Application status of risk assessment models for periodontal disease / 口腔疾病防治

@#Risk assessment models for periodontal disease provide dentists with a precise and consolidated evaluation of the prognosis of periodontitis, enabling the formulation of personalized treatment plans. Periodontal risk assessment systems have been widely applied in clinical practice and research. The application fields of periodontal risk assessment systems vary based on the distinctions between clinical periodontal parameters and risk factors. The assessment models listed below are commonly used in clinical practice, including the periodontal risk calculator (PRC), which is an individual-based periodontal risk assessment tool that collects both periodontal and systemic information for prediction; the periodontal assessment tool (PAT), which allows for quantitative differentiation of stages of periodontal disease; the periodontal risk assessment (PRA) and modified periodontal risk assessment (mPRA), which are easy to use; and the classification and regression trees (CART), which assess the periodontal prognosis based on a single affected tooth. Additionally, there are orthodontic-periodontal combined risk assessment systems and implant periapical risk assessment systems tailored for patients needing multidisciplinary treatment. This review focuses on the current application status of periodontal risk assessment systems.

Two-year follow-up of the outcomes of endoscope-assisted minimally invasive nonsurgical periodontal therapy for deep intrabony defects / 口腔疾病防治

Objective@#To explore the clinical efficacy and imaging changes of minimally invasive nonsurgical periodontal therapy (MINST) assisted by endoscopy for deep intrabony defects and to compare its effectiveness with that of traditional scaling and root planning (SRP) to therefore provide a reference for clinical periodontal treatment.@*Methods@#Patients with deep intrabony defects ≥ 4 mm in size were selected and divided into two groups: the MINST (MINST, 20 cases, 81 sites) group and the classic scaling and root planing (SRP, 20 cases, 80 sites) group. Before treatment and 12 and 24 months after treatment, probing depth (PD) and clinical attachment loss (CAL) were examined. Moreover, changes in the depth and angle of the intrabony defects were analyzed. Follow-up examination and maintenance treatment should be conducted every 3 months for 12 months after the initial treatment and every 6 months thereafter until 24 months.@*Results@#The PD and CAL of patients in both groups continued to decrease (P<0.001), and imaging examinations revealed a decrease in defect depth and an increase in intrabony defect angle (P<0.001). The changes in the first 12 months were significantly greater than those in the last 12 months in both groups (P<0.001). The decreases in PD, CAL, and depth of intrabony defects and increase in angle in the MINST group were significantly greater than those in the SRP group (P<0.001). At 12 and 24 months after treatment, the PD and CAL in the MINST group were lower than those in the SRP group (P<0.001). The defect height of the MINST group decreased more than that of the SRP group (P<0.001), and the defect angle of the MINST group increased more than that of the SRP group (P<0.001).@*Conclusion@#Minimally invasive nonsurgical periodontal therapy can significantly promote the healing of deep intrabony defects and the regeneration of alveolar bone. Imaging reflects that alveolar bone healing is rapid at first and then slows. Compared with traditional SRP, endoscopically assisted MINST can yield better clinical indicators and imaging changes in intrabony defects.

Clinical and microbiological assessment in a subpopulation of young Argentine patients with severe periodontitis / Periodontitis severa en jóvenes argentinos. Evaluación clínica y microbiológica en jóvenes argentinos con periodontitis severa

ABSTRACT Aggressive periodontitis (AP) is the most serious entity of periodontal disease (stage III/IV, grade C periodontitis according to the latest classification, 2017). Aim: to enhance knowledge of periodontal microbiota in AP in native Argentine patients and describe the effect of a combined pharmacological-mechanicalperiodontal treatment on clinical and microbiological parameters. Materials andMethod: The study analyzed 42 periodontal sites in 11 patients diagnosed with AP. Clinical periodontal parameters were recorded at baseline, 45, 90 and 180 days. Microbiological samples were taken before treatment and at 180 days. PCR was used to determine presence of the periodontopathic bacteria Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). Patients underwent periodontal therapy including antibiotics (Amoxicillin 500mg + Metronidazole 250mg; 8hs/7 days), and were reevaluated at 45, 90 and 180 days. Results: Mean age was 28.4 ± 7.9 years. The initial PCR detected the following frequencies: Aa 14.3%, Pi 61.9%, Pg 71.4%, Tf 81.0%, Fn 95.2% and Td 97.6%. Baseline microbiological samples revealed significantly higher prevalence of Pg over Aa (p=0.012). Clinical parameters improved significantly after treatment (73.8% PS<5 mm; PS, NIC, SS p<0.001). At 180 days, a significant decrease in microbiological detection rates was observed (Fn, Td, Tf, Pi, Aa p<0.05). Aa was no longer detectable while Pg did not decrease significantly (p=0.052). Fn was the only study species detected in 100% (n=11:42) of residual pockets (PS>5 mm) (p=0.053). Conclusion: In the initial samples, there was significant prevalence of Pg over Aa. Significant clinical improvement was achieved after the mechanical-pharmacological treatment, with undetectable levels ofAa, while Fn persisted in residual pockets, and Pg was present at most of the treated sites.

