Objective To evaluate the association between periodontitis and the incidence and mortality of gastrointestinal cancer. Method A comprehensive literature search was conducted to identify all relevant studies published prior to April 2019 according to the established inclusion criteria. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a random-effects model. Results We identified 10 studies with 26 estimates of the relationship between periodontitis and gastrointestinal cancer. The HR for the incidence of gastrointestinal cancer in periodontitis was 1.23 (95% CI: 1.10-1.37). Subgroup analyses showed that periodontitis was associated with an increased risk of gastrointestinal cancers in prospective cohort studies and high-quality studies, North American individuals, and individuals 18 years or older, as well as when the dental status was self-reported and when the study was adjusted for smoking. A meta-analysis of nine reports demonstrated that periodontitis was associated with increased mortality from gastrointestinal cancer (HR = 1.59, 95% CI: 1.16-2.16). Additionally, periodontitis was associated with mortality from pancreatic cancer (HR = 2.20, 95% CI: 1.44-3.37); thus, periodontitis may be a risk factor for pancreatic cancer. Conclusion Our meta-analysis demonstrated that periodontitis may be a risk factor for gastrointestinal cancers. Additional prospective cohort studies are warranted to confirm these findings.
Aim In this study, we investigate the mechanistic link between rheumatoid arthritis (RA) and periodontitis to identify a novel target (cathepsin K; Ctsk) for the treatment of comorbid periodontitis and RA. Methods An experimental model of periodontitis with arthritis was established in DBA/1 mice. We then tested the effect of BML-244, a specific inhibitor of Ctsk, by quantifying several inflammatory markers of TLR9 signalling both in vivo and in vitro. Results Our results showed that periodontitis-rheumatoid arthritis comorbidity causes severer periodontal bone and joint cartilage destruction than either disease alone. Inhibition of Ctsk reduced infiltration by dendritic cells and T cells and inflammatory cytokine production; these improvements alleviated the hard-tissue erosion in periodontitis and RA as measured by bone erosion in periodontal lesions and cartilage destruction in knee joints. Inhibition of Ctsk also decreased the expression of TLR4 and TLR9 in vivo, whereas in vitro experiments indicated that Ctsk is involved specifically in the production of cytokines in response to TLR9 engagement. Conclusion Our data reveal that periodontitis and RA may have additive pathological effects through dysregulation of the TLR9 pathway and that Ctsk is a critical mediator of this pathway and contributes to the pathogenesis of RA and periodontitis.
Aims To investigate the effect of defect morphology, bone thickness and examiner experience on the accuracy to detect the presence, the type and the depth of peri-implant defects with digital periapical radiographs (PAs) and cone beam computed tomography (CBCT) in an in vitro model. Methods Thirty six implants were placed in fresh porcine rib bone with different types of standardized defects while sites with no defect served as control. Fourteen masked examiners evaluated 324 PAs and 108 CBCT images. The presence and type of defect, the location of the bottom of the defect and the location of first bone-to-implant contact were recorded. The sensitivity, specificity, accuracy, positive and negative predictive values were calculated for each type of defect using actual measurements as the gold standard. Results The diagnostic accuracy for PAs was affected by defect morphology, exposure time, thickness of bone walls and the level of experience of the examiner. The overall diagnostic accuracy of CBCT was high (>96%) for all types of defects. Conclusion Cone beam computed tomography showed better diagnostic accuracy in the detection of peri-implant defects, this can be attributed to the fact that CBCT seems to be less affected by variables that contribute to the poorer performance of PAs.
ObjectiveMedical and recreational cannabis use is increasing significantly, but its impacts on oral health remain unclear. The aim of this study is to investigate the effects of tetrahydrocannabinol (THC), the major active component in cannabis, on periodontal fibroblast cell adhesion and migration to explore its role in periodontal regeneration and wound healing. Material and MethodsThe different distribution of cannabinoid receptors 1 (CB1) and 2 (CB2) was characterized in the mouse periodontium. Human periodontal fibroblast cell (HPLF) adhesion and migration was analysed by in vitro wound healing assay with and without THC. The focal adhesion kinase (FAK) signalling pathway was investigated to uncover the underlying cellular mechanism. The receptor dependency of cannabinoid effects was examined by using selective antagonists to block THC. ResultsBoth CB1 and CB2 were expressed in periodontal tissues but with different expression patterns. Tetrahydrocannabinol promoted periodontal cell wound healing by inducing HPLF cell adhesion and migration. This was mediated by focal adhesion kinase (FAK) activation and its modulation of MAPK activities. The effect of cannabinoids on periodontal fibroblast cell adhesion and migration was mainly dependent on the CB2. ConclusionThese results suggested that cannabinoids may contribute to developing new therapeutics for periodontal regeneration and wound healing.
