Healthy lifestyles and better periodontal health: Results from two large population-based surveys.

AIM: To ascertain whether healthy lifestyles are associated with periodontal diseases in two large-scale surveys in the US (National Health and Nutrition Examination Survey - NHANES) and the UK Biobank. METHODS: 9854 US adults and 111 679 UK adults were included in the analyses. A healthy lifestyle score (HLS), ranging between 0 and 5, was calculated based on the reported number of healthy behaviours, including never smoking, no heavy alcohol consumption, top third of leisure-time physical activity, higher dietary quality, and ideal sleep duration. The prevalence of periodontal diseases was the primary outcome in both surveys. In the NHANES, periodontal status was assessed through a full-mouth periodontal examination, while in the UKB, only self-reported periodontal status was available. RESULTS: Multiple regression analyses confirmed that the presence of at least 2-3 healthy behaviours (vs. 0-1) was associated with lower odds of overall and severe periodontitis (ORs 0.5, 0.4-0.6; p < .001 and 0.5, 0.3-0.8; p = .003, respectively) in the NHANES, and of bleeding gums (OR = 0.9, 0.8-1.0; p = .092) and loose teeth (OR = 0.6, 0.5-0.7; p < .001) in UKB. This association increased when considering prevalence of 4-5 healthy behaviours (vs. 0-1) in both the NHANES (periodontitis: OR = 0.3, 0.2-0.4; p < .001; severe periodontitis: OR = 0.1, 0.01-0.2; p < .001) and the UKB (bleeding gums: OR = 0.8, 0.7-0.9; p < .001; loose teeth: OR = 0.5, 0.4-0.6; p < .001). Mediation analyses revealed how these protective associations could be partially mediated (1-14%) by differences in biomarkers of systemic inflammation (white blood cells and neutrophils count as well as C-reactive protein). CONCLUSIONS: Adoption of healthy lifestyle behaviours is associated with a lower prevalence of periodontal diseases within two large population-based samples. This relationship exhibits a dose-response pattern, implying that greater adherence to healthy habits leads to a more significant protective effect against the odds of periodontal diseases. Additionally, our findings suggest that this protective effect is, in part, mediated by reductions in systemic inflammation.

Association between nonalcoholic fatty liver disease scores and chronic periodontitis: A retrospective cohort study.

BACKGROUND: Although several studies have demonstrated a bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and chronic periodontitis, few studies have reported that NAFLD causes chronic periodontitis, especially in the Asian population. METHODS: This study was conducted on 129,087 individuals, and the NAFLD score was assessed using the Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and Framingham Steatosis Index (FSI). The incidence of chronic periodontitis was defined as a diagnostic code with dental procedures. Multi-variable adjusted Cox proportional hazard regression analysis was performed with hazard ratio (HR) and 95% confidence intervals (CIs). RESULTS: Nine thousand one hundred and twenty-eight chronic periodontitis cases (7.1%) were identified during a mean 7.4 years follow-up period. Each NAFLD score was related to chronic periodontitis. In the FLI score, HR and 95% CIs for the incidence of chronic periodontitis compared with a low FLI group were as follows: indeterminate FLI: 1.19 (1.12-1.26), high FLI: 1.32 (1.18-1.47). In the HSI and FSI scores, HR and 95% CIs for the incidence of chronic periodontitis were 1.13 (1.05-1.22) and 1.23 (1.05-1.31), respectively. CONCLUSIONS: All NAFLD scores were associated with chronic periodontitis in the Korean population. As chronic periodontitis can aggravate the liver status, patients with NAFLD may need regular dental visits.

Performance of ChatGPT in classifying periodontitis according to the 2018 classification of periodontal diseases.