RESUMEN La periodontitis agresiva (PA) es la entidad más grave de la enfermedad periodontal (clasificación 2017: periodontitis estadio III/IV, grado C). Objetivo: mejorar el conocimiento sobre la microbiota periodontal de la PA en sujetos nativos argentinos y describir el efecto de un tratamiento mecánico-farmacológico periodontal sobre los parámetros clínicos y microbiológicos. Materiales y Método: se estudiaron 42 sitios periodontales correspondientes a 11 pacientes con PA. Los parámetros clínicos se registraron a 0, 45, 90 y 180 días. Las tomas microbiológicas se realizaron antes de iniciar el tratamiento y a los 180 días. La determinación de especies periodontopáticas (Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf, Treponema denticola (Td), Prevotella intermedia (Pi) y Fusobacterium nucleatum (Fn)) se realizó por PCR. Los pacientes iniciaron terapia básica periodontal junto con antibioticoterapia (Amoxicilina 500 mg + Metronidazol 250 mg; 8 hs/7 días) y fueron evaluados a los 45, 90 y 180 días. Resultados: la edad media fue 28,4 ± 7,9 años. Las detecciones iniciales fueron: Aa 14,3%, Pi 61,9%, Pg 71,4%, Tf 81,0%, Fn 95,2% y Td 97,6%. En las muestras iniciales la prevalencia de Pg sobre Aa fue significativamente superior (p=0,012). Los pacientes tuvieron una respuesta clínica favorable al tratamiento (73,8% PS<5 mm; PS, NIC, SS p<0,001). A 180 días, se observó una disminución estadísticamente significativa en la detección microbiana (Fn, Td, Tf, Pi, Aa p<0,05). En igual plazo, Aa no fue detectado, mientras que Pg mostró una disminución no significativa (p=0,052). Fn fue el único detectado en el 100% (n=11:42) de las bolsas periodontales residuales (PS>5 mm) (p=0,053). Conclusión: Las muestras iniciales evidenciaron prevalencia significativa de Pg sobre Aa. El tratamiento logró una significativa mejora clínica con niveles indetectables de Aa. La persistencia de Fn en las bolsas residuales y de Pg en la mayoría de los sitios tratados, caracterizaron la muestra poblacional estudiada.

Evaluation of homeopathy effects associated with conventional periodontal therapy in randomized treatment of diabetic and non-diabetic patients with periodontitis

Periodontitis and Diabetes Mellitus type 2 (DMII) are chronic diseases treated by conventional practices and traditional medicine. In many cases, when conventional medicine cannot offer a satisfactory treatment, increases the demand for alternative therapies in chronic conditions. The aim of this study randomized was to compare and evaluate for one year clinical and serologic parameters the effects of homeopathy as an adjunct of conventional periodontal therapy in individual with periodontitis and DMII. Materials and Methods:85 individuals, of both genders, between 35 and 70 years old, participated in this randomized study, which 70 were eligible in Institute of Endocrinology and Diabetes of Rio de Janeiro-Brazil. They were divided into two groups G-1: individuals with periodontitis without systemic conditions and G-2: individuals with periodontitis and DMII. Both groups received homeopathic treatment and were evaluated in clinical and laboratorial examinations. The medication used was chosen based on the similarity principle, following the Berberis 6CH protocol (2 tablets, 2 times a day for 45 days), Mercurius Solubilis / Belladona / Hepar Sulfur-6CH (2 tablets, 3 times a day for 15 days) and a Pyrogenium 200CH biotherapeutic (single weekly dose, 2 weeks). Medications are prescribed in diluted low concentration doses for all signs and symptoms, while biotherapy is used for chronic stimulation Results:Both groups showed significant improvements throughout the study,clinical and laboratorial, at 1 year baseline: reductions in total cholesterol, triglycerides, glucose, glycated hemoglobin, uric acid and CPR. Statistical and descriptive analyzes were performed. The data obtained after laboratory analysis were tabulated and then submitted to the SPSS 17.0 software for Windows (SPSS Inc., Chicago, IL) and significance level with p <0.05. For most of parameters, G-1 performed better than G-2 (p<0.05).Conclusion:After 1 year follow-up this clinical trial suggest that homeopathy therapy, as an adjunct of periondontal treatment, improves local and systemic parameters and can provide better health condition.

