Tooth Loss in Periodontitis Patients-A Risk Factor for Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.

BACKGROUND: Periodontal disease and tooth loss have been long suggested as risk factors of mild cognitive impairment. The underlying mechanisms could be systemic chronic inflammatory mediators, direct pathologic challenge to the nervous system, malnutrition and/or loss of neurosensory stimulation input causing brain atrophy. This review aimed to examine the existing literature studies linking the effect of periodontal disease and tooth loss on the development of mild cognitive impairment. METHODS: A systematic review using PEO was conducted. Three electronic databases, namely Embase, Medline and DOSS (UCLan), were searched for relevant articles published up to April 2023. Google Scholar and a hand search were also conducted to ensure no relevant studies had been missed. The Newcastle-Ottawa scale was used to assess the quality of studies. RESULTS: The findings showed that chronic periodontitis and tooth loss, both individually and in combination, led to an increased risk of mild cognitive decline in adults over 50 years. Within the limitations of this review, periodontitis and tooth loss both contribute to an increased risk of mild cognitive impairment and dementia, but the evidence so far is not strong. CONCLUSIONS: In future, more robustly designed studies investigating periodontal disease and tooth losslink with cognitive health decline are required with a longer follow-up duration.

Common Medical Devices with Uncommon Complications.

Medical devices and materials commonly used in management of common gynecological conditions or during surgical procedures may present with acute or chronic complications due to incorrect application, improper use and lack of follow up. We present two interesting cases highlighting this problem. A strong index of suspicion is very crucial in early diagnosis and successful management.

The First Occurrence of Angioedema After Discontinuation of Angiotensin-Converting Enzyme Inhibitor.

Angioedema is one of the dreaded side effects of angiotensin-converting enzyme (ACE) inhibitors. It has been well established in the literature and the timing of onset is variable from months to years after initiation of therapy. Patients remain at risk of recurrence of angioedema even after discontinuation of the drug if they developed it once while on the drug. While only recurrences of ACE inhibitor-induced angioedema are described in the literature, our patient did not develop angioedema while being on the drug and had the first occurrence of angioedema one month after the medication was discontinued. We argue that since our patient did report an ACE inhibitor-related dry cough, this case emphasizes the strength of the relation between the two common side effects of the ACE inhibitors. This favors that among the risk factors that predispose individuals to develop angioedema, ACE inhibitor-associated cough is a major one. Although the mechanism of ACE inhibitor-related cough is poorly understood, bradykinin seems to be the common culprit mediator for these two side effects. Hence, clinicians need to be aware of this potential threat and be cautioned when they witness an ACE inhibitor-related cough.