A meta-analysis on the association between obstructive sleep apnea and periodontitis.

PURPOSE: The present meta-analysis aimed to evaluate quantitively the recent scientific evidence regarding the association between obstructive sleep apnea (OSA) and periodontitis. METHODS: Databases searched were PubMed, EMBASE, Scopus, and Web of Science. Publications were included according to the inclusion criteria. The following outcomes were evaluated: the prevalence of periodontitis, probing depth (PD), clinical attachment loss (CAL), the percentage of sites with bleeding on probing (BOP), plaque index (PI), and gingival index (GI). The statistical analysis was processed using the software STATA. RESULTS: Thirteen eligible studies comprising a total of 31,800 patients were included. The meta-analysis showed an increased prevalence of periodontitis in OSA populations compared to controls. Both PD and CAL were increased in OSA populations compared with controls. (Prevalence of periodontitis: OR 2.348; 95%CI 2.221-2.482; PD: SMD = 0.681, 95% CI: 0.062-1.301, Z = 2.61, P = 0.031; CAL: SMD = 0.694, 95% CI: 0.167-1.22, Z = 2.58, P = 0.01). The study also found significantly increased BOP in patients with OSA after heterogeneity was clarified. (SMD = 0.357, 95% CI: 0.079-0.635, Z = 2.52, P = 0.012). CONCLUSIONS: The findings suggest that OSA was associated with an increased prevalence of periodontitis.

Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case-control study.

OBJECTIVES: This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1ß (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels. MATERIALS AND METHODS: Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1ß, MMP-8, and sclerostin levels. RESULTS: There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastricht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05). CONCLUSION: These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS. CLINICAL RELEVANCE: The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis. TRIAL REGISTRATION: Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020).

Oral manifestations of patients with systemic sclerosis: a meta-analysis for case-controlled studies.

BACKGROUND: Systemic sclerosis (SSc) is a multisystem rheumatic disease. Orofacial manifestations are commonly in SSc but maybe usually ignored and overshadowed by other systemic complications. Multiple comparative studies have been conducted to investigate the possible links between SSc and oral manifestations. The present study aimed to investigate the oral health status in patients with SSc. METHODS: Pubmed, Embase, Web of Science, and Scopus were searched up to July 2020. Following outcomes were evaluated: Probing depth (PD), Attachment loss (AL), Bleeding on probing (BOP), Number or percentage of Sites with PD ≥ 4 mm, Prevalence of periodontitis, Number of teeth, Decayed Teeth, Missing teeth, Filled teeth, DMFT index, and the interincisal distance. Newcastle-Ottawa Scale (NOS) were applied for quality assessment. The statistical analysis was processed using the software STATA. RESULTS: 11 eligible studies were included. The maximum interincisor distance was significantly restricted in SSc patients (SMD - 1.061; 95 %CI [- 1.546, - 0.576]; Z = 4.29, P = 0.000).The prevalence of Periodontitis (OR 7.007; 95 %CI [3.529, 13.915]; Z = 5.56, P = 0.000), PD (SMD 3.101; 95 %CI [1.374, 4.829]; Z = 3.52, P = 0.000), AL(SMD 2.584; 95 %CI [0.321, 4.846]; Z = 2.24, P = 0.025), sites with PD ≥ 4mm (SMD 2.071 ; 95 %CI [0.267, 3.875]; Z = 2.25, P = 0.024) and the number of decayed teeth (SMD, 0.186; 95 %CI [0.007, 0.365]; Z = 2.04, P = 0.041) were increased significantly in SSc population in comparison with the controls. CONCLUSIONS: SSc patients have limited mouth opening, higher periodontitis prevalence, and worse periodontal status, as well as an increased number of decayed teeth. Routinely oral hygiene instruction and initial periodontal treatment is recommended for SSc patients.

Relationship between periodontitis and rheumatoid arthritis in Vietnamese patients.

