Mouth-Heart Connection: A Systematic Review on the Impact of Periodontal Disease on Cardiovascular Health.

Periodontal diseases (PDs) and cardiovascular diseases (CVDs) are highly prevalent global diseases with increasing percentages of morbidity and mortality. Both PD and CVDs independently have multifactorial causation, and emerging evidence shows an association between PD and CVDs. Periodontal diseases like gingivitis and periodontitis are chronic inflammatory conditions that eventually cause systemic inflammation, leading to many systemic diseases like rheumatoid arthritis, cardiovascular diseases, and others. In this study, we followed a systematic review approach to give an overview of the current evidence on the association between PD and CVDs. We used a relevant search strategy to retrieve articles from databases such as PubMed and Google Scholar from 2013 to July 2023. Upon applying filters and screening through titles and abstracts, we could narrow down articles to 21. On full-text screening, we selected 10 articles for in-depth analysis. This study showed a significant correlation between PD and CVDs. Poor oral hygiene, infection, and inflammation in the oral cavity lead to systemic inflammation, causing endothelial dysfunction. There are controversial views about PD acting as an independent risk factor for CVD development, as there are other risk factors such as age, gender, smoking, etc. acting as confounding factors while establishing the link between PD and CVDs. Knowledge about oral health, maintaining good oral hygiene, and proper treatment for PD could reduce the incidence of CVDs. Further research is needed to prove that PD is an independent risk factor for CVDs.

Assessment of Oral Health Status and Treatment Needs of School Teachers in Indore City, Madhya Pradesh, India: A Cross-Sectional Study.

INTRODUCTION: Teachers are central to the well-being of a community. Being an influential part of society, their role can be broadened to promote oral health and healthy oral hygiene habits. This study was aimed at the assessment of the oral health status and treatment needs of school teachers in Indore City. METHOD: A descriptive cross-sectional study was carried out over a period of five months on 470 school teachers working in various government schools of Indore city selected through random sampling technique. The modified WHO Oral Health Assessment Form for Adults 2013 was used to record oral health status and treatment needs, while the WHO Questionnaire for Adults 2013 was used to document oral hygiene practices, dietary habits, and deleterious habits. Data was analyzed using IBM SPSS Version 25 (IBM Corp., Armonk, NY). Chi-square test, independent t-test, and one-way ANOVA were used. RESULTS: The gender distribution of the representative sample showed female predominance. The prevalence of smokeless tobacco consumption was 5.1% among the study subjects. The mean number of Decayed, Missing, and Filled Teeth (DMFT) was 3.45 ± 3.10, and the mean number of 1.52 ± 2.40 teeth showed the presence of bleeding. Around 37.2% had shallow pockets of 4-5 mm. A mean number of 4.26 ± 1.97 sextants showed 0-3 mm attachment loss. There was a significant association between the frequency and technique of toothbrushing with a decayed number of teeth (p<0.001). CONCLUSION: High proportion of dental caries and periodontal disease was seen which could be related to their oral health care-seeking behavior and the impairment related to age changes.

Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation.

Introduction: Pituitary pars intermedia dysfunction (PPID) and dental disorders are of major concern in horses older than 15 years. Although PPID in geriatric horses and dental disorders in all age groups are well described, a connection between this endocrine disease and pathological changes in equine dental structures has not yet been investigated. In humans, periodontitis is considered to be a complication of systemic diseases like diabetes mellitus type 2, obesity and various conditions leading to an impaired immune response. In PPID, cross links to insulin and immune dysregulations are proven. The aim of this study was to compare histological findings of the gingiva and the sub gingival periodontal ligament of PPID affected horses with control horses. Methods: In a case-control morphometric descriptive study, 145 dental locations of 10 PPID affected horses (27.3 ± 2.06 years) were compared with 147 dental locations of 10 controls (21.4 ± 4.12 years). Histological parameters were leukocyte infiltration, keratinization of gingival epithelium, blood vessel supply of the periodontium and structure of cementum. Results: The distribution and localization of gingival leukocyte infiltrations (LI) in PPID affected horses was more often multifocal to coalescing (p = 0.002) and reached into deeper parts of the periodontium, sometimes down to the sub gingival periodontal ligament (PDL). Aged animals of both groups showed higher prevalence (PPID: OR 1.66; controls: OR 1.15) for severe leukocyte infiltration in the PDL. PPID was not significantly associated with increased LI. The cementum bordering the soft tissue in interdental locations showed four times more irregularities in PPID affected horses than in controls which predisposes for interdental food impaction and periodontal diseases. Discussion: In summary, multifocal to coalescing leukocytes and irregular cementum are seen more often in PPID than in controls - however our findings mainly reflect an association of older age with periodontal disease.

