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Aim To assess the diagnostic utility of an oral rinse active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Materials & Methods The aMMP‐8 index test was undertaken in 408 consecutive adults, followed by a full‐mouth periodontal examination. The reference standard was the 2017 World Workshop classification of periodontal diseases. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were assessed. Results 68.6% of the participants were diagnosed with periodontitis, including Stages I (15.9%), II (15.9%), III (29.7%) and IV (7.1%). A positive aMMP‐8 POCT was associated with periodontitis after adjusting for age, gender, tobacco smoking and systemic diseases, while it was unable to differentiate among the stages/grades of periodontitis and between gingivitis/periodontal health. This test showed a sensitivity of 33.2% and a specificity of 93.0% for detecting periodontitis (threshold level >10 ng/ml). The levels of aMMP‐8 adjusted by the number of teeth present (aMMP‐8/NTP) performed better for periodontitis (sensitivity: 67.1%; specificity: 68.8%). Notably, aMMP‐8/NTP were strongly predictive for Stage IV periodontitis (threshold level =0.4312 ng/ml) (sensitivity: 89.7%; specificity: 73.6%; and AUROC: 0.856). The test performance greatly improved in combination with age and smoking, with a sensitivity of 82.5%, a specificity of 84.4%, and an AUROC of 0.883. Conclusion This aMMP‐8 POCT is able to detect periodontitis with better specificity than sensitivity across the spectrum of its severity. This test may be useful for periodontal screening in conjunction with subject characteristics and/or other sensitive screening tools. Further validation studies are needed.

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

Aims Patients with chronic kidney disease (CKD) are also susceptible to periodontitis. The causal link between periodontitis and CKD may be mediated via systemic inflammation/oxidative stress. Using structural equation modelling (SEM), this cross‐sectional study aimed to explore the causal relationship between periodontal inflammation (PI) and renal function. Materials and methods Baseline data on 770 patients with stage 3–5 (pre‐dialysis) CKD from an ongoing cohort study were used. Detailed, bioclinical data on PI and renal function, as well as potential confounders and mediators of the relationship between the two, were collected. SEMs of increasing complexity were created to test the causal assumption that PI affects renal function and vice versa. Results Structural equation modelling confirmed the assumption that PI and renal function are causally linked, mediated by systemic oxidative stress. The magnitude of this effect was such that a 10% increase in PI resulted in a 3.0% decrease in renal function and a 10% decrease in renal function resulted in a 25% increase in PI. Conclusions Periodontal inflammation represents an occult source of oxidative stress in patients with CKD. Further clinical studies are needed to confirm whether periodontal therapy, as a non‐pharmacological approach to reducing systemic inflammatory/oxidative stress burden, can improve outcomes in CKD.

Aim: To compare three periodontitis clusters (A, B and C) for alveolar bone loss (ABL) patterns, antibiotic prescriptions and surgeries and to relate them to the new classification of periodontitis. Materials and Methods: ABL patterns, prescription of systemic antibiotics and the number of surgeries were retrieved for all patients (n = 353) in the clusters. Comparisons and possible predictors for antibiotics were assessed, and results also evaluated in relation to the new classification. Results: Cluster A is characterized by angular defects often affecting the first molars and localized stage III/IV grade C periodontitis. Cluster B contains mainly localized or generalized stage III/IV, grade C patients. Cluster C contains mainly patients with generalized stage III/IV grade C periodontitis. Patients in cluster A received significantly more antibiotics compared to B and C (78% vs. 23% and 17%); the predictors for antibiotic prescription were young age and localized ABL. No differences in numbers of periodontal surgeries were observed between clusters (A = 1.0 ± 1.4, B = 1.3 ± 1.4 and C = 1.3 ± 1.5). Conclusions: Within stage III/IV grade C periodontitis, we could detect three clusters of patients. The distinct localized ABL pattern and younger age in cluster A presumably prompted clinicians to prescribe antibiotics.