Objective: This study aimed to survey periodontal status of Vietnamese patients with rheumatoid arthritis (RA) and investigates the association between periodontitis and RA in these patients.Materials and methods: We conducted a cross-sectional descriptive study on 150 RA patients and another 150 patients with osteoarthritis (OA). RA was evaluated using the DAS28 disease activity score based on C-reactive protein levels (DAS28-CRP), disease activity classification, and serum levels of RA biomarkers. Periodontal status was determined using periodontal indices.Results: The proportion of periodontitis cases in the RA group was significantly higher than the OA group (67 and 28%, respectively). The rate of severe periodontitis observed in the RA group was also significantly higher than that in the OA group (22.7 and 8%, respectively). RA patients with periodontitis had higher DAS28-CRP scores, disease activity levels, ACPA positivity and higher serum levels of CRP and ACPAs. Periodontitis is associated with an increased risk for RA (odds ratio [OR]: 5.14, 95% confidence interval [CI]: 3.14 - 8.41) and with higher disease activity classification (OR: 2.7, 95% CI: 1.14 - 6.42).Conclusions: Vietnamese RA patients often presented with a more serious periodontal condition than OA patients. We observed an association between periodontal disease (PD) status and clinic symptoms and biochemical/immunological characteristics of RA.

Association between periodontitis and risk of Alzheimer's disease, mild cognitive impairment and subjective cognitive decline: A case-control study.

AIMS: To test the hypothesis that periodontal disease contributes to increased risk of mild cognitive impairment (MCI), subjective cognitive decline (SCD) and Alzheimer's disease (AD). MATERIALS AND METHODS: This case-control study was conducted over a 3-year period in the municipality of Huddinge, Sweden. In total, 154 cases were consecutively enrolled from the Karolinska Memory Clinic at the Karolinska University Hospital and allotted to three diagnostic groups: AD, MCI and SCD, collectively referred to as "cases." Seventy-six cognitively healthy age- and gender-matched controls were randomly sampled through the Swedish population register. All cases and controls underwent clinical and radiographic oral examinations. Statistical analysis was based on logistic regression models adjusted for potential confounders. RESULTS: Poor oral health and marginal alveolar bone loss were more prevalent among cases than among controls. The cases group was associated with generalized marginal alveolar bone loss (odds ratio [OR] = 5.81; 95% confidence interval [CI] = 1.14-29.68), increased number of deep periodontal pockets (OR = 8.43; CI 4.00-17.76) and dental caries (OR = 3.36; CI 1.20-9.43). CONCLUSION: The results suggest that marginal periodontitis is associated with early cognitive impairment and AD. However, the study design does not preclude noncausal explanations.

Association of peripheral arterial disease with periodontal disease: analysis of inflammatory cytokines and an acute phase protein in gingival crevicular fluid and serum.

BACKGROUND AND OBJECTIVE: Inflammation is a common feature of both peripheral arterial disease (PAD) and periodontal disease. The aim of this study was to evaluate the relationship between PAD and periodontal disease by examining the levels of inflammatory cytokines (pentraxin 3 and interleukin 1ß) and high sensitive C-reactive protein from gingival crevicular fluid and serum. MATERIAL AND METHODS: A total of 60 patients were included in this cross-sectional study. Patients were divided into two groups based on ankle-brachial index values: with PAD (test group) and non-PAD (control group). Demographic evaluations, clinical periodontal examinations and biochemical analysis for pentraxin 3, interleukin 1ß and high sensitive C-reactive protein were performed to compare the two groups. RESULTS: There were no significant differences with respect to gender, age, body mass index, or smoking history (duration, amount) between the two groups (p > 0.05). There were no significant differences between the two groups in terms of clinical periodontal parameters (p > 0.05). Neither gingival crevicular fluid nor serum levels of the cytokines showed differences between the two groups. Logistic regression analysis revealed that, after adjusting for confounding factors (age, gender, diabetes, hypertension and body mass index), periodontitis raised the odds ratio for having PAD to 5.842 (95% confidence interval: 1.558-21.909). CONCLUSION: Although there were no significant differences with respect to clinical periodontal parameters and biochemical analyses between the study group and control, periodontitis did raise the odds ratio for having PAD. To clarify this possible relationship, future prospective studies are needed.

Fusobacterium nucleatum aggravates ulcerative colitis through promoting gut microbiota dysbiosis and dysmetabolism.