Patient experience and non-surgical periodontal therapy in a postgraduate periodontal training program: A qualitative study

ABSTRACT: Objective: To explore patient experience for non-surgical periodontal therapy using phenomenography. Methods: This qualitative study was performed in a postgraduate specialist training program in periodontics. Patients reported their experiences through in-depth interviews in order to recognize the impact of non-surgical periodontal therapy on their quality of life and their satisfaction. A homogeneous sampling procedure was used, establishing redundancy after the fifteenth interview. Interviews were audio recorded, transcribed and analyzed by three researchers who codified the answers into categories to determine the emerging topics. Results: The core emerging themes were: (i) lack of information about periodontal disease; (ii) experience during treatment; (iii) treatment implications; and (iv) clinician-patient relationship. Conclusions: Patients seem to have limited knowledge about periodontal diseases. Reasons for attendance mainly include bleeding gums, tooth mobility, and aesthetic problems. Therapy can generate pain, fear, and is considered invasive, whereas dentine hypersensitivity may occur post-operatively. Despite this, patients would be willing to undergo treatment again and were generally satisfied with the level of care and treatment received.

The Evidence-based Periodontal Risk Assessment (PRA) Tool for Nonsurgical Periodontal Therapy in a Comprehensive Periodontal Management by Risk Assessment (PEMBRA)

ABSTRACT@#In the management of periodontitis patients, periodontal risk assessment (PRA) tool is currently being applied during periodontal review (PR). However, an assessment of risk profiles during examination and diagnosis (E&D) may and would effectively assess and diagnose patients’ periodontal conditions, provide personalised treatment planning, and render an enhanced patient care through periodontal management by risk assessment (PEMBRA). From a retrospective study on selected records of 81 patients treated for chronic periodontitis, the PRA profiles of the patients were evaluated during E&D and two to three months after completion of nonsurgical periodontal therapy (NSPT) during PR. The results were analysed using SPSS version 24 for descriptive statistics. On E&D, the patients presented with 25.9% localised and 74.1% generalised chronic periodontitis. Of these, 2.5% of low-risk patients on E&D increased to 21% during PR signifying an improvement after the treatment. However, the medium-risk patients have a slight increase from 32% to 35%, and patients with a high risk of 62% were reduced to 43%. The improvement of the risk profiles for both low and high-risk groups was mostly contributed by the reduction in the plaque score, percentages of bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 5 mm. This evidence-based evaluation of PRA tool during E&D and PR is important for PEMBRA as it encouraged the clinicians to adopt periodontal management through basic periodontal examination, detailed periodontal charting, radiographic interpretation, tooth per tooth prognosis, diagnosis, and targeted NSPT.

Periodontal Diseases among Pregnant Women in Kuching, Sarawak

ABSTRACT@#Epidemiological and longitudinal studies have shown that pregnancy is associated with increased gingival inflammation and worsening of periodontal status. Prospective studies suggested that periodontal therapy during pregnancy might reduce the risk of adverse pregnancy outcomes and significant periodontal status improvement. The objectives of this study were to evaluate the prevalence of periodontal disease amongst pregnant women, and to compare periodontal conditions before and after non-surgical periodontal therapy. This study was a cross-sectional and intervention study of pregnant women at the Mother and Child Health Clinic, Jalan P. Ramlee, Kuching, who were referred to the Periodontic Unit, Jalan Masjid Dental Clinic, Kuching for further periodontal examination and treatment. All participants were examined and diagnosed with healthy periodontium or diseased periodontium. Sixty women became the subjects and 85% were diagnosed with periodontal disease, while 15% had healthy periodontium. Plaque score (PS) and bleeding score (BS) were evaluated at baseline and at eight weeks. At baseline, all periodontal parameters (mean ± SD) were higher in the diseased periodontium group compared to the healthy group (BS, 39.6 ± 21.5 vs 6.5 ± 3.9; PS, 46.4 ± 30.1 vs 33.5 ± 31.1). After two months, both groups showed improvement in all periodontal parameters; diseased periodontium (p = 0.001) and healthy periodontium group (p = 0.016). In conclusion, 85% of the participants in this study had periodontal diseases and, the non-surgical periodontal therapy improved the participants’ periodontal status. Furthermore, there was no significant adverse pregnancy outcomes reported in this study.

Terapia periodontal regenerativa con hemocomponentes en Santiago de Cuba desde lo social y formativo

RESUMEN Las periodontitis constituyen la primera causa de pérdida dentaria en la edad adulta y su tratamiento depende, casi por completo, del empleo de la implantación de sustitutos estructurales para lograr el potencial reparador necesario. El uso en los últimos años de la medicina celular regenerativa con células mononucleares, plaquetas y lisado plaquetario, han acelerado el proceso de cicatrización de los tejidos blandos y la regeneración ósea. Los resultados que se presentan derivan de una estrategia de superación profesional dirigida al periodoncista para el mejoramiento del desempeño en la aplicación de esta nueva terapéutica, como proyecto de investigación, en el Hospital Juan Bruno Zayas Alfonso de Santiago de Cuba, desde septiembre a diciembre del 2020. Su objetivo consiste en analizar la terapia periodontal regenerativa con hemocomponentes en Santiago de Cuba desde lo social y lo formativo.