Aim This study aimed to evaluate the clinical effectiveness of the probiotic Lactobacillus reuteri as an adjunct to non-surgical periodontal therapy (NSPT). Materials and Methods A double-blind, paralleled-arm, placebo-controlled and randomized clinical trial was conducted. Probiotics L. reuteri or placebo lozenges were randomly prescribed for use twice-daily for 28 days. Primary outcomes were clinical attachment levels (CAL) and probing pocket depths (PPD). All participants underwent NSPT, and follow-up clinical assessments were performed at day 90 and day 180. Results The trial response rate was 69.5% (41 out of 59). Among the test and control groups, there were significant intra-group differences in primary outcomes: CAL (both, p < .001) and PPD (both, p < .001); and in secondary outcomes: percentage of sites with 'bleeding on probing' (both, p < .001) and visible plaque (both, p < .001). There were no statistically significant inter-group differences in any outcomes at any time points (all, p > .05) nor in the changes in outcomes ( increment ) with time (all, p > .05). There was a trend of a greater magnitude of statistical change occurring among the test group compared to the control group. Conclusion The adjunctive use of probiotics with NSPT did not show any additional clinical effectiveness when compared to NSPT alone in the management of periodontitis (ChiCTR-IOR-17010526).
Aim We want to evaluate the relationship of self-assessed experience and proficiency, manual dexterity and visual-spatial ability with surgical performance. Material and methods A total of 26 professionals were included in the study which consisted of four parts: (a) self-assessment by a questionnaire regarding proficiency and experience, (b) evaluation of visual-spatial ability, (c) testing of manual dexterity assessed by validated psychomotor tests and (d) evaluation of surgical performance by Objective Structured Assessment of Technical Skills (OSATS). Results Self-assessed proficiency and experience levels did not correlate with objectively evaluated surgical performances (OSATS). However, low-level visual-spatial ability tests strongly correlated with OSATS while intermediate- and high-level tests did not. No correlation was found between psychomotor ability and clinical performance. Conclusions Self-assessed proficiency is not a good predictor for surgical performance as experts tend to be overconfident. To evaluate and predict surgical performance, visual-spatial ability tests seem to be more appropriate than measuring manual dexterity which failed to correlate with the surgical outcome.
Aim To study the soft and hard tissue alterations of the alveolar ridge after socket-shield technique. Materials and Methods In four Beagle dogs, the following treatments (Tx) were randomly assigned to 32 extraction sockets: Tx1: blood clot; Tx2: Bio-Oss Collagen; Tx3: socket-shield technique and blood clot; Tx4: socket-shield technique and Bio-Oss Collagen. The width and height alterations of the buccal bone plate were calculated by CBCT scans. The dimensional alterations of the buccal aspect of the alveolar ridge at different time points were calculated by impressions using digital imaging analysis. The dogs were sacrificed for micro-CT and histologic analysis 3 months after surgery. Results Width, height and dimensional alterations of Tx3 and Tx4 were significantly lower than those of Tx1 and Tx2. Bone morphological parameters displayed no significant differences among four groups except for the trabecular thickness of Tx1 and Tx2. The quantity and quality of hard tissue containing the residual teeth of Tx3 and Tx4 were much greater than those of Tx1 and Tx2. Conclusions Socket-shield technique may be beneficial in preserving the soft and hard tissue of the alveolar ridge, which is better than simple bone grafting in the extraction socket.
Background Resolution and prevention of peri-implant mucositis are a key in preventing peri-implantitis. This case-control study aims to assess the modifying effect of a deep mucosal tunnel (DMT) on the induction and resolution phases of experimental peri-implant mucositis. Methods Nineteen subjects with a tissue level implant were assigned to cases (DMT, depth >= 3 mm) or controls (shallow mucosal tunnel <= 1 mm, SMT). Subjects underwent a standard experimental peri-implant mucositis protocol characterized by an oral hygiene optimization phase, a 3-week induction phase using an acrylic stent to prevent self-performed oral hygiene at the experimental implant, and a 3 + 2 weeks resolution phase. Modified plaque (mPI), gingival index (mGI) and peri-implant sulcus fluid IL-1 beta concentrations were measured over time. Differences between DMT and SMT were assessed with the Mann-Whitney test. Results Modified plaque index and mGI increased in parallel during the induction phase. After resumption of oral hygiene practice, mPI and mGI resolved towards baseline values in the SMT group. In DMT, mPI and mGI values diverged: plaque resolved but resolution of inflammation was delayed and of smaller magnitude during the first 3 weeks after resumption of oral hygiene. IL-1 beta concentrations were significantly higher in DMT at 21 days (end of induction) and during the resolution phase corroborating the clinical findings. Removal of the crown and submucosal professional cleaning were needed to revert mGI to baseline values in DMT implants. Conclusions The depth of the mucosal tunnel modifies the resolution of experimental peri-implant mucositis at transmucosal implants. This observation raises important questions on the effectiveness of self-performed oral hygiene in cases where implants are placed deeper and the ability to resolve mucositis and effectively prevent peri-implantitis in such situations.