BACKGROUND: The correlation between periodontitis and ulcerative colitis (UC) has drawn widespread attention recently. Fusobacterium nucleatum (F. nucleatum) as a periodontal pathogen also has reservoirs in gut and may play a role in intestinal diseases. However, its role in the pathogenesis of UC is unclear. METHODS: Mice were orally given dextran sulphate sodium (DSS) solution and F. nucleatum to construct experimental models. The survival rate, weight, and disease activity index (DAI) of mice were monitored. Alveolar bone loss, abundance of F. nucleatum in colon, colon length, histopathological assessment, and inflammatory cytokines were detected. Apoptosis of intestinal epithelial cells (IECs) were evaluated by TUNEL assay and pro-apoptotic gene Bax. The epithelial barrier function was assessed by tight junction proteins. By 16S rRNA gene sequencing and LC-MS-based methods, the composition of the intestinal microbiota and metabolites in mice were analyzed. RESULTS: F. nucleatum facilitated alveolar bone loss and colonized only in infected colon tissue. Mice fed with DSS showed destruction of gut structure, increased expressions of interleukin one-beta (IL-1ß) and tumor necrosis factor alpha (TNF-α), decreased expression of IL-10, higher apoptosis of IECs, microbiota dysbiosis and bile acid dysmetabolism compared to healthy ones. F. nucleatum further aggravated intestinal inflammation and epithelial barrier damage. Probiotics such as Bifidobacterium and Faecalibacterium decreased, opportunistic pathogens Escherichia-Shigella increased and the differential microorganisms highly associated with inflammatory parameters and metabolites. Meanwhile, level of uric acid involving in the purine metabolism significantly elevated compared to UC mice. CONCLUSIONS: F. nucleatum promotes gut inflammation, epithelial barrier dysfunction, microbiota dysbiosis and dysmetabolism to aggravate UC.

Systemic management and periodontal treatment of HIV-necrotizing periodontitis: A case report.

BACKGROUND: Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)-positive patient including medical management and periodontal treatment. METHODS: A 28-year-old male presented to the periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm. RESULTS: Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious disease clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical nonsurgical periodontal treatment. CONCLUSIONS: This case report highlights a severe and generalized form of NP in an HIV patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral, and periodontal health.

The association between periodontitis and lung function: Results from the National Health and Nutrition Examination Survey 2009 to 2012.

BACKGROUND: We aimed to explore the association between periodontitis and lung function in the United States. METHODS: The data was based on the National Health and Nutrition Examination Survey (NHANES) 2009 to 2012. Periodontitis was defined following the CDC/AAP (Centers for Disease Control and Prevention/American Academy of periodontology) classification. Lung function measurements included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Linear regression and binary logistic regression were used to explore the association between periodontitis and lung function measurements. Restricted cubic spline was used to assess the dose-response relationships between the mean attachment loss (AL), the mean probing depth (PD) and spirometry-defined airflow obstruction (FEV1/FVC <0.7). RESULTS: A total of 6313 adults aged 30 years or older were included. Compared to those with non-periodontitis, the multivariate-adjusted odds ratios (ORs) of airflow obstruction for moderate and severe periodontitis were 1.38 (95% CI: 1.01 to 1.75) and 1.47 (95% CI: 1.06 to 2.01), the ß coefficients of FEV1 for moderate and severe periodontitis were -130.16 (95% CI: -172.30 to -88.01) and -160.46 (95% CI: -249.94 to -70.97), the ß coefficients of FVC for moderate and severe periodontitis were -100.96 (95% CI: -155.08 to -46.85) and -89.89 (95% CI: -178.45 to -1.33), the ß coefficients of FEV1/FVC for moderate and severe periodontitis were -0.01 (95% CI: -0.02 to -0.01) and -0.02 (95% CI: -0.03 to -0.01). In stratified analyses, the multivariate-adjusted ORs of airflow obstruction for the moderate and severe periodontitis were 1.27 (95% CI: 0.84 to 1.93) and 2.31 (95% CI: 1.10 to 4.83) in former smokers, 1.84 (95% CI: 1.03 to 3.30) and 1.79 (95% CI: 1.02 to 3.16) in current smokers, with no significant association observed in never smokers. Mean clinical AL and mean PD were negatively associated with FEV1, FVC, and FEV1/FVC in never, former, and current smokers. Dose-response relationship analysis showed that the risk of airflow obstruction increased with increasing mean clinical AL and mean PD, and showed a non-linear dose-response relationship. CONCLUSION: Our study suggested that moderate and severe periodontitis might be associated with the decline of lung function in the United States of America.

Porphyromonas gingivalis secretion leads to dysplasia of normal esophageal epithelial cells via the Sonic hedgehog pathway.

