ABSTRACT
Aim: Diabetes mellitus (DM), a metabolic disorder, exhibits a bidirectional relationship with periodontitis (PD), and recently, microRNAs (miRNAs) were associated with their progression. This review aims to assess the role of miRNAs in the pathogenesis of DM-associated PD and their plausible application as a biomarker for PD in individuals with DM. Materials and Methods: The search conducted until September 2023 on Medline (Pubmed), Scopus, Embase, and Web of Science using the keywords "microRNA," "miRNA," or "miR," combined with "Diabetes" and "PD" yielded 100 articles. Only research focusing on the role of miRNAs in the pathogenesis of DM-associated PD and their potential application as biomarkers for both conditions were included. Finally, 14 studies were assessed for any bias, and the collected data included study design, sample size, participant groups, age, sample obtained, PD severity, miRNAs examined, clinical and biochemical parameters related to DM and PD, and primary outcomes. Results: In vivo studies indicated altered expression of miRNAs-146a, -146b, -155, -200b, -203, and -223, specifically in the comorbid subjects with both conditions. Animal, ex vivo, and in vitro studies demonstrated altered expression of miRNAs-126, -147, -31, -25-3p, -508-3p, -214, 124-3p, -221, -222, and the SIRT6-miR-216/217 axis. These miRNAs impact innate and adaptive immune mechanisms, oxidative stress, hyperglycemia, and insulin sensitivity, thereby promoting periodontal destruction in DM. miRNA-146a emerges as a reliable biomarker of PD in DM, whereas miRNA-155 is a consistent predictor of PD in subjects without DM. Conclusions: miRNAs exert influence on immuno-inflammation in DM-associated PD. Although they can be biomarkers of PD and DM, their clinical utility is hindered by the absence of standardized tests to evaluate their sensitivity and specificity. Moreover, there has been limited exploration of the role of miRNAs in DM-associated PD through human studies. Future clinical trials are warranted to address this gap, focusing on standardizing sample collection, miRNA sources, and detection methods. This approach will enable the identification of specific miRNAs for DM-associated PD.
ABSTRACT
Periodontitis is an immuno-inflammatory disease of the soft tissues surrounding the teeth. Periodontitis is linked to many communicable and non-communicable diseases such as diabetes, cardiovascular disease, rheumatoid arthritis, and cancers. The oral-systemic link between periodontal disease and systemic diseases is attributed to the spread of inflammation, microbial products and microbes to distant organ systems. Oral bacteria reach the gut via swallowed saliva, whereby they induce gut dysbiosis and gastrointestinal dysfunctions. Some periodontal pathogens like Porphyromonas. gingivalis, Klebsiella, Helicobacter. Pylori, Streptococcus, Veillonella, Parvimonas micra, Fusobacterium nucleatum, Peptostreptococcus, Haemophilus, Aggregatibacter actinomycetomcommitans and Streptococcus mutans can withstand the unfavorable acidic, survive in the gut and result in gut dysbiosis. Gut dysbiosis increases gut inflammation, and induce dysplastic changes that lead to gut dysfunction. Various studies have linked oral bacteria, and oral-gut axis to various GIT disorders like inflammatory bowel disease, liver diseases, hepatocellular and pancreatic ductal carcinoma, ulcerative colitis, and Crohn's disease. Although the correlation between periodontitis and GIT disorders is well established, the intricate molecular mechanisms by which oral microflora induce these changes have not been discussed extensively. This review comprehensively discusses the intricate and unique molecular and immunological mechanisms by which periodontal pathogens can induce gut dysbiosis and dysfunction.
ABSTRACT
Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.
ABSTRACT
To review the new role of an age-old micronutrient - ascorbic acid - in the management of periodontal disease. Articles pertaining to the topic were searched in PubMed and other search engines from year 1974 to April 2014 with the following key words: "ascorbic acid," "ascorbate," "vitamin C," "periodontal disease," "gingivitis," "periodontitis," "anti-oxidants" and "elderly." Balanced nutrition is an essential factor in the elderly. Modification of nutritional requirement is important to overcome the effect of an unbalanced diet in older individuals as a result of several external and internal host-associated factors. Micronutrient requirements as aging advances could change, and require due attention. Ascorbic acid and its relationship with periodontal disease are very well known. However, recent changes in the concept of understanding the pathogenicity has led to a new path of therapeutic intervention with ascorbic acid in many chronic diseases. Oxidative stress with its associated burden might alter the disease process. In the era of "periodontal medicine," the impact of remote tissue changes on systemic disease has to be taken into serious consideration. Deficiency of nutritional impact on the host, with micronutrient vitamin C detailed in this review with sources, absorption, interaction and its relationship with systemic disease, and thereby the impact on periodontal disease. Ascorbic acid plays an important role in the aging process, and in the maintenance of periodontal health in the elderly.