Relationship between periodontal disease and mortality in patients treated with maintenance hemodialysis.

BACKGROUND: The relationship between periodontitis and outcomes in patients treated with long-term hemodialysis is controversial. Our previous work suggests that periodontitis is associated with malnutrition and inflammation. Here, we hypothesize that periodontitis is associated with mortality in hemodialysis patients. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 253 patients undergoing hemodialysis at a single hospital-based dialysis facility. PREDICTOR: Severity of periodontal disease (mild, moderate, or severe based on oral examination of 6 teeth). OUTCOMES & MEASUREMENTS: All-cause and cardiovascular mortality during a 6-year follow-up after an oral health examination of index teeth. RESULTS: During the 6-year follow-up, 102 patients died. Death occurred in 70.6%, 41.8%, and 24.0% of patients with severe, moderate, and mild/no periodontitis, respectively. Using mild/no periodontitis as the reference group and adjustment for demographic characteristics, comorbid conditions, and selected laboratory values, HRs for all-cause mortality were 1.39 (95% CI, 0.83-2.34) and 1.83 (95% CI, 1.04-3.24) for moderate and severe periodontitis, respectively. HRs for cardiovascular mortality were not statistically significant. LIMITATIONS: Single assessment of periodontal disease severity. CONCLUSIONS: For patients undergoing long-term hemodialysis, periodontitis is associated with increased risk of death. Clinical trials are required to determine whether treatment of periodontitis decreases mortality.

Periodontal disease is associated with metabolic syndrome in hemodialysis patients.

BACKGROUND: Periodontitis and metabolic syndrome are highly prevalent in hemodialysis (HD) patients but little information is available on their association. Thus, this study aimed to assess the association between these two conditions in a HD cohort. METHODS: Data from 253 HD patients were analyzed. The association of periodontitis, gingival inflammation and dental plaque burden with metabolic syndrome and its individual component conditions were evaluated. Adjustments for age, gender, socioeconomic status, comorbidity and smoking status were considered. RESULTS: The prevalence of metabolic syndrome was 65.1% among individuals (n = 149) with moderate-severe periodontitis, 54.5% among individuals (n = 55) with mild periodontitis and 36.7% among individuals (n = 49) without periodontitis. After adjustment of confounders, patients with moderate-severe periodontitis were 2.736 [95% confidence interval (CI), 1.293-5.790] times more likely to develop metabolic syndrome than were those without periodontitis. In addition, the odds ratio for metabolic syndrome was 1.561 (95% CI, 1.121-2.166) per score of gingival inflammation severity and 1.724 (95% CI, 1.135-12.615) per score of dental plaque burden. CONCLUSIONS: Moderate-severe periodontitis is associated with metabolic syndrome in HD patients. Whether improved oral health reduces the risk of metabolic syndrome is worth determining through further studies.

Entecavir add-on Peg-interferon therapy plays a positive role in reversing hepatic fibrosis in treatment-naïve chronic hepatitis B patients: a prospective and randomized controlled trial.

BACKGROUND: The efficacy of entecavir (ETV) add-on peg-interferon therapy compared with ETV monotherapy in treatment-naïve hepatitis B virus (HBV) patients remains controversial. We investigated whether adding peg-interferon to ongoing ETV treatment leads to a better curative effect or not. METHODS: All patients have been recruited between August 2013 and January 2015 from the Shanghai Public Health Clinical Center and Zhongshan Hospital (China). Eligible HBV patients (n = 144) were randomly divided (1:1) to receive either ETV monotherapy (n = 70) or peg-interferon add-on therapy from week 26 to 52 (n = 74). Patients were followed-up for at least 2 years. Indexes including hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) seroconversion rate, sustained virologic response, transient elastography value, and histological scores were evaluated every 3 months until the end of the study. The rate of patients with HBsAg loss was defined as the primary endpoint criteria. RESULTS: At week 26, no patient achieved HBsAg seroconversion in either group. At week 52, one patient in the monotherapy group was HBsAg-negative but there was none in the combination therapy group. The monotherapy group showed significantly better liver function recovery results than the combination therapy group. At week 78, one patient in the combination group had HBsAg seroconverted. At week 104, only three patients in the combination therapy group were HBsAg-negative compared with one patient in monotherapy. The mean alanine aminotransferase and aspartate aminotransferase levels and transient elastography values decreased significantly compared with baseline. Both groups showed a favorable decrease in alpha-fetoprotein (monotherapy: 4.5 [2.8, 7.1] vs. 2.2 [1.8, 3.1] ng/mL, P < 0.001; combination therapy: 5.7 [3.0, 18.8] vs. 3.2 [2.0, 4.3] ng/mL, P < 0.001) and an improved result of liver biopsy examination scores. The combination group showed a better improvement in histology compared with the monotherapy group (mean transient elastography value 6.6 [4.9, 9.8] vs. 7.8 [5.4, 11.1] kPa, P = 0.028). But there was no significant difference in HBsAg conversion rate (1.8% [1/56] vs. 4.1% [3/73], P = 0.809) and HBeAg conversion rate (12.5% [7/56] vs. 11.0% [8/73], P = 0.787), as well as HBV-DNA, sustained virologic response (93.2% vs. 98.5%, P = 0.150) between the two groups. CONCLUSIONS: Both therapies supported liver function recovery and histology improvement. Combination therapy did not show better anti-viral efficacy in HBsAg or HBeAg seroconversion compared with monotherapy. However, combination therapy played a more positive role in reversing hepatic fibrosis compared with monotherapy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02849132; https://clinicaltrials.gov/ct2/show/NCT02849132.