ABSTRACT Periodontitis is the first cause of tooth loss in adulthood and its treatment depends, almost entirely, on the use of implantation of structural substitutes to achieve the necessary restorative potential. The use in recent years of regenerative cell medicine with mononuclear cells, platelets and platelet lysate, has accelerated the process of soft tissue healing and bone regeneration. The results presented are derived from a professional improvement strategy aimed at the periodontist to improve performance in the application of this new therapy, as a research project, at the Juan Bruno Zayas Alfonso Hospital in Santiago de Cuba, from September to December 2020. Its objective is to analyze regenerative periodontal therapy with blood components in Santiago de Cuba from a social and educational perspective.

Role Of Periodontal Therapy On Glycemic Control-A Systematic Review

Background:Periodontitis is a term used to describe an inflammatory process ,which is initiated by the plaque biofilm that leads to the loss of periodontal attachment from adjacent alveolar bone and surface of root ultimately results in tooth loss. Although, periodontitis is bacterial infection associated with gram negative anaerobes, in recent years,a two-way correlation has been postulated between periodontitis and diabetes mellitus. It has been found that periodontal diseases may increase the severity in subjects exhibiting diabetes mellitus. Aim:The aim of the present study was role of periodontal therapy on glycemiccontrol-a systematic review. Material And Methods:A Systematic review of clinical trials assessing the relationship between DM and chronic periodontitis. Electronic search based on internet sites (From2009-2019) by MEDLINE,PubMed,Google Scholar and SCOPUSwere used.Result:On basis of this systemic review it can be concluded that non-surgical periodontal therapy is advantageous in clinical parameters and serum HbA1c levels in chronic periodontitis patients suffering from diabetes mellitus. Conclusion:Recent evidence and literature suggests that there exists a strong interconnection between DM and chronic periodontitis.Diabetic patients with periodontal disease have two chronic conditions, of which may affect each other, and require regular professionalevaluations, patient education and consistent educational reinforcement by health care providers both medical and dental.

Changes and clinical significance of four biomarkers in gingival crevicular fluid after nonsurgical periodontal therapy / 口腔疾病防治

Objective@# To study the changes in levels of interleukin (IL)-6, IL-10, tumor necrosis factor-alpha (TNF-α), and alkaline phosphatase (ALP) in the gingival crevicular fluid (GCF) of patients with severe chronic periodontitis before and after nonsurgical periodontal therapy and to explore the relationship among the levels of these four biomarkers in GCF, their periodontal status and their clinical significance to evaluate the effect of nonsurgical periodontal therapy and periodontitis activity.@*Methods@# In total, 30 patients with severe chronic periodontitis were enrolled in a 1-year longitudinal pilot study (Chinese Clinical Trial Registry: ChiCTR-OCH-13004679). At baseline and 1, 3, 6, and 12 months after nonsurgical therapy, the periodontal clinical indicators plaque index (PLI), probing depth (PD), clinical attachment loss (CAL), sulcus bleeding index (SBI) were recorded. Filter paper strips were used to collect two deep-pocket (probing depth ≥ 6 mm) and two shallow-pocket (probing depth ≤ 4 mm) periodontal sites for each patient and weighed. The levels of interleukin IL-6, IL-10, TNF-α, and ALP in GCF were assessed using enzyme-linked immunosorbent assay. Meanwhile, 30 healthy sites of 15 subjects with healthy periodontium were used as the baseline controls for patients with severe chronic periodontitis.@*Results @#At the baseline, the TNF-α, ALP and IL-6 levels in GCF of the disease sites of patients with periodontitis were significantly higher than those in healthy periodontal sites of the control group (P < 0.001), and the levels of IL-10 were significantly lower than those in the control group (P < 0.001). In patients with severe chronic periodontitis, the levels of TNF-α, ALP and IL-6 in GCF at deep-pocket sites were significantly higher than those at shallow-pocket sites (P <0.001), and the IL-10 levels were significantly lower than those at shallow-pocket sites (P < 0.001). 1, 3, 6, and 12 months after nonsurgical treatment, the levels of TNF-α and ALP in GCF at the shallow- and deep-pocket sites in patients with chronic periodontitis significantly decreased, the level of IL-10 significantly increased (P < 0.005), and the level of IL-6 in GCF at the deep-pocket sites significantly decreased (P < 0.005). However, there was no significant difference in IL-6 level at shallow-pocket sites (P > 0.05). 1, 3, 6, and 12 months after nonsurgical treatment, the periodontal clinical indicators were improved compared with the baseline. In addition, there was a significant correlation between the levels of these four biomarkers and the periodontal clinical parameters (P < 0.05). During the two follow-up visits after nonsurgical periodontal therapy, the sites with more than 2-mm increase in attachment loss had significant differences in the levels of the four biomarkers in the GCF compared with the previous visit time (P < 0.005).@*Conclusion@#The detection of the levels of these four biomarkers in GCF has strong clinical significance for assessing the severity of periodontitis and the efficacy of nonsurgical periodontal therapy. Increased levels of TNF-α, ALP, and IL-6 and decreased IL-10 levels in GCF may indicate periodontitis progression at this site.