OBJECTIVES: This study assessed the ability of ChatGPT, an artificial intelligence(AI) language model, to determine the stage, grade, and extent of periodontitis based on the 2018 classification. MATERIALS AND METHODS: This study used baseline digital data of 200 untreated periodontitis patients to compare standardized reference diagnoses (RDs) with ChatGPT findings and determine the best criteria for assessing stage and grade. RDs were provided by four experts who examined each case. Standardized texts containing the relevant information for each situation were constructed to query ChatGPT. RDs were compared to ChatGPT's responses. Variables influencing the responses of ChatGPT were evaluated. RESULTS: ChatGPT successfully identified the periodontitis stage, grade, and extent in 59.5%, 50.5%, and 84.0% of cases, respectively. Cohen's kappa values for stage, grade and extent were respectively 0.447, 0.284, and 0.652. A multiple correspondence analysis showed high variance between ChatGPT's staging and the variables affecting the stage (64.08%) and low variance between ChatGPT's grading and the variables affecting the grade (42.71%). CONCLUSIONS: The present performance of ChatGPT in the classification of periodontitis exhibited a reasonable level. However, it is expected that additional improvements would increase its effectiveness and broaden its range of functionalities (NCT05926999). CLINICAL RELEVANCE: Despite ChatGPT's current limitations in accurately classifying periodontitis, it is important to note that the model has not been specifically trained for this task. However, it is expected that with additional improvements, the effectiveness and capabilities of ChatGPT might be enhanced.

Excessive weight in pregnant women increases the chance of diagnosing periodontitis combined with tooth loss.

BACKGROUND: Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy. METHODS: A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level. RESULTS: The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: ORadjusted:1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: ORadjusted:1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance. CONCLUSIONS: There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss.

Associations between oral health and depression and anxiety: A cross-sectional and prospective cohort study from the UK Biobank.

AIM: To investigate the associations between oral health and depression, anxiety and their comorbidity in the UK Biobank cohort. MATERIALS AND METHODS: Oral health problems were self-reported at baseline. Symptoms of depression and anxiety were assessed using the Mental Health Questionnaire (PHQ-4) in a cross-sectional study. In the cohort study, diagnoses of depression and anxiety disorders were based on hospital records. Logistic regression and Cox regression models were used to analyse the association between oral health and depression/anxiety. RESULTS: A total of 305,188 participants were included in the cross-sectional study, and multivariate analysis showed that periodontal disease was associated with depression and/or anxiety (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.73-1.86). In the prospective cohort study involving 264,706 participants, periodontal disease was significantly associated with an increased risk of depression and/or anxiety (hazard ratio [HR]: 1.14, 95% CI: 1.10-1.19), depression (HR: 1.19, 95% CI: 1.13-1.25) and anxiety (HR: 1.13, 95% CI: 1.07-1.19). Periodontal disease was also significantly associated with comorbid depression and anxiety (HR: 1.27, 95% CI: 1.16-1.38). Multiple mediation analysis using baseline inflammatory factors showed that white blood cell count and C-reactive protein explained 3.07% and 3.15% of the association between periodontal disease and depression and anxiety, respectively. However, the results of longitudinal multiple mediation analysis of inflammatory factors at first follow-up (N = 10,673) were not significant. CONCLUSIONS: Periodontal disease was found to be consistently associated with an increased risk of depression, anxiety and their comorbidity.

Convergence of inflammatory response: Salivary cytokine dynamics in coronavirus disease 2019 and periodontal disease.

