aMMP-8 Oral Fluid PoC Test in Relation to Oral and Systemic Diseases.

The manuscript uses the previously published literature and highlights the benefits of active-matrix metalloproteinase (aMMP)-8 chairside/point-of-care (PoC) diagnostic tools as adjunctive measures in oral and systemic diseases. Previous studies suggest that as a biomarker, aMMP-8 is more precise than total MMP-8, MMP-9, MMP-2, MMP-3, MMP-13, MMP-7, MMP-1, calprotectin, myeloperoxidase (MPO), human neutrophil elastase (HNE), tissue inhibitor of matrix metalloproteinase (TIMP)-1, and bleeding of probing (BOP). Therefore, aMMP-8 could be implemented as the needed key biomarker for the new disease classification for both periodontitis and peri-implantitis. With a sensitivity to the tune of 75-85% and specificity in the range of 80-90%, lateral flow aMMP-8 PoC testing is comparable to catalytic protease activity assays for aMMP-8. The test can be further applied to estimate the glycemic status of an individual, to ascertain whether a person is at risk for COVID-19, in managing the oral side effects of radiotherapy carried in head and neck cancers, and in selected cases pertaining to reproductive health. In the future, aMMP-8 could find application as a potential systemic biomarker in diseases affecting the cardiovascular system, cancers, bacteremia, sepsis, diabetes, obesity, meningitis, as well as pancreatitis. The aMMP-8 PoCT is the first practical test in the emerging new dental clinical field, that is, oral clinical chemistry representing oral medicine, clinical chemistry, peri-implantology, and periodontology.

Ability of matrix metalloproteinase-8 biosensor, IFMA, and ELISA immunoassays to differentiate between periodontal health, gingivitis, and periodontitis.

OBJECTIVE: The aim of this study was to determine the diagnostic utility of an MMP-8 biosensor assay in differentiating periodontal health from gingivitis and periodontitis and compare it with an established time-resolved immunofluorescence assay (IFMA) and enzyme-linked immunosorbent assay (ELISA). BACKGROUND: Currently available antibody-based assays display a wide variability in their ability to accurately measure matrix metalloproteinase-8 (MMP-8) levels in saliva. METHODS: Salivary MMP-8 levels were analyzed in 189 systemically healthy participants using an antibody-based biosensor prototype that operates using a surface acoustic wave technology and compared with IFMA and ELISA antibody assays. Participants were categorized into 3 groups: periodontal health (59), gingivitis (63), and periodontitis (67). A sub-population of participants (n = 20) with periodontitis received periodontal treatment and were monitored for 6 months. RESULTS: All the assays demonstrated significantly higher salivary MMP-8 concentrations in participants with periodontitis versus gingivitis, periodontitis versus health, and gingivitis versus health (all p < .05). The biosensor data demonstrated significant correlations with IFMA (r = .354, p < .001) and ELISA (r = .681, p < .001). Significant reductions in salivary MMP-8 concentrations were detected by the biosensor (p = .030) and IFMA (p = .002) in participants with periodontitis 6 months after non-surgical periodontal treatment. IFMA had the best sensitivity (89.2%) for detecting periodontitis and gingivitis versus health and 96.6% for detecting periodontitis versus health and gingivitis. The biosensor had an AUC value of 0.81 and diagnostic accuracy of 74.2% for differentiating periodontitis and gingivitis from health; an AUC value of 0.86 and diagnostic accuracy of 82.8% for periodontitis versus health and gingivitis. CONCLUSIONS: The biosensor, IFMA, and ELISA assays differentiated between periodontal health, gingivitis, and periodontitis based on salivary MMP-8 levels. Only the biosensor and, particularly, IFMA identified an effect of periodontal treatment in the participants with periodontitis. Our findings support the potential utility of salivary oral fluid aMMP-8-based point-of-care technology in the future of periodontal diagnostics.

Association of Periodontal Disease with Hypertension in Nigerian Patients: A Comparative Study.