Aim This study aimed at exploring changes in YAP expression and their effect on periodontitis (PD) combined with traumatic occlusion (TO). Materials and Methods BALB/cJ mice were used to establish a PD model by local administration of Porphyromonas gingivalis (P.g, ATCC 33277) and a TO model by occlusal elevation (OE) using composite resin bonding on the bilateral maxillary molar. The mouse fibroblast cell line (L929) and pre-osteoblast cell line (MC3T3-E1) were subjected to cyclic tensile/compressive stress and inflammatory stimuli (lipopolysaccharide from Escherichia coli) to verify in vivo results. Results Severe bone resorption was observed by microCT scanning in OE with P.g group, when compared to OE only and P.g only groups. Mechanical stress caused by OE activated the Hippo-YAP pathway in periodontal tissues and upregulated the expression of JNK/AP-1. OE with P.g further promoted the expression of YAP and JNK/AP1, leading to the upregulation of the JNK/AP-1 related inflammatory cytokines TNF-alpha and IL6. Similar results were obtained when osteoblasts were subjected to mechanical stress in vitro. Conclusions Our study demonstrated that periodontitis with TO caused severe inflammation-induced bone resorption. Activation of YAP and upregulation of JNK/AP-1 induced by TO potentially aggravated the symptoms of PD.
Aim To assess the status of periodontal health knowledge, attitudes and practices (KAP) among Chinese adults. Materials and Methods A cross-sectional study was conducted in a nationally representative sample of adults (N = 50,991) aged 20 years or older from ten provinces, autonomous regions, and municipalities. Percentages of Chinese adults with correct periodontal knowledge, positive periodontal attitudes, and practices were estimated. Multiple logistic regression analyses were used to examine the related factors. Results Less than 20% of Chinese adults were knowledgeable about periodontal disease. Very few (2.6%) of Chinese adults use dental floss >= once a day and undergo scaling >= once a year and visit a dentist (6.4%) in the case of gingival bleeding. Periodontal health KAP was associated with gender, age, body mass index, marital status, place of residence, education level, income, smoking status, and history of periodontal disease. Conclusions Periodontal health KAP are generally poor among the Chinese adult population. Community-based health strategies to improve periodontal health KAP need to be implemented. Increasing knowledge of periodontal disease, the cultivation of correct practices in response to gingival bleeding, and the development of good habits concerning the use of dental floss and regular scaling should be public oral health priorities.
Background Implementation of the new classification of periodontal diseases requires careful navigation of the new case definitions and organization of the diagnostic process along rationale and easily applicable algorithms. The aim of this report was to describe the rationale for one such approach designed for clinical practice and education. Methods The authors developed empiric decision-making algorithms based on the new classification to effectively discriminate between the key periodontal diagnoses of periodontal health, gingivitis and periodontitis. Results A stepwise approach is proposed that includes (a) a sensitive screening step able to discriminate periodontal health, gingivitis and suspect periodontitis; (b) a specific confirmation step to provide differential diagnosis between periodontitis and the other conditions characterized by attachment loss; (c) a step to assess the severity and complexity of management of the periodontitis case (staging); and (d) a step to assess the risk profile of the case (grading). Specific decision-making algorithms are described for all steps of the diagnostic process. Conclusions The proposed process allows discrimination between the different case definitions of periodontal health and disease. The diagnostic accuracy and cost-effectiveness of the process need to be validated in prospective trials generalizable to operators with different level of expertise, different populations and clinical settings.
Aim To evaluate the long-term (>= 2 years) stability of root coverage procedures for single gingival recessions. Materials and Methods A complete literature search was performed up to July 2018. Randomized controlled trials (RCTs) following >= 2 years were selected. Primary outcomes were complete root coverage (CRC) and mean root coverage (MRC). Secondary outcomes were width of keratinized tissue (KTW) and patient-centred parameters. Meta-analysis was conducted when possible. Results A total of fifteen RCTs were included. The results demonstrated significantly higher MRC in short-term than long-term after coronally advanced flap (CAF; 7.29%, p = 0.006). When CAF combined with connective tissue graft (CTG), no significant difference was observed in CRC or MRC for short-term versus long-term (1.00, p = 0.97; 2.35%, p = 0.09), and it resulted in better long-term efficacy than CAF alone in terms of CRC (0.69, p = 0.0006) and KTW (-0.63 mm, p = 0.04). For CAF plus enamel matrix derivative, the meta-analysis showed no significant difference between the short-term and long-term results of CRC (1.26, p = 0.21). Conclusions CAF alone could result in decreased postoperative percentage of root coverage with time. CAF + CTG could maintain long-term stability and result in better root coverage outcomes than CAF.