Objectives: To investigate the pathogenic effect of Porphyromonas gingivalis cultured media on the esophagus and the mechanism underlying the effect. Background: Periodontitis is strongly associated with esophageal squamous cell carcinoma (ESCC). The cultured media of P. gingivalis may act on healthy esophagus to trigger a malignant transformation; however, this has not been confirmed. Methods: Cell migration assays and cell cycle measurements were performed on normal human esophageal epithelial cells in the presence or absence of P. gingivalis cultured media. The esophagi of healthy adult C57BL/6J mice were isolated and cultured in-vitro. Hematoxylin-eosin and immunohistochemical staining using antibodies against proliferating cell nuclear antigen (PCNA), Claudin 1 and Claudin 4 were performed to detect dysplasia in specific tissues. Total mRNA was extracted to determine transcriptional dysregulation. A specific inhibitor of Sonic hedgehog signaling, cyclopamine, was used to confirm the underlying molecular mechanism. Results: In the presence of P. gingivalis cultured media, proliferation and migration of normal human esophageal epithelial cells were up-regulated, and aneuploid cells appeared. Compared with control cells, the arrangement of mouse esophageal epithelial cells became disordered, the percentage of PCNA-positive cells increased, and the positive staining of Claudin 1 and Claudin 4 became weak. In addition, the expression of cancer-related pathway genes was up-regulated but tight junction-related gene expression was down-regulated. The Sonic hedgehog pathway was abnormally activated, and its inhibition reduced the pathogenic effect of P. gingivalis cultured media. Conclusions: We revealed that the cultured media of the key periodontal pathogen, P. gingivalis, can induce the malignant transformation of normal esophageal epithelium through the Sonic hedgehog pathway.

Identifying Factors Associated with Periodontal Disease Using Machine Learning.

Objective: This study aimed to identify combinations of chronic conditions associated with the presence and severity of periodontal disease (PD) after accounting for a series of demographic and behavioral characteristics in a nationally representative sample of US adults. Materials and Methods: A cross-sectional study of the 2013-2014 National Health and Nutrition Examination Survey (n = 4555). Outcome measure: PD using clinical attachment loss (measured as none, mild, moderate, or severe). The main independent variables were self-reported chronic conditions, while other covariates included demographic and behavioral variables. Classification and regression tree analysis was used to identify combinations of specific chronic conditions associated with PD and PD with higher severity. Random forest was used to identify the most important variables associated with the presence and severity of PD. Results: The prevalence of PD was 77% among the study population. The percentage of those with PD was higher among younger and middle-aged (< 61 years old) than older (> 61 years old) adults. Age and education level were the two most important predictors for the presence and severity of PD. Other significant factors included alcohol use, type of medical insurance, sex, and non-white race. Accounting for only chronic conditions, hypertension and diabetes were the two chronic conditions associated with the presence and severity of PD. Conclusions: Sociodemographic and behavioral factors emerged as more strongly associated with the presence and severity of PD than chronic conditions. Accounting for the co-occurrence for sociodemographic and behavioral factors will be informative for identifying people vulnerable to the development of PD.

Effect of Subgingival Instrumentation on Neutrophil Elastase and C-Reactive Protein in Grade B and C Periodontitis: Exploratory Analysis of a Prospective Cohort Study.

Background: Assessment of the effect of subgingival instrumentation (SI) on systemic inflammation in periodontitis grades B (BP) and C (CP). Methods: In this prospective cohort study, eight BP and 46 CP patients received SI. Data were collected prior to and 12 weeks after SI. Blood was sampled prior to, one day, 6, and 12 weeks after SI. Neutrophil elastase (NE), C-reactive protein (CRP), leukocyte count, lipopolysaccharide binding protein, interleukin 6 (IL-6) and IL-8 were assessed. Results: Both groups showed significant clinical improvement. NE was lower in BP than CP at baseline and 1 day after SI, while CRP was lower in BP than CP at baseline (p < 0.05). NE and CRP had a peak 1 day after SI (p < 0.05). Between-subjects effects due to CP (p = 0.042) and PISA (p = 0.005) occurred. Within-subjects NE change was confirmed and modulated by grade (p = 0.017), smoking (p = 0.029), number of teeth (p = 0.033), and PISA (p = 0.002). For CRP between-subjects effects due to BMI (p = 0.008) were seen. Within-subjects PISA modulated the change of CRP over time (p = 0.017). Conclusions: In untreated CP, NE and CRP were higher than in BP. SI results in better PPD and PISA reduction in BP than CP. Trial registration: Deutsches Register Klinischer Studien DRKS00026952 28 October 2021 registered retrospectively.

