Periodontal Therapy in Bariatric Surgery Patients with Periodontitis: Randomized Control Clinical Trial.

Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test (TG) and control group (CG). One month before BS (pre-BS), patients in the TG (n = 15) received non-surgical periodontal therapy, while patients in the CG (n = 15) received only mechanical plaque removal. Patients were re-examined 3 and 6 months after BS. Differences between the TG and CG in clinical periodontal parameters, systemic health-related serum biomarkers, parameters of obesity, and prevalence of obesity-related diseases were evaluated. Results: From the 30 included patients, 26 were re-examined at 3 months and 20 patients at 6 months. Periodontal parameters bleeding on probing (p = 0.015), periodontal pocket dept (PPD, p = 0.0015), % PPD > 4 mm (p < 0.001), and full-mouth plaque levels (p = 0.002) were lower in the TG than in the CG at 6 months after BS. There is a general improvement in systemic health after BS without significant differences (p > 0.05) between the TG and CG at the 6-month follow-up. The TG shows a tendency for improvement in metabolic syndrome components at the 6-month follow-up compared to pre-BS (p < 0.05). Conclusions: Non-surgical periodontal therapy in periodontitis patients before the BS may improve periodontal health 3 and 6 months after the surgery. The possible benefits of periodontal therapy on the overall health of BS patients should be further explored.

The functions of Th17/Treg cells and relevant studies on the treatment of periodontitis and atherosclerosis / 口腔疾病防治

@#Periodontitis is a chronic infectious disease in which periodontal tissue loss is caused by dental plaque biofilm. Atherosclerosis is a chronic inflammatory disease that occurs in the walls of arteries and is characterized by lipid accumulation. Recently, many studies have suggested that there is a certain relationship between periodontitis and atherosclerosis. From an epidemiological perspective, a previous literature review indicated that patients with periodontitis have a higher incidence of atherosclerosis. IL-17 secreted by Th17 cells may aggravate the progression of the two diseases by elevating the levels of matrix metalloproteinases, which may damage the connective tissue. Treg cells reduce the activation of T cells and limit the development of inflammation by secreting anti-inflammatory factors and expressing coinhibitory molecules. Periodontal intervention may contribute to the treatment of atherosclerosis by reducing inflammatory markers in atherosclerosis. Many studies have shown that periodontitis and atherosclerosis may interact with each other, but further studies are needed to explore the concrete mechanism of the interaction between periodontitis and atherosclerosis.

Effects of Periodontal Intervention on Levels of Serum High-sensitivity C-reactive Protein and Interleukin 6, and on Carotid Artery in Rats with Chronic Periodontitis and Hyperlipidemia.

OBJECTIVE: To investigate the effects of nonsurgical periodontal therapy on the serum interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) and on the carotid artery in rats with chronic periodontitis (CP) and with or without hyperlipidemia (HL). METHODS: A total of 29 Sprague-Dawley rats were randomly divided into two groups: group A (CP, n = 14) and B (CP + HL, n = 15), and subjected to the corresponding treatment. Groups A and B were further divided into groups A1/B1 (without periodontal interventions) and A2/B2 (with periodontal interventions). The serum IL-6 and hsCRP levels were evaluated before periodontal intervention and at 1, 3, 5, and 7 weeks after periodontal intervention. The rats were euthanised 8 weeks after the periodontal intervention and the histopathologic changes in the carotid artery were observed. RESULTS: The serum hsCRP and serum IL-6 levels in groups A1 and B1 were elevated with time; they were significantly higher in group B1 than in group A1 (P < 0.001) at all time points. The hsCRP and IL-6 levels in groups A2 and B2 increased with time and reached the maximum level 1 week after the second intervention, and then gradually decreased. Atherosclerotic plaques, fibrous cap, and calcium salt deposits were apparent in the rats of group B1, whereas no obvious atherosclerotic changes were observed in the rats of groups A2 and B2. CONCLUSION: Periodontal interventions resulted in acute, short-term systemic inflammation. However, it was beneficial in long-term as it improved the carotid artery integrity.

The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database.

Periodontal disease has been linked to poor glycemic control among individuals with type 2 diabetes. Using integrated dental, medical, and pharmacy commercial claims from Truven MarketScan® Research Databases, we implement inverse probability weighting and doubly robust methods to estimate a relationship between a periodontal intervention and healthcare costs and utilization. Among individuals newly diagnosed with type 2 diabetes, we find that a periodontal intervention is associated with lower total healthcare costs (-$1799), lower total medical costs excluding pharmacy costs (-$1577), and lower total type 2 diabetes-related healthcare costs (-$408). © 2016 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Periodontitis and obstructive sleep apnea's bidirectional relationship: a systematic review and meta-analysis.

PURPOSE: The aim of this study is to evaluate the association between periodontal disease and obstructive sleep apnea (OSA). METHODS: Electronic search using PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Trial Registry, Cochrane Database of Systematic Reviews, Scopus, and Embase was carried out for randomized controlled trials, longitudinal, cohort, case-control, and epidemiological studies on humans, published until October 2014. Manual searches were also performed. The participants considered were adult subjects with OSA and chronic periodontitis. The authors reviewed all articles and extracted data using a customized data abstraction sheet. Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Six studies met the inclusion criteria set for this review. They evaluated the association between periodontal disease and OSA and the efficacy of periodontal interventions on OSA occurrence and severity. The periodontal disease outcome measures included clinical attachment loss, periodontal pocket depth, oral hygiene indices, radiographic alveolar bone loss, and salivary cytokines. Meta-analysis of four studies revealed a statistically significant association between periodontal disease and OSA (pooled odds ratio = 1.65, 95 % confidence interval (CI) = 1.11, 2.46, P = 0.01). There is insufficient evidence on the efficacy of periodontal disease interventions. CONCLUSIONS: There is some evidence to a plausible association between periodontal disease and OSA. Evidence on the efficacy of periodontal disease interventions is insufficient. The causal-effect relationship of periodontal disease and OSA is debatable. Further research with case-control studies is warranted.