Background: Periodontal disease is associated with immune dysregulation, and cytokines released can add on to the coronavirus disease 2019 (COVID-19)-associated cytokine storm, further worsening the related adverse outcomes. Specific studies investigating cytokine levels in COVID-19 patients with periodontal disease are lacking. Examining the correlation between these conditions could aid in categorizing risk categories, determining referrals, and strengthening oral hygiene protocols. The current study sought to evaluate cytokine levels in the saliva of COVID-19-positive patients with and without periodontal disease. Materials and Methods: Twenty-six COVID-19-positive patients were subjected to periodontal examination, saliva collection, and assessment of cytokine levels through cytokine bead-based multiplex assay, using fluorescence-encoded beads with flow cytometry (BD FACS LSRFortessa). Eleven cytokines were assessed (interleukin [IL] 2, 4, 6, 10, 17A, and interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-α), chemokine ligand 2 (CCL2/monocyte chemoattractant protein-1), C-X-C motif chemokine ligand (CXCL) 8/IL 8, CXCL 9/monokine-induced gamma interferon [MIG]), and CXCL 10 (chemokine IFN-gamma inducible protein 10 kDa). The cytokine levels of the recruited subjects were also compared graphically with the salivary cytokine levels reported in the literature for health, COVID-19, and periodontal disease alone. Results: Out of 26 COVID-19-positive patients, 17 had periodontal disease. Levels of all cytokines were raised in patients with both diseases when compared to values reported in literature for health, periodontal disease alone, or COVID-19 alone. However, there was no statistical difference among the recruited subjects for IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-gamma, TNF-α, CCL2, CXCL 8, and CXCL 10. MIG levels were found to be higher in periodontally healthy, COVID-19-positive subjects (P = 0.01). Conclusions: Periodontal disease might contribute to the COVID-19-induced cytokine storm, potentially amplifying its impact.

Inflammatory profile of patients with different weight diagnoses and similar periodontal condition: A systematic review.

Background: This study aimed to systematically review the literature regarding the inflammatory profiles, measured by cytokines and chemokines, of individuals with different diagnoses of weight, but with the similar periodontal condition. Materials and Methods: Searches were performed in five databases (Scopus, EMBASE, PubMed, Web of Science, and Cochrane-Central). Studies that compared the inflammatory profile of normal-weight individuals to those with obesity and evaluated the same cytokine, collection method, and periodontal diagnosis (periodontal health, gingivitis, or periodontitis) were included. Cross-sectional studies underwent evaluation by independent researchers using the Joanna Briggs Institute Critical Appraisal Checklist. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system assessed evidence certainty. Results: Twelve studies were included. The diagnosis of obesity was done on the basis of body mass index, waist circumference, and waist-hip ratio. Pro-inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF]-α, IL-1ß, IL-31, and IL-34) were analyzed in serum, saliva, gingival crevicular fluid (GCF), and plasma. Periodontal diagnoses varied across studies. TNF-α expression was significantly higher in individuals with obesity and periodontal health or periodontitis. Serum IL-1ß levels showed mixed results, but salivary IL-1ß levels were elevated in obese individuals. IL-6 levels were higher in obese individuals, regardless of periodontal status. IL-34 and IL-10 showed no significant differences across groups. Monocyte chemoattractant protein-4 (MCP-4) levels were higher in obese individuals with periodontitis or periodontal health. IL-31 and IL-34 in GCF showed no significant differences between obese and nonobese individuals, without periodontitis. Conclusions: Heterogeneous results were noted for IL-6, IL-1ß, IL-31, IL-34, TNF-α, and MCP-4, hindering conclusions on weight's impact on inflammatory profiles in periodontal patients.

Scanning electron microscopic analysis of 5% glycolic acid as a novel alternative to 17% ethylenediaminetetraacetic acid in root biomodification: An in vitro study.

Background: Nonsurgical periodontal therapy results in the formation of a smear layer which inhibits tissue regeneration. Root biomodification (RB) using various agents has been tried for the enhancement of new attachment formation. However, no substantial therapeutic advantages of currently available root conditioning agents have been reported emphasizing the need for additional biologically acceptable agents. Glycolic acid (GA) due to its antimicrobial nature and ability of initiation and proliferation of fibroblasts may potentially modify root surface enabling regeneration. Materials and Methods: Eighty specimens from 40 single-rooted teeth were treated with 17% ethylenediaminetetraacetic acid (EDTA) and 5% GA and scanning electron microscopy analysis was done. The micrographs were examined for the evaluation of smear layer removal, total number of dentinal tubules, total number of patent dentinal tubules, mean diameter and surface area of dentinal tubules, and dentin erosion. Statistical analysis was done using unpaired t-test for intergroup comparison. Results: The efficacy of smear layer removal (P = 0.01) and dentin erosion (P = 0.042) was significantly better in the GA group. Both the groups showed no difference in dentinal tubule-related parameters. Conclusion: GA showed improved RB with greater smear layer removal and lesser dentin erosion, indicating its use as a potent alternative to the conventional EDTA root conditioning.