Dental Infection Causing Methicillin-Resistant Staphylococcus aureus Bacteremia and Spinal Infection: A Case Report.

Poor dentition as a source of infection causing bacteremia and spinal infections (such as paraspinal abscess, and discitis) should be considered even in the absence of recent dental surgery. The case presents a patient found to have an infection in the cervical and thoracic spine, methicillin-resistant Staphylococcus aureus bacteremia, and poor dentition. Although the patient had a history of drug use, he denied a history of intravenous drug use. He had Crohn's disease that resulted in periodontal and endodontal tooth disease. The patient was found to have poor dentition with erythematous gums. He had not been to the dentist in over 24 years and had active dental caries. Since he presented with bacteremia and a spinal infection, it is likely the patient had an infection in the oral cavity that spread hematogenously to the blood, and then the spine. This report highlights the importance of considering tooth infections as the source of bacteremia and spinal infections.

Periodontal Disease and Adverse Neonatal Outcomes: A Systematic Review and Meta-Analysis.

Objective: The aim of this study was to evaluate the association between maternal periodontal disease (PD) and three main adverse neonatal outcomes, namely, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA). Methods: The Ovid Medline, Web of Science, Embase, and Cochrane Library were searched up to 6 December 2020 for relevant observational studies on an association between PD and risk of PTB, LBW, and SGA. Eligibility criteria included observational studies which compared the prevalence of PTB and/or LBW and/or SGA between PD women and periodontal health controls. The exclusion criteria included incomplete data, animal research, and mixing up various pregnancy outcomes, such as "preterm low birth weight" and languages other than Chinese and English. Data were extracted and analyzed independently by two authors. The meta-analysis was performed using Stata Statistical Software, Release 12 (StataCorp LP, College Station, TX, USA). Odds ratio (OR), confidence intervals (CIs), and heterogeneity (I 2) were computed. Results: Fourteen case-control studies and 10 prospective cohort studies, involving 15,278 participants, were identified. Based on fixed effect meta-analysis, PTB showed a significant association with PD (OR = 1.57, 95% CI: 1.39-1.77, P < 0.00001) and LBW also showed a significant association with PD (OR = 2.43, 95% CI: 1.75-3.37, P < 0.00001) in a random effect meta-analysis. However, a random effect meta-analysis showed no relationship between PD and SGA (OR = 1.62, 95% CI: 0.86-3.07, P = 0.136). Conclusion: Our findings indicate that pregnant women with PD have a significantly higher risk of PTB and LBW. However, large prospective, blinded cohort studies with standardized diagnostic criteria of PD and adequate control of confounding factors are still required to confirm the relationship between PD and adverse neonatal outcomes.

Interplay of Microbiota and Citrullination in the Immunopathogenesis of Rheumatoid Arthritis.

Microbiota is a balanced ecosystem that has important functions to the host health including development, defense, digestion, and absorption of dietary fibers and minerals, vitamin synthesizes, protection, and training the host immune system. On the other hand, its dysbiosis is linked to many human diseases such as rheumatoid arthritis (RA). The RA is an inflammatory autoimmune disorder caused by genetic and environmental factors; microbiota may be considered as a risk environmental factor for it. Citrullination is a post-translation modification (PMT) that converts the amino acid arginine to amino acid citrulline in certain proteins. These citrullinated proteins are recognized as a foreign antigen by the immune system resulting in the upregulation of inflammatory action such as in RA. The current work highlights the effect of both gut and oral microbiota dysbiosis on the development of RA, as well as discusses how the alteration in microbiota composition leads to the overgrowth of some bacterial species that entangled in RA pathogenicity. The evidence suggested that some oral and gut microbial species such as Porphyromonas gingivalis and Prevotella copri, respectively, contribute to RA pathogenesis. During dysbiosis, these bacteria can mediate the citrullination of either human or bacteria proteins to trigger an immune response that leads to the generation of autoantibodies.