Background: Periodontal diseases are chronic and inflammatory in nature, and have been associated with hypertension, a major risk factor for cardiovascular diseases. Hypertension is prevalent among Nigerians. However, controlled studies on the relationship between hypertension and periodontal disease in Nigeria are limited. Here, we investigated the relationship between periodontal diseases and hypertension among Nigerians. Methodology: This comparative, cross-sectional study assessed the periodontal clinical parameters, and body mass index (BMI) of 75 hypertensives and 75 gender-matched normotensive controls in a teaching hospital in Lagos, Nigeria. Hypertension was categorized as blood pressure ≥140/90 mm Hg based on the WHO guidelines. Sociodemography, periodontal parameters, BMI, and blood pressure were documented in interviewer-administered questionnaires. Periodontal disease was assessed by the highest Community Periodontal Index (CPI) scores, CPI sextants, gingival index (GI), simplified oral hygiene index (OHIS), and number of teeth with gingival recession. Hypertension was the dependent variable, while periodontal disease, obesity, age were the independent variables. P values <0.05 were considered statistically significant. Results: The mean CPI 3 sextant was significantly associated with hypertension (P<0.05). The independent predictors of hypertension were moderate gingival inflammation (OR 3.314, 95% CI 1.156-9.502, p=0.026), older age >60 years (OR 11.527, 95%CI 2.976-44.651, P<0.001), overweight/obesity (OR 3.279, 95%CI 1.414-7.602, P=0.006), and lower education (OR 3.070, 95% CI 1.288-7.319, P=0.011). Conclusion: In addition to the known risk factors for hypertension, moderate gingivitis was a predictor of hypertension, while hypertensives had a greater extent of pockets than non-hypertensives. This study reiterates the association of preventable, low-grade periodontal inflammation with hypertension.

Oral health related quality of life among HIV positive patients attending two HIV outpatient clinics in Nigeria - a cross sectional study.

BACKGROUND: The human immunodeficiency virus infection remains a devastating disease of public health importance. OBJECTIVES: To assess the association between oral health and quality of life and the factors affecting the oral health related quality of life among HIV positive patients in Nigeria. METHODS: This was a cross sectional study of HIV positive patients attending two HIV outpatient clinics in Nigeria. Impact of oral health on quality of life was assessed using the OHIP-14. Oral health status was assessed by the DMFT and Simplified OHI indices. Level of significance was set at p< 0.05. RESULTS: Three hundred and fifty-two patients were seen, 64.2% being females. Prevalence of impact was 8.5%; and the mean OHIP scores was 8.05±9.54. Highest impact was "painful aching" 67(19.1%) with the domain of physical pain scoring the highest mean impact of 2.32. Most patients (88.6%) were on HAART. Following logistic regression, after controlling for potential confounders, independent factors associated with poor OHRQoL were perceived need for dental treatment, HAART use, and higher DMFT (p<0.05). CONCLUSION: The domain of physical pain had the highest impact, while perceived need for dental treatment, HAART use and higher caries index were contributory to poor OHRQoL.

The COVID-19 pandemic and dental residency training in Nigeria.

INTRODUCTION: The COVID-19 pandemic has had wide-ranging effects on dental practice across the world. In particular, if has also affected the training of dental residents, who are specialists in training. Thus, the aim of this study was to assess the knowledge, perception and attitude of dental residents in Nigeria to the pandemic and its perceived impact on the dental residency training programme across the country. MATERIALS AND METHODS: This was a cross-sectional study of dental residents in teaching hospitals across Nigeria. Self-administered questionnaires were distributed to consenting participants through an online data collection platform (Google forms), between April and June 2020. Data were collected on sociodemographics, knowledge and awareness of coronavirus as well as impact of the pandemic. Data analysis was carried out with the Statistical Package for Social Sciences (SPSS) version 20. Level of significance was set at p-value < .05. RESULTS: A total of 104 dental residents participated in the study from ten residency training institutions in the country with a mean age of 35.65 ± 4.8 years. Almost all 98 (94.2%) of the residents showed a good knowledge of COVID 19. About two-thirds, 72 (69.2%) of the participants were mostly worried about COVID-19 affecting their residency training program 72 (69.2%), with their greatest source of worry being the risk of contracting the virus in the dental clinic. CONCLUSION: The dental residents had a very good knowledge of the epidemiology, diagnosis, prevention and treatment of COVID-19 and majority of them felt that it would affect their training residency programme.