Evidence linking the role of periodontal viruses in coronary artery disease with and without periodontitis.

BACKGROUND: Viruses are considered to be a newer family associated with inflammatory diseases. Yet the role of periodontal viruses in coronary artery diseases (CAD) remains unclear. Thus, the current study aims to evaluate the prevalence of periodontal viruses and compare the same in cardiac samples of CAD patients with and without periodontitis. METHODS: A total of 60 patients with CAD indicated for coronary artery bypass graft surgery (CABG) were included. These were grouped into 36 patients with healthy periodontium (CAD only) and 24 patients with periodontitis (CAD + P). The demographic variables, cardiac parameters and periodontal parameters were recorded. Cardiac tissue samples were collected during the CABG surgery and were analyzed by reverse transcriptase polymerase chain reaction for periodontal viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV) and Herpes simplex virus. All the parameters were statistically analyzed. RESULTS: Among the demographic variables, age was statistically significant between the groups. Plaque index, bleeding index, probing depth, and clinical attachment level (CAL) were significantly higher in CAD+P group (P ˂0.05). Periodontal viruses such as EBV and CMV were significantly higher (62.5% and 75% respectively, P ˂0.05) in the cardiac samples of the CAD+P than CAD only (25% and 47.2%, respectively). A significant association between EBV and CAL was revealed by multiple logistic regression analysis. (B = 0.374, P = 0.046) CONCLUSIONS: The results revealed a higher prevalence of periodontal viruses such as EBV and CMV in CAD patients with periodontitis suggesting it as one of the risk factors for CAD. This is supported by the fact that severity of periodontal disease (CAL) is associated with the presence of EBV in coronary artery plaque samples in the current study.

Melatonin improves periodontitis-induced kidney damage by decreasing inflammatory stress and apoptosis in rats.

BACKGROUND: Two main aims of this animal study were to inspect the possible effects of periodontitis on the structure and functions of the kidneys and the therapeutic effectiveness of melatonin. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into three groups: control, experimental periodontitis (Ep), and Ep-melatonin (Ep-Mel). Periodontitis was induced by placing 3.0-silk sutures sub-paramarginally around the cervix of right-left mandibular first molars and maintaining the sutures for 5 weeks. Then melatonin (10 mg/kg body weight/day, 14 days), and the vehicle was administered intraperitonally. Mandibular and kidney tissue samples were obtained following the euthanasia. Periodontal bone loss was measured via histological and microcomputed tomographic slices. On right kidney histopathological and immunohistochemical, and on the left kidney biochemical (malonyl-aldehyde [MDA], glutathione, oxidative stress [OSI], tumor necrosis factor [TNF]-α, interleukin [IL]-1ß, matrix metalloproteinase [MMP]-8, MMP-9, and cathepsin D levels) evaluations were performed. Renal functional status was analyzed by levels of serum creatinine, urea, cystatin-C, and urea creatinine. RESULTS: Melatonin significantly restricted ligature-induced periodontal bone loss (P <0 .01) and suppressed the levels of proinflammatory cytokines (TNF-α and IL-1ß), oxidative stress (MDA and OSI), and proteases (MMP-8, MMP-9, and CtD) that was significantly higher in the kidneys of the rats with periodontitis (P <0.05). In addition, periodontitis-related histological damages and apoptotic activity were also significantly lower in the Ep-Mel group (P <0.05). However, the markers of renal function of the Ep group were detected slightly impaired in comparison with the control group (P >0.05); and the therapeutic activity of melatonin was limited (P >0.05). CONCLUSION: Melatonin restricts the periodontitis-induced inflammatory stress, apoptosis, and structural but not functional impairments.

Subgingival microbiota in a population with and without cognitive dysfunction.