Effect of the antimicrobial photodynamic therapy in the treatment of periodontitis in type 2 diabetes mellitus: a systematic review and meta-analysis / 口腔疾病防治

Objective@#This systematic review and meta-analysis was undertaken to evaluate the efficacy of antibacterial photodynamic therapy (aPDT) in the treatment of periodontitis in type-2 diabetes mellitus (T2DM) patients and to provide better treatment for patients with T2DM complicated with periodontitis.@*Methods@#The PubMed, Cochrane, Embase, Web of Science, CNKI, CBM, and Wanfang databases were searched for relevant randomized controlled trials (RCTs). RevMan 5.3 was applied for the meta-analysis, and a systematic evaluation was conducted.@*Results@#A total of 8 RCTs were included. The results showed that compared to simple subgingival scaling and root planing (SRP), aPDT assisted SRP had a better effect on improving the probing depth (PD) at 3 months after treatment, The difference was statistically significant [WMD=-0.32,95%CI（-0.45, -0.2）, P < 0.05], but 6 months after treatment, there was no significant difference in the two groups [ WMD=-0.15,95%CI（-0.40, 0.10）,P=0.23]. During the 6-month follow-up period, there were no significant differences in the clinical attachment level (CAL), bleeding on probing (BOP) or hemoglobin A1c (HbA1c) between the two groups (P> 0.05).@*Conclusion@#aPDT-assisted periodontal nonsurgical treatment in T2DM patients can improve PD in the short term but has no significant effect on the improvement of CAL, BOP and HbA1c.

Research progress on the application of photodynamic therapy in periodontal treatment / 口腔疾病防治

@#Periodontitis is a chronic inflammatory disease that is initiated by bacteria. Pathogens and their virulence factors alter normal cellular metabolic activity and deteriorate periodontal microconditions. Owing to the complexity of tooth structure and the limitation of conventional treatment, we may not live up to all patients’ expectations, especially those with grade C and stage Ⅲ or Ⅳ periodontitis. With the advantages of bactericidal effects, high safety, inhibition of bacterial drug resistance and promotion of tissue healing, photodynamic therapy （PDT） seems to be an ideal technology in periodontal treatment. However, it cannot remove subgingival stones and still cannot replace mechanical treatment to preliminarily control periodontal inflammation. Therefore, near-infrared low-energy light combined with traditional photosensitizers is mostly used in clinical periodontal adjuvant treatment. In periodontal maintenance treatment on a regular basis, a single application can also reduce the sensitivity of patients and effectively control plaque, but its effect will be affected by the degree of periodontal inflammation, the concentration and type of photosensitizer, the energy of the light source, etc. With the further development of material science, the performance of photosensitizers to accelerate oxides and target bacteria will be optimized. In the future, parameters of PDT need to be designed in large-scale studies in accord with different stages and grades of periodontitis.

Clinical efficacy evaluation of minimally invasive periodontal therapy assisted by endoscopy / 口腔疾病防治

Objective @# To investigate the clinical effect of periodontal endoscope-assisted scaling and root planing (SRP) in treating advanced periodontitis. @*Methods@# Nineteen cases of grade Ⅲ and Ⅳ periodontitis selected from June 2017 to January 2019 in the Nanjing Stomatological Hospital, Medical School of Nanjing University were divided into the periodontal endoscope and control groups. In the periodontal endoscope group, SRP was performed under a periodontal microscope in one treatment after initial supragingival scaling; in the control group, SRP was performed under regular conditions, and additional SRP was conducted in positive bleeding on probing sites twice every other week as needed. Periodontal status, including probing depth (PD), bleeding on probing (BOP) and attachment loss (AL), was recorded by a Florida probe.@*Results@# For sites of 4<PD ≤ 6 mm, there was no significant difference in PD- and BOP-positive rates or AL between the two groups at baseline. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. PD in the endoscope group was smaller than that in the control group at 3 months (P < 0.05). There was no significant difference between the two groups at 6 months (P >0.05). There was no significant difference in the BOP positive rate or AL change between the two groups at 3 months and 6 months (P > 0.05). For sites with PD > 6 mm, at baseline, the positive rates of PD, BOP and AL in the endoscope group were more serious than those in the control group, and the differences were statistically significant. The PD- and BOP-positive rates and AL in the endoscope group and control group decreased significantly from baseline at 3 and 6 months. However, PD in the endoscope group became shallower than that in the control group (P < 0.05) after 3 and 6 months. There was no significant difference in the BOP positive rate or AL between the two groups (P>0.05). @*Conclusion @#When compared to regular SRP, periodontal microscope-assisted SRP achieves better improvement in PD and is more beneficial for reducing the BOP and AL of deeper sites.

