Oral Versus Gastrointestinal Mucosal Immune Niches in Homeostasis and Allostasis.

Different body systems (epidermis, respiratory tract, cornea, oral cavity, and gastrointestinal tract) are in continuous direct contact with innocuous and/or potentially harmful external agents, exhibiting dynamic and highly selective interaction throughout the epithelia, which function as both a physical and chemical protective barrier. Resident immune cells in the epithelia are constantly challenged and must distinguish among antigens that must be either tolerated or those to which a response must be mounted for. When such a decision begins to take place in lymphoid foci and/or mucosa-associated lymphoid tissues, the epithelia network of immune surveillance actively dominates both oral and gastrointestinal compartments, which are thought to operate in the same immune continuum. However, anatomical variations clearly differentiate immune processes in both the mouth and gastrointestinal tract that demonstrate a wide array of independent immune responses. From single vs. multiple epithelia cell layers, widespread cell-to-cell junction types, microbial-associated recognition receptors, dendritic cell function as well as related signaling, the objective of this review is to specifically contrast the current knowledge of oral versus gut immune niches in the context of epithelia/lymphoid foci/MALT local immunity and systemic output. Related differences in 1) anatomy 2) cell-to-cell communication 3) antigen capture/processing/presentation 4) signaling in regulatory vs. proinflammatory responses and 5) systemic output consequences and its relations to disease pathogenesis are discussed.

Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow-up.

The effect of weight loss on the periodontal condition remains unclear. The present prospective study thus aimed to evaluate the effect of weight loss on the periodontal status of 57 obese patients (BMI ≥30 kg/m2) with ages ranging from 18 to 60 years, at 12 months following bariatric surgery. Demographic, biological and behavioral variables were analyzed. All participants underwent a periodontal examination, including plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL). Anthropometric measurements, such as weight, height and body mass index (BMI) were calculated. Fisher's exact test, ANOVA, Bonferroni, Spearman's rank correlation and Wilcoxon signed-rank tests were used for the statistical analysis (P<0.05). Prior to surgery, 49% of patients were classified as having obesity class I, 33% as obesity class II and 18% as obesity class III. Variables, such as BMI and PD exhibited statistically significant differences among the obesity class I, II and III groups (P<0.05). As regards periodontal diagnosis, 37% of patients were classified as having gingivitis, 46% as having periodontitis stages I-II, and 17% as having periodontitis stages III-IV. BMI, PI, BOP and PD exhibited statistically significant differences following bariatric surgery (P<0.0001). No statistically significant differences were observed in the CAL (P>0.05). Thus, the findings of the present study suggest that weight loss was associated with decreased periodontal inflammation and an improved plaque control following bariatric surgery. CAL remained unaltered during the study period.

A Multidisciplinary Approach of an Endo-Perio Lesion in a Severely Compromised Tooth: An 18-Year Follow-up Case Report.

This case report describes the diagnosis, multidisciplinary treatment, and long-term follow-up of a severely compromised tooth in a patient who was referred for assessing a gingival recession. Clinical evaluation of the left maxillary canine showed 12 mm of mid-buccal gingival recession, probing depth of 14 mm on the mesial-buccal aspect, and grade III mobility. A periapical radiograph revealed extensive periapical and lateral radiolucency. The first step of the treatment was to carry out oral hygiene instructions and full-mouth debridement. After that, endodontic treatment was performed immediately. Periodontal reevaluation four months after endodontic therapy revealed that probing depths of all sites were within 3 mm and periapical radiograph showed a slight decrease in periapical and lateral radiolucency. It was subsequently decided to perform root coverage with a laterally positioned flap and subepithelial connective tissue graft. Six months after surgery, the root surface showed 1 mm recession, representing root coverage of 91.7% and a gain of attachment of 13 mm. The patient was enrolled in a 6-month supportive periodontal therapy. Treatment outcomes were evaluated over 18 years, with successful radiographic and clinical results throughout the follow-up period. The successful management of endo-periodontal lesions requires an accurate diagnosis, which is imperative to provide proper therapy in the correct treatment sequence.

Review of obesity and periodontitis: an epidemiological view.

Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.

Efficacy of Local and Systemic Antimicrobials in the Non-Surgical Treatment of Smokers With Chronic Periodontitis: A Systematic Review.

BACKGROUND: The aim of this systematic review is to evaluate whether use of local or systemic antimicrobials would improve clinical results of non-surgical periodontal therapy for smokers with chronic periodontitis (CP). METHODS: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and The Cochrane Central Register of Controlled Trials were searched up to and including March 2016. Randomized clinical trials of duration of at least 6 months were included if they reported on treatment of smokers (≥10 cigarettes per day for minimum 12 months) with CP with non-surgical periodontal therapy either alone or associated with local or systemic antimicrobials. Random-effects meta-analyses were undertaken to evaluate mean differences in probing depth (PD) and clinical attachment level (CAL). RESULTS: Of 108 potentially eligible articles, seven were included. Most individual studies (75%) testing locally delivered antibiotics reported that smokers benefited from this treatment approach. Pooled estimates found additional PD reduction of 0.81 mm (P = 0.01) and CAL gain of 0.91 mm (P = 0.01) at sites with baseline PD ≥5 mm. Conversely, meta-analysis on systemic use of antimicrobials failed to detect significant differences in mean changes from baseline, and only one trial supported their use. CONCLUSIONS: In smokers with CP, adjunctive use of local antimicrobials improved efficacy of non-surgical periodontal therapy in reducing PD and improving CAL at sites presenting PD ≥5 mm before treatment. Current evidence does not demonstrate similar gains when scaling and root planing plus systemic antimicrobial/antibiotics were associated with therapy.