Periodontal status and mandibular biomechanics in rats subjected to hyposalivation and periodontitis.

Xerostomia emerges as a consequence of salivary gland hypofunction, and seriously compromises the integrity of hard and soft oral tissues, whileperiodontitis is an infectious disease characterized by biofilm accumulation, inflammation and alveolar bone resorption. AIM: The aim this study was to compare the deleterious effects caused by experimental hyposalivation, periodontitis, and the combination of both on periodontal tissues and mandibular biomechanics in rats. MATERIALS AND METHOD: Hyposalivation (group H) was induced through bilateral submandibulectomy. Periodontitis (group EP) was induced by injecting LPS (1 mg/ml) into the gingiva of the first lower molars. A third group was subjected to both conditions (group H+EP). Alveolar bone loss was evaluated by micro-computed tomography and histomorphometric analysis, and gingival inflammatory mediators were assessed by specific techniques. Biomechanical properties were evaluated in mandible. RESULTS: Alveolar bone loss increased similarly in groups H, EP and H+EP compared to control. Metalloproteinase (MMP2 and MMP9) activity was similar in H and control, but higher in groups EP and H+EP (MMP2: C 9644+2214, EP 34441+3336, H 5818+1532, H+EP 42673+3184; MMP9: C 5792+961, EP 14807+861, H 9295+520, H+EP 4838+1531). The rest of the inflammatory mediators evaluated increased in groups H, EP and H+EP to a greater or lesser extent with respect to the control, although in most cases, they were higher in groups EP and H+EP than in group H. The biomechanical properties of the mandible increased in group H compared to the other three groups. CONCLUSIONS: Both hyposalivation and periodontitis cause periodontal damage, but hyposalivation also produces biomechanical alterations, causing more extensive deleterious effects than periodontitis.

La xerostomía surge como consecuencia de la hipofunción de las glándulas salivales y compromete seriamente la integridad de los tejidos orales duros y blandos, mientras que la periodontitis es una enfermedad infecciosa caracterizada por la acumulación de biofilm, inflamación y reabsorción ósea alveolar. OBJETIVO: El objetivo del presente estudio fue comparar los efectos deletéreos causados por la hiposalivación y la periodontitis experimental, y la combinación de ambas sobre los tejidos periodontales y la biomecánica mandibular en ratas. MATERIALES Y MÉTODOS: La hiposalivación (H) se indujo mediante una submandibulectomía bilateral. Por otra parte, la periodontitis (PE) se indujo mediante la inyección de LPS (1 mg/ml) en la encía de los primeros molares inferiores. Otro grupo se sometió a ambas condiciones (H+PE). La pérdida ósea alveolar se evaluó mediante tomografia microcomputarizada y análisis histomorfométrico, mientras que los mediadores inflamatorios gingivales fueron determinados mediante técnicas específicas. Se evaluaron las propiedades biomecánicas en la mandíbula. RESULTADOS: La hiposalivación aumentó la pérdida ósea alveolar en comparación con el control de forma similar a la PE y H+PE. La actividad de las metaloproteinasas (MMP2 y MMP9) fue similar en los grupos H y control, pero resultó mayor en los grupos PE y H+PE (MMP2: C 9644+2214, PE 34441+3336, H 5818+1532, H+PE 42673+3184; MMP9: C 5792+961, PE 14807+861, H 9295+520, H+PE 24838+1531). El resto de los mediadores inflamatorios evaluados aumentaron en mayor o menor medida en los grupos H, PE y H+PE respecto al control, aunque en la mayoría de los casos fueron superiores en los grupos PE y H+PE respecto al grupo H. Sin embargo, las propiedades biomecánicas de la mandíbula aumentaron en el grupo H con respecto a los otros grupos. CONCLUSIONES: Tanto la hiposalivación como la periodontitis causan daño periodontal, pero la hiposalivación también produce alteraciones biomecánicas, provocando efectos deletéreos más extensos que la periodontitis.