Comprehensive Review on Non-Surgical Periodontal Therapy

Periodontitis is one the most common diseases of the oral cavity and affects majority of the population. In the recent times there have been several advances in the treatment modalities for the same. One of the most common aetiological factors for the disease is dental plaque. Thus, the aim of various therapeutic options is the elimination of dental plaque. The methods range from something as simple as tooth brushing and oral hygiene practices to those administered by a dental professional. There are various mechanical methods and chemical methods for the same. There are also certain methods like the usage of local drug delivery and mouthwashes that can be used as adjuncts to any type of periodontal therapy. The treatment modalities can be surgical or non-surgical. With the patient being kept at the centre of the equation, non-surgical periodontal therapy is more acceptable to the patient and is also easy to perform and not very complex. In the present review, various options for the management of periodontal disease through non-surgical periodontal therapy have been addressed along with recent advances towards the same.

Evaluation of the Masticatory Efficiency Pre- and Post-Periodontal Treatment in Patients with Periodontitis in South Indian Population.

Mastication is the very first step in digestion which facilitates digestion by grinding the food. Masticatory efficiency is regulated by a variety of factors such as health status of periodontium, occlusal contacts, oral musculature and bite force.METHODSA controlled parallel design interventional study was conducted. A total of 40 subjects (40-70 years) attending the Out-Patient Department of Saveetha Dental College and Hospitals, (SIMATS), Chennai, were recruited for the study. Group A or Test group consisted of patients with chronic periodontitis and Group B or Control group had patients with healthy periodontium. Using pre-weighted chewing gum which tend to change colour on mastication, Test and Control groups were asked to masticate for 20 chewing cycles. The chewing gums were then weighed again using the laboratory analytical balance. The above procedure was carried over at baseline, immediate, 1-week and 1-month post-periodontal therapy for every patient belonging to the Test group. The periodontal therapies that were performed were scaling, root planing and flap surgery. The masticatory efficiency was evaluated by comparing the mass of the chewing gum between the Test group and Control group and between each interval within the test group.

A study of susceptibility genes in rare monozygotic twins with generalized aggressive periodontitis / 口腔疾病防治

Objective@#Exploring the effects of susceptibility genes on aggressive periodontitis during its occurrence and development lays a foundation for further research on its genetic pathogenesis.@*Methods@#Medical history and clini⁃ cal indicators were collected from monozygotic twins with generalized aggressive periodontitis. Susceptibility genes were detected by polymerase chain reaction⁃restriction fragment length polymorphisms, and the exon gene components were analyzed by whole⁃exome sequencing. @*Results @#The severity of generalized aggressive periodontitis in the twins was dif⁃ ferent (P < 0.05). Florida diagnosis results showed that the younger sister’ s explored clinical depth (probing depth, PD) and clinical attachment loss (CAL) were higher than those for the elder sister, but her clinical bleeding index (bleeding on probing, BOP) was lower than that of the elder sister. In addition, their responses to periodontal basic treatment were different (P < 0.05). After treatment, the improvement of CAL and decline in BOP were more obvious in the elder sister,and the proportion of different periodontal pocket depths in the elder sister decreased after treatment, while the de⁃ crease was slighter in the younger sister. Genetic tests revealed that the twins had the same genotypes at target suscepti⁃ bility genes (IL⁃1β⁃511, IL⁃1β+3953, TNF⁃α⁃308, FcγR⁃IIIb, VDR, and ER) and differential exon gene components, and that the suspected differential genes, e.g. ZFPM1, PTH2, ZFYVE16, and LY6G6C, might be related to their pheno⁃ typic differences.@* Conclusion@#These monozygotic twins had different phenotypes of generalized aggressive periodonti⁃ tis. Their shared susceptibility genes increased the risk of disease, and their different genetic mutations affected the phe⁃ notype of the disease

A Meta-analysis of the effect of non-surgical periodontal therapy on inflammatory factors in patients with chronic kidney disease and periodontitis / 华西口腔医学杂志

OBJECTIVE@#A study was conducted to systematically evaluate the clinical efficacy of inflammatory factors in patients with chronic kidney disease and periodontitis after non-surgical periodontal therapy.@*METHODS@#We searched the databases of CNKI, Wanfang, CBM, PubMed, Embase, and Cochrane Library from inception to December 2019. Two reviewers independently collected all literature related to inflammatory factors in patients with chronic kidney disease and periodontitis after non-surgical periodontal therapy. These factors include C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). The literature was screened according to the inclusion and exclusion criteria. The quality of the studies was strictly evaluated, and the data were extracted. The literature of randomized controlled trials in accordance with the standards was Meta-analyzed with Revman 5.3 software.@*RESULTS@#Six randomized controlled trials were included. Compared with the control groups, the results of meta-analysis showed that non-surgical periodontal therapy significantly reduced the levels of CRP [MD=-0.58, 95%CI (-1.13, -0.02), P=0.04] and IL-6 [MD=-2.76, 95%CI (-5.15, -0.37), P=0.02] in these patients but not that of TNF-α [MD=-3.87, 95%CI (-8.79, 1.05), P=0.12].@*CONCLUSIONS@#Simultaneous regular renal treatment and non-surgical periodontal therapy can help relieve the periodontal damage on patients with chronic kidney disease and periodontitis. Moreover, it can improve the status of some inflammatory factors. This finding is conducive to the control and treatment of chronic kidney disease and periodontitis and needs to be a focus of research and in clinical operation.

