Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis.

AIM: To systematically review the literature to evaluate the recurrence of disease of people in long-term supportive periodontal care (SPC), previously treated for periodontitis, and determine the effect of different methods of managing recurrence. The review focused on stage IV periodontitis. MATERIALS AND METHODS: An electronic search was conducted (until May 2020) for prospective clinical trials. Tooth loss was the primary outcome. RESULTS: Twenty-four publications were retrieved to address recurrence of disease in long-term SPC. Eight studies were included in the meta-analyses for tooth loss, and three studies for disease progression/recurrence (clinical attachment level [CAL] loss ≥2 mm). For patients in SPC of 5-20 years, prevalence of losing more than one tooth was 9.6% (95% confidence interval [CI] 5%-14%), while experiencing more than one site of CAL loss ≥2 mm was 24.8% (95% CI 11%-38%). Six studies informed on the effect of different methods of managing recurrence, with no clear evidence of superiority between methods. No data was found specifically for stage IV periodontitis. CONCLUSIONS: A small proportion of patients with stage III/IV periodontitis will experience tooth loss in long-term SPC (tendency for greater prevalence with time). Regular SPC appears to be important for reduction of tooth loss. No superior method to manage disease recurrence was found.

Has the quality of reporting in periodontology changed in 14 years? A systematic review.

BACKGROUND: Quality of reporting randomized controlled trials (RCTs) in periodontology has been poor. Consolidated Standards of Reporting Trials guidelines and an extension for non-pharmacologic trials (CONSORT-NPE), were introduced to aid in improving this. AIMS: The aim of this study was to assess the quality of reporting in periodontology, changes over the last 14 years, and adherence to CONSORT-NPE. METHODS: Randomized controlled trials in humans, published in three periodontal journals, from 2013 to 2015 were included. Search was conducted through Medline, Embase and hand searching. RESULTS: One hundred and seventy-three full-text articles included. Two reviewers screened for reporting quality (κ = 0.69, 95% CI 0.60-0.76). 84% of studies (n = 145) described randomization methods, 74% (n = 128) highlighted examiner blinding and 87% (n = 151) accounted for patients at study conclusion. Patient and caregiver blinding was addressed in 50% (n = 70) and 50% (n = 27) of studies respectively. 64% (n = 110) described adequate allocation concealment. Compared with Montenegro et al. (2002, Journal of Dental Research, 81, 866), improvements seen in describing randomization (2002, 16.5%; 2016, 84%), allocation concealment (2002, 6.5%; 2016, 64%), caregiver masking (2002, 17%; 2016, 50%). CONSORT-NPE; 62% (n = 107) had detailed explanations of all treatments, 88% (n = 152) lacked protocols for adherence of caregivers' to an intervention. Only 17% (n = 29) described caregivers' expertise and case volume. CONCLUSIONS: Substantial improvements have occurred. Attention is required for statistical analysis of patient losses and masking. CONSORT-NPE aspects were poorly reported.

The relationship between cotinine and periodontal disease.

Smoking is a risk factor for periodontitis but there are conflicting reports about the relationship between the severity of periodontitis and smoking behaviour, in part because self-reported smoking status may be inaccurate. Cotinine, a major metabolite of nicotine with a longer half-life (17 h versus 30 min), may be a more useful biochemical marker of smoking status. Smoking behaviour, plasma cotinine levels, and measures of periodontitis severity in 135 adults with moderate-advanced periodontitis were studied. Smokers had comparable periodontitis at a younger age than non-smokers. Smoking, as measured by cigarettes smoked per day and plasma cotinine levels, was significantly related to the severity of periodontitis.