Background Few studies have looked at professional assessment or patient perception of aesthetics after root coverage procedures. The addition of connective tissue grafts (CTG) seems to improve aesthetic outcomes. The objective of this a priori analysis was to compare aesthetics after addition of CTG or a collagen matrix (CMX) to coronally advanced flap (CAF). Methods Two independent, trained and calibrated assessors analysed baseline and 6-month post-operative Images from 183 subjects with 475 recessions from a previously reported multicentre multinational randomized clinical trial. The root coverage aesthetic score (RES) was assessed in its five constituent components after assessing the suitability of images blindly with regard to treatment assignment and centre. Data were analysed at the tooth and subject level. Results One hundred and fifty-five subjects (81 CTG) and 393 teeth (207 CTG) were included in the analysis. CTG control subjects had higher total RES scores (mean adjusted difference of 1.3 +/- 0.8 RES units, p = 0.002). Analyses of RES subcomponents showed that the CTG group had higher scores in terms of gingival margin position but that better marginal tissue contour (OR 3.0, 95% CI 1.2-7.7) and soft tissue texture (OR 3.3, 95% CI 1.9-5.8) was observed for the CMX group. No significant differences were observed for mucogingival alignment and gingival colour. Conclusion Better overall RES scores were observed for the CTG group. Better marginal tissue texture and marginal contour were observed in the CMX group. More research and development is needed to optimize materials to be used in conjunction with CAF to improve root coverage without negatively affecting tissue texture and marginal contour.
Aim To evaluate the adjunctive efficacy of Er:YAG laser use with mechanical scaling and root planing (SRP) for non-surgical treatment of periodontitis. Materials and Methods In a randomized, single-blinded, controlled trial, 27 patients were recruited. Using a split-mouth design, two quadrants were randomly allocated into either a test group or a control group. The test quadrants received Er:YAG laser (ERL; 100 mJ/pulse; 15 Hz to hard tissue and 50 mJ/pulse; 30 Hz to soft tissue) plus SRP treatment, while the control quadrants received SRP only. We evaluated periodontal indexes, including probing depth (PD), clinical attachment level (CAL), bleeding index (BI), and plaque index (PLI) at baseline, 3 months, and 6 months. Results The PD and CAL means in the ERL + SRP group were significantly lower than those in the SRP group at 3-month follow-up (PD: 2.98 +/- 0.38 mm vs. 3.09 +/- 0.35 mm; CAL: 4.51 +/- 0.69 mm vs. 4.72 +/- 0.67 mm) and 6-month follow-up (PD: 2.91 +/- 0.31 mm vs. 3.02 +/- 0.30 mm; CAL: 4.52 +/- 0.65 mm vs. 4.72 +/- 0.66 mm; p = 0.03 for both PD and CAL). There were no significant differences in BI and PLI between two groups. Conclusions The Er:YAG laser treatment combined with conventional SRP significantly improved PD and CAL compared to SRP therapy alone; however, these differences were very small and, as a result, the adjunctive effect of Er:YAG laser is likely to be minimal clinically important.
Aim To investigate the association between specific dental therapy for periodontal disease and the risk of ischaemic stroke. Materials and Methods We conducted a population-based cohort study that used data from the Taiwan National Health Insurance Research Database 2005 for the period of 2000-2013. Our observations focused on patients with the diagnoses of gingivitis or periodontitis with and without specific treatment and subsequent incidence of ischaemic stroke. Dental care services include dental scaling, intensive treatment (subgingival curettage and root planing) and tooth extraction. Multivariate Cox regression analysis was used to estimate the hazard ratios and corresponding 95% confidence intervals (95% CI). Results Compared with those in the gingivitis cohort, patients with periodontitis have a higher risk of ischaemic stroke and a lower survival rate of stroke over the 10-year follow-up period. After integrative dental care, both dental scaling and intensive treatment, the risk was reduced, especially in patients with periodontitis, while patients with periodontal disease may have an increased risk of stroke after tooth extraction therapy. Conclusions Our study showed that periodontitis is a risk factor for ischaemic stroke. Both dental scaling and intensive treatment for periodontal disease are associated with a lower risk of further ischaemic stroke events.