Effect of initial periodontal therapy on blood parameters related to erythrocyte and platelet in patients with type 2 diabetes mellitus and chronic periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To compare the blood parameters related to erythrocyte and platelet between baseline and 3 months after initial periodontal therapy in patients with both type 2 diabetes mellitus and chronic periodontitis (DM-P).@*METHODS@#According to the International Symposium on Classification of Periodontal Diseases and Conditions in 1999 and the diagnostic criteria of type 2 diabetes mellitus proposed by the World Health Organization in 1999, 35 patients with DM-P were recruited. All the participants received initial periodontal therapy, including oral hygiene instruction, scaling, and root planning provided by one senior periodontist. Original diet, exercise, and medication for blood glucose control were unchanged for all the participants. At baseline and 3 months after initial periodontal therapy, the clinical periodontal parameters, including probing depth (PD), bleeding index (BI) and clinical attachment loss (CAL); erythrocyte-related indexes, including red blood cell (RBC) count, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC volume distribution width (RDW); platelet-related indexes, including platelet (PLT) count, mean platelet volume (MPV), platelet distribution width (PDW), plateletocrit (PCT) were measured and compared.@*RESULTS@#Compared with baseline, the periodontal parameters, including PD [(3.370±0.601) mm vs. (2.729±0.431) mm], BI [2.160 (1.550~3.410) vs. 1.420 (1.000~2.970)] and CAL [(3.307±1.577) mm vs. (2.990±1.587) mm], were significantly reduced (P < 0.001) three months after the initial periodontal therapy; the erythrocyte-related indexes, including RBC count [(4.727±0.392)×1012/L vs. (4.825±0.394)×1012/L, P=0.010], HGB [(145.886±11.792) g/L vs. (149.200±12.979) g/L, P=0.007] and HCT [43.40% (37.50%~48.50%) vs. 43.80% (38.50%~53.20%), P=0.003], were significantly increased three months after the initial periodontal therapy; PLT count [(216.714±61.900)×109/L vs. (205.886±62.051)×109/L, P=0.016] was significantly reduced 3 months after the initial periodontal therapy.@*CONCLUSIONS@#The initial periodontal therapy can significantly improve blood parameters related to RBC and PLT, which might decrease the risk of vascular complications in DM-P patients.

Efeito do tratamento periodontal não cirúrgico em indivíduos com artrite reumatóide e periodontite: aspectos epidemiológicos, clínicos, microbiológicos e biomarcadores / Effect of non-surgical periodontal treatment in individuals with rheumatoid arthritis and periodontitis: epidemiological, clinical, microbiological and biomarkers aspects

Objetivos: Evidências atuais reconhece que a periodontite (PE) e a artrite reumatóide (AR) compartilham comuns fatores de risco e alguns caminhos fisiopatológicos semelhantes, como inflamação crônica induzida por citocinas pró-inflamatórias e destruição de tecidos conjuntivos e ósseos. Assim, esta tese apresenta quatro estudos da possível associação entre PE e AR com os seguintes objetivos: avaliar a condição periodontal, gravidade e extensão da periodontite e aspectos clínicos e epidemiológicos da sua associação com a AR. Investigar a influência do tratamento periodontal não cirúrgico (TPNS) sobre os parâmetros clínicos periodontais, níveis bacterianos de A. actinomycetemcomitans, P. gingivalis, T. forsythia, T dentícola e a atividade da AR (DAS28). Adicionalmente quantificar níveis sanguíneos e salivares dos biomarcadores RANKL, OPG, RANKL / OPG, Survivina, e anticorpos antipeptídeos citrulinados cíclicos (ACPAs) e anti-carbamiladas (Anti-CarP). Métodos: A amostra do estudo foi composta por um total de 471 indivíduos divididos aleatoriamente em grupos, de acordo com o objetivo de cada estudo. O ensaio clínico realizou as seguintes avaliações no início do estudo (T1) e 45 dias (T2) após TPNC: exames periodontais de boca completa, análise microbiológica por meio de qPCR em tempo real, avaliações do Disease Activity Score (DAS-28). Em adição, a quantificação de biomarcadores e anticorpos Anti-Carp e ACPAs realizada por meio de ELISA no soro/saliva. Resultados: O presente estudo reportou uma alta prevalência de PE em indivíduos com AR e uma importante associação entre ocorrência, gravidade e extensão da PE associadas à AR e ao tabagismo. O tratamento periodontal não cirúrgico foi eficaz em melhorar a condição cliníca periodontal, reduziu a presença dos patógenos periodontais avaliados e melhorou o quadro clínico da AR (redução dos escores de DAS-28). Adicionalmente, reduziu os níveis de survivina, RANKL e concentração de ACPAs e Anti-CarP. Conclusão: Nossos achados corroboram a robustez das evidências científicas da associação entre periodontite e AR. Assim, o controle da infecção periodontal em pacientes com AR e PE pode ser uma importante ferramenta terapêutica no controle da AR.