A Systematic Literature Review on Inflammatory Markers in the Saliva of Patients with Multiple Sclerosis: A Cause or a Consequence of Periodontal Diseases.

Background and Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disease often linked with systemic conditions such as periodontal diseases (PDs). This systematic review aims to explore the association between inflammatory markers in saliva and PDs in MS patients, assessing the use of saliva as a non-invasive tool to monitor disease progression. Materials and Methods: 82 publications were examined after a thorough search of scholarly databases to determine whether inflammatory markers were present in MS patients and whether they were associated with periodontal disease (PD). Quality and bias were assessed using the Newcastle-Ottawa Scale, resulting in eight articles that were thoroughly analyzed. Results: The results point to a strong correlation between MS and periodontal disorders, which may point to the same pathophysiological mechanism. It does, however, underscore the necessity of additional study to determine a definitive causal association. Conclusions: The findings indicate a strong association between MS and PDs, likely mediated by systemic inflammatory responses detectable in saliva. The review highlights the importance of oral health in managing MS and supports the utility of saliva as a practical, non-invasive medium for monitoring systemic inflammation. Further research is necessary to confirm the causal relationships and to consider integrating salivary diagnostics into routine clinical management for MS patients.

Iron Deficiency Anemia and Its Impact on Oral Health-A Literature Review.

Oral disease interventions primarily focus on behavioral changes like dietary improvements and ensuring better oral hygiene. However, recognizing the influence of biological factors, including genetics and early-life nutrition, is crucial. Iron deficiency (ID) and its advanced form, iron deficiency anemia (IDA), affect nearly two billion people globally, especially children and pregnant women. We conducted a comprehensive search using Medline via EndNote and Web of Science, employing keywords related to iron deficiency anemia (IDA), and we identified 36 studies deemed relevant for inclusion in this literature review. IDA prevalence is notably high among pregnant women and young children. Both IDA and early-childhood caries (ECC) disproportionately affect impoverished populations, highlighting the socioeconomic dimension of this issue. IDA presents with various oral mucosal changes and is closely linked to candidiasis. Additionally, IDA can hinder tooth development and weaken the immune response. Multiple population surveys have revealed a significant association between ECC and IDA. While some studies have explored the IDA-periodontal disease link, the current evidence is relatively limited in its robustness. In conclusion, more comprehensive longitudinal studies are essential to deepen our understanding of the IDA-oral disease connection. Investigating the underlying biological mechanisms is critical to developing effective interventions, particularly for vulnerable populations affected by IDA.

MMP-8 in Periodontal Sites of Postpartum and without-Any-Pregnancy Women.

The hypothesis that physiological changes in women can affect periodontal tissues is the subject of this study, and inflammatory markers such as matrix metalloproteinase-8 can measure susceptibility to inflammation. The study aimed to analyze MMP-8 levels in periodontal sites of postpartum women and women without a history of pregnancy, comparing health parameters and periodontal disease. This is a case-control study with 40 participants, 20 cases (women in the postpartum period) and 20 controls (women without any pregnancy), who underwent clinical periodontal examination and the collection of crevicular gingival fluid. The ELISA test was used to detect MMP-8 levels. Postpartum women had worse periodontal parameters, such as bleeding index on probing, number of sites with CAL ≥ 3, and fewer teeth present. In the group of women without a history of pregnancy, a significantly lower MMP-8 level was observed in healthy sites and a higher one was observed in periodontal pockets (p < 0.01). In contrast, in postpartum women, MMP-8 levels were elevated in both healthy sites and periodontal pockets (p > 0.01). The MMP-8 levels in gingival fluid appear to be related to periodontal clinical parameters and may be a possible marker of enzymatic changes involved in periodontal tissue destruction in postpartum women.