EFFECT OF PERIODONTAL INTERVENTION ON BNP AND IL -1βINDICATIVES IN PA-TIENTS WITH CHRONIC CARDIAC FAILURE / 现代医院

Objective To compare the changes of BNP and IL-1βin patients with chronic heart failure combined with chro-nic periodontitis before and after periodontal intervention treatment and investigate the improve effect of periodontal intervention treat-ment on the prognosis of chronic heart failure.Methods 38 patients with chronic heart failure combined with chronic periodontitis were divided into the intervention group (n=20) and the control group (n=18).The intervention group was given periodontal inter-vention and the control group was only given oral hygiene education .The baseline and changes of bleeding index , periodontal attach-ment loss and BNP, IL-1βof the two groups were recorded respectively.Results After periodontal treatment, the bleeding index, periodontal attachment loss and the baseline in the intervention group were significantly differenct compared with the control group (p<0.05).The changes of BNP and IL-1βindex in the intervention group were also significantly different from those of the control group (p<0.05).Conclusion The oral hygiene and periodontal health status of the patients could be improved by periodontal inter-vention.It can also improve the prognosis of patients with periodontitis combined with chronic heart failure .In conclusion, the perio-dontal intervention treatment plays a positive role in the treatment of chronic heart failure disease .

Periodontal intervention effects on pregnancy outcomes in women with preeclampsia / Eficacia de la intervencion periodontal en el producto del embarazo en mujeres con pre-eclampsia

Objective: To determine the efficacy of periodontal intervention on pregnancy outcome in mild preeclamptic women.Methods: A sample of 60 pregnant women with mild preeclampsia (blood pressure levels <160/110 mm and proteinuria >300 mg/l in 24 hours urine) from the Hospital Universitario del Valle (Cali, Colombia) was included to the study. Preeclamptic women were randomized in two groups, one with periodontal intervention (PIG, N=28) and another in which the periodontal intervention was practiced after childbirth (NPIG, N=32). Maternal socio-demographic, medical and periodontal data were obtained. PIG included patients in which supragingival and subgingival cleaning within ultrasonic and manual devices were performed after study inclusion. The progression from mild to severe preeclampsia, eclampsia or HELLP syndrome, the number of days of clinical stability and the percentile of birth-weight adjusted for gestational age were evaluated in both groups. Results: Most of the patients (60%) were multigravids. Gestational age at inclusion was 31.8±1.6 weeks. Chronic periodontitis was a frequent finding (61.7%). Social, demographic, medical and periodontal conditions were similar between both groups. Disease progression to severe preeclampsia, eclampsia or HELLP syndrome was also similar (89.2% PIG versus 84.4%, p=0.65) (OR=1.06 IC 95% 0.87-1.29, p=0.65). Days of clinical stability were similar between the groups (median 10 days , range 1-46, PIG versus 12 days, range 1-59, p=0.57) and the percentile of birth weight adjusted with gestational age had no differences between the groups (median percentil 50 range 5-90 PIG versus percentil 55 range 5-95, p=0.73). Conclusion: Periodontal intervention does not seem to harm the health, the severity or alter the frequency on maternal complications in mild preeclampsia subjects.

Objetivo: Determinar la eficacia y seguridad de la intervención periodontal sobre el producto del embarazo en gestantes hospitalizadas con diagnóstico de pre-eclampsia sin complicaciones. Métodos: En un ensayo clínico controlado se evaluaron 60 mujeres embarazadas con diagnóstico de pre-eclampsia leve (presión arterial <160/110 mm Hg y proteinuria >300 mg/l en orina de 24 horas), que se trataron en la unidad de alto riesgo obstétrico del Hospital Universitario del Valle (Cali, Colombia). Se evaluaron las características socio-demográficas, así como los aspectos médicos y periodontales. De este conjunto 28 (46.7%) gestantes se incluyeron al azar en el grupo con intervención periodontal anteparto (GIP) y 32 (53.3%) en el grupo sin intervención periodontal (GNIP). El análisis se hizo de acuerdo con la intención de tratamiento. La variable dependiente fue la proporción de mujeres que agravaron su condición pre-eclámptica hacia pre-eclampsia severa, eclampsia o síndrome de HELLP, el número de días de estabilidad clínica y el percentil de peso del recién nacido ajustado para la edad de la gestación. Resultados: De las pacientes 60% eran multíparas. La edad gestacional promedio de ingreso al estudio fue 31.8 semanas. El diagnóstico periodontal más frecuente fue periodontitis crónica (61.7%). Las características socio-demográficas, obstétricas y periodontales fueron afines en ambos grupos. La pre-eclampsia se agravó de manera comparable en los dos grupos (GIP 89.2% versus GNIP 84.4%, p=0.65) (OR=1.06 IC 95% 0.87-1.29, p=0.65). La estabilidad clínica en días, fue parecida en ambos grupos (GIP mediana 10 días, rango 1-46 versus GNIP 12 días, rango 1-59, p=0.57). La mediana del peso del recién nacido ajustado por la edad gestacional fue semejante en los dos grupos (GIP percentil 50, rango 5-90 versus GNIP percentil 53 rango 5-95, p=0.73).