Predictors of periodontal disease among rural Indian type 2 diabetic population.

BACKGROUND: Periodontal Disease (PD) is associated with complications of diabetes. Control of the PD reduces glycated hemoglobin (HbA1c) level. This study aimed to evaluate the relationship of PD with duration, severity of diabetes and eGFR. MATERIAL AND METHOD: A Prospective observational study conducted at Sidhi Vinayaka Hospitals (SVH) Sangareddy during the period of January 2014 to December 2019. Total 1436 patients with a definite diagnosis of type 2 diabetes (T2DM), between the ages of 45-60 years were included. They were classified according to CPITN score for PD and compared against the variables. RESULTS: A total of 1436 consecutive outpatients attending to SVH were included. Among them 662 (46.1%) were males and 774(53.9%) were females. The mean age of the patients was 48.3(SD ± 10.62) and mean duration of diabetes was 2.9(SD ± 4.18). The mean fasting blood glucose was 198.5(SD ± 85), mean post prandial blood glucose was 277.2 (SD ± 107.7) and mean HBA1c was 9.98% (SD ± 2.6). Among the study group 1198 (83.4%) had none/mild (Grade I) PD, 192(13.4%) had moderate/severe (Grade II) PD and 46(3.2%) were completely edentulous (Grade III). CONCLUSION: There is a linear correlation between PD and age of patient, duration of diabetes, eGFR and level of glycemic status among rural population with T2DM.

Inflammation in Periodontal Disease: Possible Link to Vascular Disease.

Inflammation is a well-organized protective response to pathogens and consists of immune cell recruitment into areas of infection. Inflammation either clears pathogens and gets resolved leading to tissue healing or remains predominantly unresolved triggering pathological processes in organs. Periodontal disease (PD) that is initiated by specific bacteria also triggers production of inflammatory mediators. These processes lead to loss of tissue structure and function. Reactive oxygen species and oxidative stress play a role in susceptibility to periodontal pathogenic bacterial infections. Periodontal inflammation is a risk factor for systemic inflammation and eventually cardiovascular disease (CVD). This review discusses the role of inflammation in PD and its two way association with other health conditions such as diabetes and CVD. Some of the mechanisms underpinning the links between inflammation, diabetes, CVD and PD are also discussed. Finally, we review available epidemiological data and other reports to assess possible links between oral health and CVD.

Evaluation of IL6, IL10 and VDR alleles distribution in an Italian large sample of subjects affected by chronic periodontal disease.

In recent decades, the role played by the immune response to bacteria in the pathogenesis of chronic periodontal disease (PD) has long been studied. Although from the clinical point of view, adequate oral hygiene is essential to ensure a satisfactory response of the host to infections, modulation of the reaction of immune system could be influenced by genetic factors. The aim of the present study was to investigate the distribution of alleles of polymorphisms relevant for chronic periodontitis in a sample of adult subjects affected by chronic PD. The present study was conducted with sample collected in Italian private practice offices from January 2013 to December 2017. The sample included 744 adult patients diagnosed with chronic periodontitis. The inclusion criteria were as follows: age > 18 years, diagnosis of chronic PD. The diagnosis of chronic periodontitis was based on the criteria established by the American Academy of Periodontology. No significant difference in allele distribution among patients from different Italian regions was found. Results, supporting absence of population heterogeneity for the investigated polymorphisms in Italy, suggest similar effect in periodontitis etiology.

Risk of colorectal cancer in patients with periodontal disease severity: a nationwide, population-based cohort study.