Role of diet in primary and secondary prevention of periodontitis and non-specific inflammatory bowel diseases. Part II.

INTRODUCTION AND OBJECTIVE: Both periodontitis and non-specific bowel diseases (IBD) are complex chronic diseases, and the elements connecting them are the dysregulated microbiota and abnormal immune response of the host. In turn, in the etiology of these diseases, the common environmental risk factor is improper mode of nutrition. The aim of the study is to review nutritional interventions and effective nutritional protocols applied in periodontitis and IBD. The result of the review will be identification of dietary recommendations exerting a beneficial effect on the reduction of the risk of development and alleviation of the severity of both diseases. At the same time, non-recommended dietary choices will be indicated. REVIEW METHODS: A review of literature was carried out using the databases PubMed, Google Scholar, and Web of Science. Publications were analyzed by a non-systematic literature review aimed at making a brief synthesis of the collected information. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: Diets recommended to patients with both periodontitis and IBD included the Mediterranean diet, DASH diet and vegetarian diet; excluding veganism, raw foodism and fruitarianism. For patients with IBD, special dietary recommendations were elaborated on the recommendations of the International Organization for Research into Inflammatory Bowel Diseases (IOIBD), and specific diets, i.e. specific carbohydrate diet (SCD), and Groningen anti-inflammatory diet (GrAID). In the process of treatment of oral and intestinal dysbiosis, probiotic therapy is beneficial in both diseases, specified as the Western diet. Non-conventional diets are not recommended. SUMMARY: Diet therapy for inflammatory periodontal diseases and IBD requires extensive individualization; nevertheless, a universal principle is avoidance of highly processed food, and implementation of easily digestible meals based on natural, ecological products. Proper nutrition plays a crucial role in primary prevention of both diseases analyzed, whereas in secondary prevention, diet therapy is a valuable supplementation of pharmacotherapy.

Treatment of periodontitis ameliorates the severity and extent of psoriasis-A randomized clinical trial.

AIM: To assess the impact of non-surgical periodontitis treatment over conventional dermatological treatment on the severity and extent of psoriasis in patients affected by comorbid psoriasis and periodontitis. METHODS: Seventy-four patients affected by both psoriasis and Stages I-IV periodontitis were randomized to receive either Steps 1-2 (non-surgical) of periodontal therapy (test group; n = 37) or no treatment (control group; n = 37). The two groups were balanced in terms of psoriasis medications, with the majority of the included patients undergoing biologics (74.0%) as monotherapy, while minor proportions were under systemic medications (13.7%) or none/topical/phototherapy (12.3%). The psoriasis area severity index (PASI) was regarded as the primary outcome. The body surface area (BSA) and the dermatology life quality index (DLQI) were additionally considered as dermatological outcomes. Probing pocket depth, recession depth, clinical attachment level periodontal inflamed surface area, and [full mouth plaque score] etc, periodontal inflamed surface area, and full-mouth plaque and bleeding scores (FMPS/FMBS) were also measured. RESULTS: Periodontal therapy in the test group led to statistically significant lower PASI scores at 10 weeks (mean = 3.15; standard deviation [SD] = 3.78) compared to the control group (mean = 7.11; SD = 6.09) (mean difference [MD] = -4.0; 95% confidence interval [CI]: -6.3, -1.6; p = .001). The test group also showed improvements in BSA (MD = -4.3) and periodontal parameters compared to the control group. DLQI only showed a non-statistically significant tendency (MD = -2.0). CONCLUSION: Steps 1-2 of periodontal therapy showed an additional effect over conventional dermatological treatment in reducing the severity and extent of psoriasis (Clinicaltrials.gov: NCT05311501).