Aim: To explore the feasibility of screening for periodontitis by measuring biomarkers, namely total proteolytic activity (TPA), matrix metalloproteinase (MMP)-8, chitinase, lysozyme or their combination, in saliva, oral rinse and gingival crevicular fluid (GCF). Material and methods: Subjects were recruited among healthy/gingivitis individuals and untreated periodontitis patients in Academic Centre for Dentistry Amsterdam (ACTA). All participants donated samples of unstimulated whole saliva, oral rinse and GCF. The protein concentrations and MMP-8 levels were determined by ELISA. Enzymatic activities were measured using appropriate fluorogenic substrates. Results: In oral rinse samples, periodontitis patients (n = 19) exhibited significantly higher concentrations of MMP-8 and TPA than controls (n = 20). MMP-8 in combination with chitinase explained 88% of the variance and assigned a subject to control or periodontitis group, with best accuracy (87.2%) in oral rinse. Conclusions: The combination of MMP-8 and chitinase in the current oral rinse procedure has the potential to discriminate periodontitis from periodontal health/gingivitis.

AIM: To investigate the association between dietary inflammatory potential and poor periodontal health.MATERIAL AND METHODS: A cross-sectional analysis of a nationally representative sample of participants was performed. NHANES 2011-2014 (n = 7,081) and NHANES 2001-2004 (n = 5,098) were used as discovery and validation datasets, respectively. The energy-adjusted dietary inflammatory index (E-DII) score was calculated for each participant based on 24-hr dietary recalls to assess diet-associated inflammation. Periodontitis was defined by the CDC/AAP using clinical periodontal parameters. Natural cubic spline was applied to identify any non-linear associations of the E-DII score with moderate/severe periodontitis. Furthermore, interaction analyses were performed by age, gender, and race/ethnicity to explore the moderating roles of these factors.RESULTS: In the discovery dataset, a non-linear positive relationship with periodontitis was identified for the E-DII score (P non-linearity < .001) after adjustment for potential confounders. Compared with those individuals in the lowest tertile of E-DII, participants in the highest tertile who consumed a pro-inflammatory diet were 53% more likely to be periodontitis (OR tertile3vs1 = 1.53, 95% CI: 1.33-1.77). The validation dataset showed similar associations. Relatively stronger associations were seen in older adults and males.CONCLUSION: Consuming a pro-inflammatory diet indicated by the E-DII score is associated with periodontal disease in the U.S. general adult population.

Data sources The national electronic health records of the Hamad Medical Corporation (HMC) in the State of Qatar.Data extraction and synthesis This case-control study included 568 patients from the HMC electronic database for data eliciting from 27 February 2020 to 31 July 2020. Patients with coronavirus disease 2019 (COVID-19) complications were considered as cases. Controls were defined as COVID-19 patients without major complications (discharged). Multivariate logistic regression was performed to assess the association between the exposures (periodontitis, demographics and medical conditions) and outcomes (COVID-19 complications). The association was adjusted for possible confounding factors. Additionally, sensitivity analyses were performed to account for stronger risk factors of the determined complications. The results were reported using the odds ratio (OR) and 95% confidence intervals (CIs). Laboratory data (blood parameters concerning the course of COVID-19) were also compared between the case and control groups.Results The patients were divided into 40 cases and 528 controls. Among the patients with periodontitis, 12.8% (33/258) went through COVID-19 complications, whereas 2.2% (7/310) of those without periodontitis experienced complications. The adjusted OR of patients with periodontitis was 3.67 (95% CI 1.46-9.27) for all COVID-19 complications, 8.81 (95% CI 1.00-77.7) for death, 3.54 (95% CI 1.39-9.05) for intensive care unit admission and 4.57 (95% CI 1.19-17.4) for the need of assisted ventilation. After conducting subgroup analyses for age, diabetes and smoking, periodontitis was still significantly associated with all the outcomes. Laboratory biomarkers (haemoglobin A1c, white blood cells and C-reactive protein) had higher levels in COVID-19 patients with periodontitis than those without periodontal disease.Conclusions This study concluded that periodontitis was significantly associated with higher risks of COVID-19 complications and higher blood marker levels. These results, however, are not of high quality and further research in this regard is required.