Aim: The aim of this study was to compare the subgingival microbiota of people with Alzheimer´s disease (AD), mild cognitive impairment (MCI), subjective cognitive decline (SCD) and cognitively healthy individuals. Materials and methods: The study population was recruited from 2013 to 2017 and comprised 132 cases recently diagnosed with AD (n = 46), MCI (n = 40) or SCD (n = 46), and 63 cognitively healthy controls. Subgingival samples were collected, and the microbiotas were characterized by 16S rRNA gene sequencing. Results: The relative abundance of the ten most common genera did not differ between the cases and control groups. However, the microbial richness and evenness were higher in cases than in controls and differed across the four groups. The variables with the greatest influence on the microbial community composition were related to periodontal disease followed by body mass index, study group affiliation and smoking. Ten taxa exhibited significant differences between case participants and controls. Two Operational Taxonomic Units were particularly abundant in AD compared to controls: Slackia exigua, which was also associated with deep periodontal pockets, and a Lachnospiraceae [G-7] bacterium. Conclusion: It is concluded that in individuals with cognitive impairment or AD, the subgingival microbiota exhibits shifts typical of periodontal disease.

Serum migration inhibitory factor levels in periodontal health and disease, its correlation with clinical parameters.

OBJECTIVES: Periodontal infections are an important risk factor for systemic disease and are driven primarily by the cytokines. Migration Inhibitory Factor (MIF) is a key cytokine which mediates acute and chronic inflammation alongside, a molecular link between chronic inflammation and immune mediated conditions. Hence, the present study was carried to measure the serum MIF levels in periodontal health, disease and to correlate the levels with the clinical parameters. MATERIAL AND METHODS: Sixty subjects were divided into three groups (each group n = 20) based on the gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) as group I healthy; group II gingivitis; and group III chronic periodontitis. The serum MIF level was measured using quantitative sandwich enzyme immunoassay technique. RESULTS: Highest level was detected in Group III with a mean of 71.8 ng/ml and the lowest in group I (6.1 ng/ml). Serum MIF levels did not correlate with the clinical parameters. CONCLUSION: Increased serum MIF levels in chronic periodontitis patients suggest its role as an inflammatory biomarker and may have a role in inflating the systemic inflammation. Summary: Serum Migration inhibitory factor can be used as an inflammatory marker for periodontal disease.

Periodontal conditions, retinopathy, and serum markers in individuals with type 1 diabetes.

BACKGROUND: The prevalence of diabetes is high and increasing. Periodontitis has been identified as a risk factor in both type 1 and 2 diabetes. The study purpose was to assess periodontal conditions, retinopathy, and serum glutamic acid decarboxylase antibody (GADA) titers in relation to retinopathy in individuals with type 1 diabetes (T1D). METHODS: The study is a case series. Adult individuals with a diagnosis of T1D (n = 85) monitored ≥5 years were recruited from an endocrinology clinic. Peripheral venous blood samples were analyzed including assessments of serum HbA1c levels and GADA titers. Medical and periodontal conditions were examined, and the data assessed. Independent t tests, binary and multivariate analyses, χ2 and odds ratios were employed. RESULTS: Gingivitis was found in 68.2%, periodontitis in 21.2%, and retinopathy in 64.7%, GADA (≥35 U/mL) in 54.1%, and serum HbA1c > 48 mmol/mol in 94.3% of the individuals. The unadjusted odds ratio for periodontitis to differentiate a diagnosis of retinopathy was 7.3 (95%CI 1.6, 4.4, P <0.01). Multivariate analyses identified the following dependent factors to differentiate retinopathy; age, T1D duration, gingivitis, periodontitis at P < 0.001, sex, and serum GADA at P < 0.01, and by the number of remaining teeth at P < 0.05. CONCLUSION: Retinopathy as a complication to T1D is linked to the duration of diabetes, age of the individual and with increasing severity to periodontitis. Periodontal intervention studies are warranted.

Analyzing the Association between Hyperuricemia and Periodontitis: A Cross-Sectional Study Using KoGES HEXA Data.