Nigerian undergraduate dental students' knowledge, perception, and attitude to COVID-19 and infection control practices.

PURPOSE/OBJECTIVES: The current coronavirus disease 19 (COVID-19) pandemic has affected most countries. Infection, Prevention, and Control training is important in mitigating the spread of COVID-19. The closure of universities by the Nigerian government has hampered academic activities of dental students. Our objectives were to assess the knowledge, perception, and attitude of undergraduate dental students in Nigeria to the COVID-19 pandemic and infection control practices. METHODS: This was a cross-sectional study of undergraduate clinical dental students from the dental schools in Nigeria. Self-administered questionnaires were distributed to participants using an online data collection platform. Correct responses to the 45-item questionnaire on COVID-19 knowledge were scored to determine their knowledge level. A Likert scale of 1-5 was used to assess the 13-item perception and attitude questions. The level of significance was set at P values ≤ 0.05. RESULTS: A total of 102 undergraduate clinical dental students participated in the study. Males represented 54.9%, and mean age was 25.3 ± 2.4 years. Fifty percent of the students had adequate knowledge of COVID-19. Final-year students (58.1%) demonstrated more adequate knowledge of COVID-19 than penultimate-year students (28.6%, P = 0.008). Most (95.1%) respondents had positive attitudes towards infection control practices against COVID-19. CONCLUSION: Although the clinical dental students had a positive attitude to infection control practices against COVID-19, the overall knowledge of COVID-19 was barely adequate. Guidelines on COVID-19 from reputable health authorities should be reviewed by dental school authorities and disseminated to the students to suit their clinical practice.

Association of Elevated C-Reactive Protein with Severe Periodontitis in Hypertensive Patients in Lagos, Nigeria: A Pilot Study.

BACKGROUND: Epidemiological studies have shown that individuals with chronic periodontitis have a significantly higher risk of developing cardiovascular complications, which might be attributed to the increased production of inflammatory cytokines initiated by the complex microbiota in dental biofilm. AIM: The study aims to evaluate the association between chronic periodontitis and C-reactive protein (CRP) levels in a group of hypertensive individuals in Nigeria. MATERIALS AND METHODS: The investigator enrolled 50 hypertensive patients with chronic periodontitis into the study from the medical outpatient clinic of a teaching hospital in Lagos, Nigeria. Full-mouth periodontal examination was done to assess the participant's periodontal status, with probing depths and clinical attachment levels of six sites on all teeth. The investigator defined periodontitis as at least one interproximal site with probing depth ≥4 mm. Classification of participants into three groups was done based on their severity of periodontitis; mild (n = 16), moderate (n = 27), and severe (n = 7) periodontitis. Their CRP serum levels were measured, and the association with the severity of periodontitis was determined. P was found to be ≤ 0.05. RESULTS: The median CRP levels were 1.0 (0.6, 2.2), 2.4 (1.1, 4.8), and 4.1 mg/L (3.3, 9.4) for mild, moderate, and severe chronic periodontitis, respectively. The association between the serum CRP levels and severity of periodontitis was statistically significant (P = 0.006). CONCLUSION: There was an association of elevated serum CRP level with increased severity of chronic periodontitis in hypertensive individuals. This preliminary finding among Nigerians suggests that chronic periodontal inflammation may contribute to systemic inflammatory burden in hypertensive patients.

Effect of Calcium Channel Blockers on Gingival Tissues in Hypertensive Patients in Lagos, Nigeria: A Pilot Study.