BACKGROUND: Periodontal disease (PD) and colorectal cancer (CRC) were associated with chronic inflammation. This retrospective cohort study examined the association between PD severity and CRC in a large-scale, population-based Chinese cohort. METHODS: A total of approximately 106,487 individuals with newly diagnosed PD and 106,487 age-matched and sex-matched patients without PD from 2000 to 2002 were identified from Taiwan's National Health Insurance Research Database (NHIRD). RESULTS: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with PD than in those without PD (log-rank test, P < 0.001). After adjustment for age, sex, and comorbidities, patients with PD were associated with a significantly higher risk of CRC compared with those without PD (adjusted HR = 1.64, 95% CI = 1.50-1.80). Further, the risk of CRC appeared to increase with increasing frequency of PD medical visits [adjusted HR (95% CI) was 1.78 (1.58-2.02) and 1.53 (1.35-1.74) for annual visits > 10 and < 4, respectively]. CONCLUSION: Based on our study, PD severity was associated with an increase in the risk of CRC. Further mechanistic research is needed.

Caracterización del paciente que solicita atención de especialidad en periodoncia en una población chilena / Characteristics of patients requesting treatment at a periodontics specialty facility in a Chilean population

Objetivo: Realizar la caracterización de los pacientes que solicitan atención de especialidad en periodoncia. Material y métodos: Estudio descriptivo que incluyó a todos los pacientes inscritos para recibir atención odontológica de una población de la Quinta Región de Chile. Los datos se agruparon de acuerdo con el sexo femenino, masculino y rango de edad. Se registró ausencia o presencia de hábito de tabaco, diabetes mellitus (DM) tipo 2, ingreso a tratamiento periodontal, abandono de tratamiento e ingreso a terapia periodontal de mantenimiento (TPM). Para el análisis estadístico las diferencias en la frecuencia se determinó con χ2, alpha de 0.05, nivel de confianza de 95%, potencia de 80% y t Student evaluando diferencias en la edad, sexo femenino y sexo masculino. Resultados: Solicitaron atención 110 pacientes, 75 sexo femenino y 35 sexo masculino, ingresaron a la especialidad el 94%. La edad promedio fue de 41 (DE 15) años. Durante el seguimiento por un año, el 68% se mantuvo en tratamiento y el 19% ingresó a TPM. La tasa de DM tipo 2 fue de 4% en mujeres y 31% en hombres (p < 0.001). El rango de edad entre 14 a 29 años abandonó más el tratamiento periodontal. En relación con la DM tipo 2 las diferencias fueron estadísticamente significativas en la edad promedio, 39.5 (DE 15.3) años (p= 0.002) y edad promedio de abandono, 33.2 (DE 17.7) años (p > 0.001). Conclusiones: Las mujeres asisten más a tratamiento periodontal que los hombres y las personas jóvenes abandonan más el tratamiento. Al estudiar ambos sexos, masculino y femenino, los hombres alcanzaron un mayor porcentaje de DM tipo 2. Además el paciente diabético demostró ser más joven en edad promedio y en edad promedio de abandono de tratamiento periodontal.

Objective: To undertake characterization of patients requesting periodontic specialty care. Material and methods: The present was a descriptive study which included all patients registered to receive dental care in a population of the Quinta Region in Chile. Data were grouped according to male and female gender, as well as age range. The following was recorded: presence or absence of tobacco use habit, type II diabetes mellitus (DM), admission to periodontal treatment, treatment desertion and admission to posttreatment periodontal therapy (PTPT). For statistical analysis of frequency differences χ2 test, alpha 0.05, confidence level 95% potency 80% and t student test were used, assessing differences according to age and gender. Results: 110 patients requested treatment: 75 female and 35 male. 94% were admitted in the specialty program. Average age was 41 years (SD 15). During the one-year follow-up, 68% of patients remained in treatment, and 19% was admitted in PTPT. Type II DM rate was 4% for females and 31% for males (p < 0.001). Patients in age range 14-29 years were more prone to abandon periodontal treatment. With respect to type II DM differences were statistically significant in average age, 39.5 (SD 15.3) years (p = 0.002) and average age for desertion 33.2 (SD 17.7) years (p > 0.001). Conclusions: Women were more inclined to attend periodontal treatment than men, young patients deserted treatment more frequently. Studies on both genders revealed that males exhibited greater rate of type II DM. Additionally, diabetic patients were younger in average age as well as in average age for desertion of periodontal treatment.