Hyperuricemia arises from the buildup of excessive uric acid in the blood, and it is implicated in the development of periodontitis. The objective of this study was to investigate the association between hyperuricemia and periodontitis using a cross-sectional study design and Korean Genome and Epidemiology Study Health Examinee (KoGES HEXA) data. This prospective cohort study used epidemiological data from the KoGES from 2004 to 2016. Among 173,209 participants, 8809 with hyperuricemia and 126,465 controls (non-hyperuricemia) were selected. This study defined hyperuricemia as >7.0 mg/dL of uric acid in men and >6.0 mg/dL in women. This study analyzed the history of periodontitis among hyperuricemia and control participants. Participants' age, gender, income, obesity, smoking, alcohol consumption, and nutritional intake were all examined. Chi-square tests, independent t-tests, and two-tailed analyses were used for statistical analysis. The adjusted OR (aOR) of hyperuricemia for periodontitis was 0.89 (95% confidence interval (CI) = 0.81-0.96, p = 0.005). This study demonstrated that hyperuricemia was associated with periodontitis. This finding meant that elevated uric acid levels could have a positive effect on periodontitis. However, further studies should be performed to determine the range of uric acid levels beneficial to periodontal health.

Further evidence on the relationship between abdominal aortic aneurysm and periodontitis: A cross-sectional study.

BACKGROUND: Periodontitis is a chronic inflammatory disease characterized by Gram-negative bacteria responsible for the degradation of tissues surrounding tooth. Moreover, periopathogens can invade the bloodstream, disseminate and promote cardiovascular disease, such as the link between Porphyromonas gingivalis and atherosclerosis. The aim of this study was to explore the relationship between the severity of periodontitis and of abdominal aortic aneurysm (AAA). METHODS: This cross-sectional study compared patients with stable AAA (n = 30) and patients with unstable AAA (n = 31) based on aortic diameter, growth rate, and eligibility for surgical intervention. Periodontal clinical parameters were recorded as well as the Periodontal Inflamed Surface Area and the Periodontal Index for Risk of Infectiousness (PIRI). Microbiological analyses were performed on saliva and supragingival and subgingival plaque. Quantification of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) was done by quantitative polymerase chain reaction. RESULTS: The two AAA groups were homogeneous for age, sex, and most risk factors except hypertension and chronic obstructive pulmonary disease. Periodontal parameters were comparable but the proportion of patients with high PIRI scores was greater in those with unstable AAA (51.6% versus 23.3%). The probing depth (PD) and the proportion of PD >6 mm were positively correlated with AAA size and thrombus volume. Several associations were found between periopathogens such as Pg and AAA diameters and volumes, but no difference could be evidenced between stable and unstable AAA groups. CONCLUSIONS: Periodontitis was highly prevalent in both stable and unstable AAA patients. Severe and progressive periodontitis (stage IV and grade C) tended to be more frequent in the group of patients with unstable AAA. Moreover, Pg was observed in all the samples (saliva, supragingival, and subgingival plaque) and was correlated with AAA diameters and volumes. The study evidenced potential relationships between periodontitis severity and size of AAA.

Melatonin ameliorates periodontitis-related inflammatory stress at cardiac left ventricular tissues in rats.

BACKGROUND: The aim of this experimental rat study was to investigate the potential inflammatory effects of periodontitis on cardiac left ventricular tissue and the therapeutic activity of melatonin on these effects. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into three groups: control, experimental periodontitis (Ep), and Ep-melatonin (Ep-Mel). Experimental periodontitis was induced by placing and maintaining 3.0 silk ligatures at a peri marginal position on the left and right mandibular first molars for 5 weeks. Afterward, following the removal of ligatures, melatonin (10 mg/body weight) to Ep-Mel group, and vehicle (saline) to Ep and control groups were administered intraperitoneally for 14 days. On the first day of the eighth week, mandibular and cardiac left ventricular tissue samples were obtained following the euthanasia of the rats in all groups. Alveolar bone loss measurements were made on histological and microcomputed tomographic slices. Cardiac tissue levels of malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), matrix metalloproteinase-9 (MMP-9), and cardiac Troponin-T (cTnT) were evaluated by appropriate biochemical methods. RESULTS: Measurements made on the histological and microcomputed tomographic slices showed that melatonin significantly limits the ligature-induced periodontal tissue destruction (P <0.01). In addition, melatonin was detected to cause a significant decrease of MDA, MMP-9, and cTnT levels which were found to be significantly higher on rats with Ep (P <0.05) while having no significant effect on antioxidant levels (GSH, SOD, and CAT) (P >0.05). CONCLUSION: Melatonin might be regarded as an important supportive therapeutic agent to reduce the early degenerative changes and possible hypertrophic remodeling at cardiac left ventricular tissues provoked by periodontitis-related bacteria and/or periodontal inflammation.