The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial.

AIM: To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS: Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS: Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS: The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS: gov identification number: NCT05456555.

Delving into Matrix Metalloproteinase-1 (MMP-1) and its Significance in Periodontal Diseases.

Matrix metalloproteinase-1 (MMP-1) plays a pivotal role in the pathogenesis of periodontal diseases, particularly periodontitis, by virtue of its collagenolytic activity targeting collagen type I, the primary component of periodontal tissues. This review abstract elucidates the intricate involvement of MMP-1 in periodontal tissue homeostasis and its dysregulation in disease states. Elevated MMP-1 levels, observed in gingival tissues and crevicular fluid of individuals with periodontitis, correlate with the degradation of collagen fibers within the periodontium. This degradation contributes to the detachment of teeth from surrounding tissues and exacerbates alveolar bone resorption, hallmark features of periodontal breakdown. Therapeutically, targeting MMP-1 activity emerges as a promising strategy, prompting ongoing research into MMP inhibitors and host modulation therapies. Understanding MMP-1's nuanced role in periodontal diseases paves the way for personalized treatment approaches and holds promise in reshaping periodontal disease management for improved patient outcomes and periodontal health.

The Prevalence of Smokeless Tobacco Consumption and Its Effects on Gingival and Periodontal Health Among the Adults in the Emirates of Sharjah, UAE - A Cross-Sectional Study.

Introduction: Smokeless tobacco (SLT) has been linked with various oral signs and symptoms, such as oral mucosal lesions and gingival and periodontal effects. However, there is limited research on the prevalence of SLT use and its impact on gingival and periodontal health in the adult population of the Emirates of Sharjah. Aim: To assess the prevalence of SLT consumption and its effects on gingival and periodontal health in the adult population of the Emirates of Sharjah. Methods: The study evaluated 171 dentate patients aged 18-77 years who use SLT or are nonsmokers. Data were collected through a questionnaire on SLT use and periodontal health assessed using plaque index, gingival index (GI), attachment score, and gingival recession (GR). Statistical analysis was done using SPSS 27.0 version. Results: Among 390 screened participants, 28 subjects (21 males and 7 females) were SLT users with prevalence of 7.18%. No significant differences were found in plaque index, GI, or periodontal pocket depth. However, SLT users had significantly higher clinical attachment loss scores (mean 4.01 mm, SD 0.35) compared to non-users (mean 1.49 mm, SD 1.12). Significant differences were also observed in GR. Conclusions: This study provides insights into the prevalence and impact of SLT use on periodontal and gingival health in UAE adults. SLT usage is associated with a higher risk of periodontitis and gingivitis, indicating the need for awareness and intervention. Further research is required to validate results and consider confounding factors.

Do systemic amoxicillin and metronidazole during the non-surgical peri-implantitis treatment phase prevent the need for future surgical treatment? A retrospective long-term cohort study.

AIM: The aim of this retrospective long-term follow-up of a 3-month RCT was to assess whether non-surgical peri-implantitis treatment with adjunctive systemic antibiotics influenced the need for additional surgical treatment. MATERIALS AND METHODS: Patients enrolled in an aftercare programme following non-surgical peri-implantitis treatment, with or without systemic amoxicillin and metronidazole, were analysed. Data had previously been collected pre-treatment (T0) and 3 months after treatment (T1) and were additionally collected during subsequent aftercare visits, until the final assessment (T2). Primary outcome was the need for additional surgical peri-implantitis therapy during the aftercare programme, analysed via Kaplan-Meier analysis and Cox regression. Secondary outcomes involved clinical parameters, assessed using parametric and non-parametric tests. RESULTS: Forty-five patients (22 AB- group, 23 AB+ group) were included. The mean follow-up time between T1 and T2 was 35.9 months (SD = 21.0). 73.9% of the AB+ group and 50.0% of the AB- group did not receive additional surgical therapy (log-rank test, p = .110). The adjusted Cox regression model did not provide a significant result for antibiotics (ß = .441, 95% CI = 0.159-1.220, p = .115). Univariable regression analysis highlighted the influence of baseline peri-implant pocket depth on the need for surgical treatment (ß = 1.446, 95% CI = 1.035-2.020, p = .031). CONCLUSIONS: Systemic amoxicillin and metronidazole administered during non-surgical peri-implantitis treatment do not seem to prevent the need for additional surgical therapy in the long term, during a structured aftercare programme.