BACKGROUND: Long-term treatment of common chronic cardiac conditions such as hypertension with calcium channel blockers (CCBs) has long been associated with gingival hyperplasia. This oral side effect may affect esthetics and function, yet often overlooked and therefore underreported among Nigerians. AIM: This study aimed to determine the association of CCBs with gingival overgrowth (GO) in hypertensive patients. METHODS: This was a hospital-based, case-control study conducted among 116 hypertensive patients (58 CCB and 58 non-CCB age-matched controls) attending the medical outpatient clinic of a tertiary health institution in Lagos, Nigeria. Data collection tools included interviewer-administered questionnaires and periodontal examination. Sociodemographic details, medical history, and periodontal indices (gingival index, plaque index, class of GO according to drug-induced GO [DIGO] Clinical Index) were recorded. RESULTS: The mean age was 59.4 ± 12.6 years, females representing 50.9%. In the CCB group, 39 (67.2%) participants were on amlodipine and 19 (32.8%) were on nifedipine. The mean duration of CCB use was 55.6 ± 53 months. DIGO was higher in CCB (36.2%) than that in non-CCB participants (17.2%) (χ2 = 4.4, P = 0.036). The risk of GO was higher in CCB users (odds ratio [OR] 2.7, [95% confidence interval (CI)]: 1.1-6.5). Amlodipine users had higher DIGO (37.5%) than that of nifedipine users (21.1%) (OR 2.3, [95% CI]: 1.0-5.3). The predominant class of DIGO among the CCB users was Class 2 DIGO Clinical Index (90.5%). CONCLUSION: The study reveals that the risk of GO is nearly three times in CCB than that of non-CCB users and twice higher in amlodipine than nifedipine users in Nigeria.

Relevance of routine blood pressure assessment among dental patients in Lagos, Nigeria.

AIM: To determine the relevance of routine blood pressure (BP) measurement in patients attending the dental clinic. MATERIALS AND METHODS: This was a retrospective survey of patients who attended the dental clinic in the Preventive Dentistry Department of a tertiary Hospital in Lagos, Nigeria over an eighteen month period. Data retrieved from the patient's hospital records included age, sex, BP and history of hypertension. Data was analyzed using Epi info 2011 package. p-value <0.05 was considered statistically significant. RESULTS: A total of 1910 patients' records were assessed. Females represented 53.4% (n = 1020) of the study population. The mean age was 37.1 ± 15.0 years (range 18-88 years). The prevalence of hypertension was 39.9% (n = 763). Hypertension was stage 1 in 25.5%, stage 2 in 9.8% and severe in 4.6% of the dental patients. Past medical history of hypertension was obtained for 952 patients (49.8%). Of the 763 patients with high blood pressure, 14.8% had a known history of hypertension, while 42.1% were previously undiagnosed (p < 0.0001). Systolic and diastolic BP increased with increasing age (p < 0.05) and was significantly higher in males than females (p < 0.05). CONCLUSION: The high prevalence of hypertension noted among the study population with its potential consequence during dental procedures makes the measurement of blood pressure a valuable assessment in a dental clinic. CLINICAL SIGNIFICANCE: The high prevalence of hypertension particularly the previously undiagnosed cases among the dental patients highlights the relevance of routine blood pressure assessment prior to dental procedures in contemporary dental practice, so as to minimize the potential complications that could occur.

Severe presentation of necrotizing ulcerative periodontitis in a Nigerian HIV-positive patient: a case report.

OBJECTIVE: To report a case of severe necrotizing ulcerative periodontitis (NUP) with a rarely associated sequestrum formation in a Nigerian HIV-positive patient. CLINICAL PRESENTATION AND INTERVENTION: A 47-year-old HIV-positive male patient with no history of previous dental visits presented with a severe toothache in his lower jaw of 4 weeks' duration, which had affected his ability to chew properly. Clinical examination revealed marked gingival inflammation, moderate gingival recession and mobility of some of his lower anterior teeth: 31, 32, and 33. There was also a sequestrum present associated with the affected teeth. His CD4 cell count was 226 cells/mm(3). His viral load was very high (360,082 copies/ml). The intervention included thorough debridement of the necrotic lesion and sequestrectomy. The patient responded well to treatment after 1 week of follow-up. Unfortunately, the CD4 count was not assessed further because the patient was lost to follow-up. CONCLUSION: This case showed that a high CD4 cell count does not necessarily prevent the occurrence of NUP in HIV-positive patients. Intervention might have enhanced a rapid positive response to the treatment within a short time.