))(2) (3), and [Cu(5-Me-phen)(2)(CH(3)CN)](BF(4))(2) (4) each crystallize in the space group C2/c with compounds 1, 2, and 4 comprising an isomorphous set. The disubstituted complex [Cu(5,6-Me(2)-phen)(2)(CH(3)CN)](BF(4))(2) (5) crystallizes in the space group P2(1)/c. Each structure is characterized by a distorted trigonal bipyramidal arrangement of ligands around the central copper atom with approximate or exact C(2) symmetry. The progression from electron-withdrawing to electron-donating substituents on the phenanthroline ligands correlates with less accessible reduction potentials for the bis-chelate complexes.

Monkeys were trained to emit 10 responses to terminate a schedule complex consisting of a light and masking noise in the presence of which brief, intravenous injections of naloxone (0.01 mg/kg per injection), dl-cyclazocine (0.003, 0.01 mg/kg per injection), or saline were scheduled to occur over blocks of consecutive daily sessions. Completion of the fixed ratio (FR 10) response requirement terminated the schedule complex, producing a time-out of 60 s in which responses were without consequence and injections did not occur. Sessions lasted for 100 min or ended after 100 injections, whichever came first. When monkeys received an intramuscular injection of morphine (10 mg/kg) 60 min preceding each session, responding to avoid injections of naloxone or cyclazocine was well maintained, though morphine-dependent monkeys tolerated injections of saline or the vehicle in which cyclazocine was dissolved. When the morphine pretreatment regimen was discontinued, monkeys tolerated injections of naloxone and cyclazocine though, at the larger cyclazocine dose (0.01 mg/kg per injection), responding was maintained for at least 30 consecutive sessions in two postdependent animals, but not in two other monkeys treated identically. The capacity of these morphine-antagonist drugs to support responding that avoids their injection depends evidently upon whether monkeys are rendered morphine dependent or not; in the case of cyclazocine, however, an increased sensitivity to the negative-reinforcing effects of the drug appears to persist in some "postdependent" monkeys.