Objectives: Current evidence recognizes that periodontitis (PE) and rheumatoid arthritis (RA) share common risk factors and some similar pathophysiological pathways, such as chronic inflammation induced by pro-inflammatory cytokines and destruction of connective and bone tissues. Thus, this thesis presents four studies of the possible association between PE and RA with the following objectives: to assess the periodontal condition, severity and extent of periodontitis and the clinical and epidemiological aspects of its association with RA. To investigate the influence of non-surgical periodontal treatment (TPNS) on the periodontal clinical parameters, bacterial levels of A. actinomycetemcomitans, P. gingivalis, T. forsythia, T dentic and the activity of RA (DAS28). In addition to quantify blood and salivary levels of the biomarkers RANKL, OPG, RANKL / OPG, Survivina, and cyclic citrullinated anti-peptide antibodies (ACPAs) and anti-carbamylates (Anti-CarP). Methods: The study sample consisted of a total of 471 individuals randomly divided into groups, according to the objective of each study. The clinical trial performed the following assessments at baseline (T1) and 45 days (T2) after TPNC: periodontal examinations of full mouth, microbiological analysis using real-time qPCR, assessments of the Disease Activity Score (DAS-28). In addition, the quantification of biomarkers and Anti-Carp antibodies and ACPAs performed by ELISA in serum / saliva. Results: The present study reported a high prevalence of PE in individuals with RA and an important association between the occurrence, severity and extent of PE associated with RA and smoking. The non-surgical periodontal treatment was effective in improving the clinical periodontal condition, reduced the presence of the periodontal pathogens evaluated and improved the clinical picture of RA (reduced DAS-28 scores). Additionally, it reduced the levels of survivin, RANKL and concentration of ACPAs and Anti-CarP. Conclusion: Our findings corroborate the robustness of the scientific evidence on the association between periodontitis and RA. Thus, the control of periodontal infection in patients with RA and PE can be an important therapeutic tool in the control of RA.

A influência da doença periodontal e a manipulação dos tecidos periodontais na bacteremia sistêmica: uma revisão de literatura / The influence of periodontal disease and the manipulation of periodontal tissues on systemic bacteremia: a review of the literature

Periodontal disease is the most prevalent oral infection in patients admitted to intensive care units. The periodontium is surrounded by a multitude of lymphatic vessels. Through this path, the lymphatic fluid mixes with the venous blood, resulting in an invasion of bacteria in the circulatory system, even for a short period of time. Periodontal bacteria, in addition to entering the circulatory system, produce inflammatory mediators that are generally not limited to periodontal tissues. Through these and other processes, it is possible to observe the relationship between periodontal diseases and systemic diseases. The objective of this review was to observe the pathways between periodontal disease and systemic events, emphasizing the bacteremia caused by the manipulation of periodontal tissues in patients with periodontitis. A search was performed on the Pubmed, Lilacs and Scielo databases, using the English descriptors "periodontal diseases", "periodontitis", "bacteremia", "bacteraemia" and "periodontal therapy". Studies show that periodontal disease and manipulation of periodontal tissues are capable of promoting bacteremia and of influencing systemic diseases. It was also concluded that the studies present a heterogeneous methodology, which suggests the need for greater standardization to better compare the data (AU)

A doença periodontal é a infecção bucal de maior prevalência em pacientes internados em unidades de terapia intensiva. O periodonto é cercado por uma infinidade de vasos linfáticos. Por este trajeto, o fluido linfático se mistura ao sangue venoso, resultando numa invasão de bactérias no sistema circulatório, ainda que por curto período de tempo. As bactérias periodontais, além de adentrarem no sistema circulatório, produzem mediadores inflamatórios que, geralmente, não se limitam aos tecidos periodontais. Por meio desses e outros processos, é possível observar a relação das doenças periodontais com as doenças sistêmicas. O objetivo desta revisão foi observar as vias de ligação entre a doença periodontal e os eventos sistêmicos, salientando a bacteremia originada da manipulação dos tecidos periodontais em pacientes com periodontite. Foi realizada uma busca nas bases de dados Pubmed, Lilacs e Scielo, utilizando os descritores em inglês "periodontal diseases", "periodontitis", "bacteremia", "bacteraemia", "periodontal therapy". Estudos mostram que a doença periodontal e a manipulação dos tecidos periodontais são capazes de promover a bacteremia e de influenciar doenças sistêmicas. Concluiu-se ainda, que os estudos apresentam uma metodologia heterogênea, o que sugere a necessidade de maior padronização para melhor comparação dos dados (AU)