Aim This study aimed to characterize the salivary proteome during the induction and resolution of gingival inflammation in the course of human experimental gingivitis (EG), and to cluster the proteomic profiles based on the clinically defined "slow" and "fast" response patterns. Materials and Methods A total of 50 unstimulated whole saliva were obtained from the EG model which was induced over 21 days (days 0, 7, 14 and 21), followed by a two-week resolution phase (day 35). Label-free quantitative proteomics using liquid chromatography-tandem mass spectrometry was applied. Regulated proteins were subject to Gene Ontology enrichment analysis. Results A total of 804 human proteins were quantified by >= 2 peptides. Principal component analysis depicted significant differences between "fast" and "slow" responders. Despite gingival and plaque scores being similar at baseline among the two groups, "fast" responders presented with 48 proteins that were at > 4-fold higher levels than "slow" responders. These up-regulated proteins showed enrichment in "antigen presentation" and "proteolysis." Conclusions Together, these findings highlight the utility of integrative systems-level quantitative proteomic approaches to unravel the molecular basis of "salivary proteotypes" associated with gingivitis dubbed as "fast" and "slow" responders. Hence, these differential responses may help prognosticate individual susceptibility to gingival inflammation., Journal of Clinical Periodontology, 47 (11), ISSN:0303-6979, ISSN:1600-051X

Aim To compare outcomes of rhFGF-2 + DBBM therapy with rhFGF-2 alone in the treatment of intrabony defects. This study provides 2-year follow-up results from the previous randomized controlled trial. Materials and methods Defects were randomly allocated to receive rhFGF-2 + DBBM (test) or rhFGF-2 (control). Treated sites were re-evaluated at 2 years postoperatively, using original clinical and patient-centred measures. Results Thirty-eight sites were available for re-evaluation. At 2 years, both groups showed a significant improvement in clinical attachment level (CAL) from baseline. A gain in CAL of 3.4 ± 1.3 mm in the test group and 3.1 ± 1.5 mm in the control group was found. No significant inter-group difference was noted. Both groups showed a progressive increase in radiographic bone fill (RBF). The test treatment yielded greater RBF (56%) compared with the control group (41%). The control treatment performed better in contained defects in terms of CAL and RBF. There was no significant difference in patient-reported outcomes between groups. Conclusions At 2-year follow-up, the test and cotrol treatments were similarly effective in improving CAL, whereas the test treatment achieved a significantly greater RBF. In both treatments, favourable clinical, radiographic, and patient-reported outcomes can be sustained for at least 2 years. Trial registration The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000025257.

Background Bleeding on brushing (BoB) is an important sign of gingival inflammation. Recently, the use of intelligent toothbrushes and oral health Apps has shown potential to improve oral and periodontal health. In the context of the introduction of an Internet of things network of intelligent power‐driven toothbrushes in a supportive periodontal care programme, the aim of this study was (a) to audit the adoption and retention of this new technology; and (b) to preliminarily assess the feasibility to gather data on BoB and associate them with clinical periodontal parameters. Methods 100 subjects with different periodontal case diagnoses participating in supportive periodontal care (SPC) were provided with and instructed on the use of an intelligent power‐driven toothbrush connected with an App (I‐Brush). Brushing sessions and occurrence of BoB were recorded through the App and stored in a data protection compliant backend. Subject retention was audited over time. BoB recorded in the two weeks before the SPC appointment was associated with clinical parameters observed by the clinician blind to App data. Results 75% of subjects provided data from using the power toothbrush and the App for a minimum of 10 brushing sessions over an average period of 362 days. Compared with baseline, subjects’ oral hygiene, bleeding on probing and prevalence of residual pockets improved gradually while using the I‐Brush. The number of BoB episodes in the two weeks leading to the SPC appointment and the number of residual pockets predicted BOP (p