Total tooth loss and systemic correlates of inflammation: role of obesity.

Obesity and edentulism are both associated with multiple systemic disorders with an inflammatory background including periodontal diseases. This study aimed to evaluate the different impact of obesity on inflammation in dentate and toothless subjects. The data came from the population-based, cross-sectional study SHIP (Study of Health in Pomerania). We determined anthropometric measures including BMI, waist-to-hip ratio (WHR), diagnostic periodontal parameters, and systemic metabolites. It was shown that measures of systemic markers of inflammation and lipid or glucose metabolism (P < 0.001) were increased with higher WHR. When adjusted for age, sex, smoking, diabetes, education, physical activity, and last dentist's appointment, C-reactive protein (CRP), fibrinogen, and leukocyte count were significantly related to WHR increasing from the first to the fourth WHR quartile (P < 0.001) as well as to the BMI. In both dentate and edentulous subjects higher WHR contributes significantly to increasing systemic CRP and fibrinogen with sex differences. In toothless subjects, while still dependent on increasing WHR, the inflammatory markers CRP and fibrinogen were higher than in dentate subjects, thereby revealing effect modification between sex and edentulism (P < 0.010). In conclusion, subjects with total tooth loss, although devoid of periodontal inflammation, may exhibit increased levels of systemic inflammatory mediators. Possible implications are discussed with respect to obesity and its relationship to inflammation.

Functional status of peripheral blood T-cells in ischemic stroke patients.

Stroke is a major cause of disability and leading cause of death in the northern hemisphere. Only recently it became evident that cerebral ischemia not only leads to brain tissue damage and subsequent local inflammation but also to a dramatic loss of peripheral blood T-cells with subsequent infections. However, only scarce information is available on the activation status of surviving T cells. This study therefore addressed the functional consequences of immunological changes induced by stroke in humans. For this purpose peripheral blood T-cells were isolated from 93 stroke patients and the expression of activation makers was determined. In addition ex vivo stimulation assays were applied to asses the functionality of T cells derived from blood of stroke patients. Compared to healthy controls, stroke patients demonstrated an enhanced surface expression of HLA-DR (p<0.0001) and CD25 (p = 0.02) on T cells, revealing that stroke leads to T cell activation, while CTLA-4 remained undetectable. In vitro studies revealed that catecholamines inhibit CTLA-4 upregulation in activated T cells. Ex vivo, T cells of stroke patients proliferated unimpaired and released increased amounts of the proinflammatory cytokine TNF-alpha (p<0.01) and IL-6 (p<0.05). Also, in sera of stroke patients HMGB1 concentrations were increased (p = 0.0002). The data demonstrate that surviving T cells in stroke patients remain fully functional and are primed towards a TH1 response, in addition we provide evidence that catecholamine mediated inhibition of CTLA-4 expression and serum HMGB1 release are possible mediators in stroke induced activation of T cells.

Association between type 1 and type 2 diabetes with periodontal disease and tooth loss.

AIM: The aim of this study was to determine whether both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are associated with increased prevalence and extent of periodontal disease and tooth loss compared with non-diabetic subjects within a homogeneous adult study population. MATERIAL AND METHODS: T1DM, T2DM and non-diabetic subjects were recruited from the population-based Study of Health in Pomerania. Additionally, T1DM subjects were retrieved from a Diabetes Centre. The total study population comprised 145 T1DM and 2647 non-diabetic subjects aged 20-59 years, and 182 T2DM and 1314 non-diabetic subjects aged 50-81 years. Periodontal disease was assessed by attachment loss (AL) and the number of missing teeth. RESULTS: Multivariable regression revealed an association between T1DM (p<0.001) and T2DM (p<0.01) with mean AL after full adjustment. After age stratification (p=0.04 for interaction), the effect of T2DM was only statistically significant in the 60-69-year-old subjects (B=0.90 (95% confidence intervals [95% CI]; 0.49, 1.31). T1DM was positively associated with tooth loss (adjusted, p<0.001). The association between T2DM and tooth loss was statistically significant only for females (odds ratios=1.60 [95% CI: 1.10, 2.33]). CONCLUSIONS: Our study confirmed an association between both T1DM and T2DM with periodontitis and tooth loss. Therefore, oral health education should be promoted in diabetic subjects.