Cytokine levels in the gingival crevicular fluid and their association with periodontal status of down syndrome patients: a cross-sectional study.

OBJECTIVE: To evaluate cytokine levels of interleukin (IL)-1ß, IL-4, IL-6, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the gingival crevicular fluid (GCF) of periodontal sites in individuals with Down syndrome (DS) and analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A cross-sectional study was conducted with 49 DS patients and 32 individuals without DS (non-DS group). Periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and visible plaque index (VPI) were evaluated. The periodontal sites were classified as shallow, moderate, and deep. GCF was collected in all shallow sites and, when present, in moderate and deep sites for the analysis of cytokine levels. The cytokines, IL-1ß, IL-4, IL-6, IL-17a, TNF-α, and IFN-γ, were quantified using the Luminex® automatic analyzer system. RESULTS: The DS group presented greater severity of periodontitis compared to the non-DS group (P = 0.005). The DS group showed a significant direct correlation of IL-1ß and an inverse correlation of IFN-γ and IL-14 with all periodontal variables. In the analysis stratified by periodontal pocket depth, we observed a higher level of IFN-γ, IL-17a, IL-1ß, and IL-6 in the shallow sites, and IL-17a, IL-1ß, and IL-6 in deep pockets of DS group individuals. Multivariate models showed that higher levels of IL-1ß, IL-4, IL-6, and IL-17a were associated with Down syndrome even after adjusting for periodontal status, sex, and age. CONCLUSION: The findings suggest that people with DS have greater periodontal impairment and higher levels of cytokines in GCF, even in sites having clinical periodontal parameters similar to those of individuals without DS. These data reiterate the concept of an altered and less effective immune response in the population with DS in the face of a periodontal microbial challenge. CLINICAL RELEVANCE: Elevated periodontal inflammation burden can be observed with higher cytokine levels in the gingival crevicular fluid of people with Down syndrome, especially IL-1, IL-4, IL-6, and IL-17, regardless of the stage of periodontitis.

Clinical and Demographic Profiling of Periodontal Diseases: A Retrospective Analysis Using the 2018 Periodontal Classification Algorithm.

The research presented in this retrospective study aimed to investigate the prevalence of periodontal diseases within a population and explore potential demographic and clinical variations among patients diagnosed with periodontitis. The study involved the analysis of 104 patient records from the Periodontology Clinic at the University of Medicine and Pharmacy in Craiova, collected between 2018 and 2019. Utilizing the 2018 classification algorithm for periodontal diseases, patients were categorized into three groups: a control group without periodontal issues (Group H), a gingivitis group (Group G), and a periodontitis group (Group P). The collected data encompassed demographic information, oral hygiene indicators, and clinical parameters. Statistical analysis and graphical representation revealed notable trends, such as the higher prevalence of periodontitis (51%) compared to gingivitis (14%), with 35% of participants showing no signs of periodontal involvement. Detailed group analyses highlighted specific patterns, including a substantial male predominance among patients without periodontal issues and varying distributions of periodontal stages based on gender. Additionally, the study explored age-related variations, revealing an increasing average age from the control group (33.04 years) to the gingivitis group (34.86 years) and a significant rise in the periodontitis group (45.49 years). The findings underscore the importance of early detection and intervention in periodontal diseases and provide valuable insights for clinicians in tailoring individualized diagnostic and treatment approaches.