Polymorphism of OAS2 rs739901 C/A Involves the Susceptibility to EV71 Infection in Chinese Children.

This study aimed to assess the relationship of OAS2 rs739901 5,-flanking C/A polymorphisms with the susceptibility to Enterovirus-71 (EV71) infection. We investigated 294 hand-foot-mouth disease (HFMD) Chinese children with EV71 infection (165 mild cases and 129 encephalitis cases). The improved multiplex ligation detection reaction (iMLDR) technique was used to test the genotypes. In EV71-infected patients, the CA genotype distribution (P=0.007), A allele frequency (OR 1.32,95% CI 1.0-1.7, P=0.034) and CA+AA carriage frequency (P=0.003) of OAS2 rs739901 5'-flanking were obviously elevated as compared with controls, but there were no statistically significant differences between mild cases and encephalitis cases. In EV71-infected patients, the counts of white blood cells (P=0.034) and blood glucose concentrations (P=0.042) were raised in A carriers (CA+AA). Among different genotypes of encephalitis cases, the contents of cerebrospinal fluid (CSF) showed no significant differences. IFN-γ levels in EV71-infected patients were higher than those in controls (mild group vs. control group, P<0.01; encephalitis group vs. control group, P<0.01;). In encephalitis cases, IFN-γ levels were reduced (P<0.05) in A carriers compared to CC genotype, however, there were no significant differences between genotypes CA and AA (P=0.226). These findings suggest that OAS2 rs739901 5'-flanking C/A genetic polymorphisms involve the susceptibility to EV71 infection, and A allele might be a risk factor of the susceptibility to EV-71 infection.

Does periodontitis reflect inflammation and malnutrition status in hemodialysis patients?

BACKGROUND: Chronic infection and inflammation, including periodontitis, is linked to an increased risk for atherosclerosis. To investigate the possible adverse effects of periodontitis in maintenance hemodialysis patients, we compared periodontal severity with malnutrition and inflammation, which are associated with poor atherosclerotic outcome in hemodialysis patients. METHODS: Two hundred fifty-three hemodialysis patients were included in this study to evaluate clinical periodontal status by using the Plaque Index, Gingival Index, and Periodontal Disease Index. Geographic, hematologic, biochemical, and dialysis-related data also were collected. Values for nutritional and inflammatory markers, such as albumin, blood urea nitrogen, creatinine, transferrin, absolute lymphocyte count, normalized protein catabolic rate, high-sensitivity C-reactive protein, and ferritin, were included for analysis with the Periodontal Index. RESULTS: Poor oral health status was shown by 80.6% of hemodialysis patients with periodontal disease. In an analysis of geographic and disease-related parameters, we found that aging, smoking, diabetes, and longer dialysis duration were associated with severity of periodontitis. Parameters of malnutrition and inflammation also were associated with poor periodontal status. We next conducted multiple regression analysis and found that age, diabetes, smoking, albumin level, and dialysis duration were associated independently with periodontitis severity in hemodialysis patients. According to the severity of periodontitis, there were higher percentiles of patients with malnutrition (chi-square = 13.055; P = 0.005) and inflammation (chi-square = 10.046; P = 0.018) in the severe group. CONCLUSION: Periodontal health is poor in hemodialysis patients and correlates with markers of malnutrition and inflammation. Its diagnosis and treatment deserve better awareness.

Radiographic outcome of necrotic immature teeth treated with two endodontic techniques: A retrospective analysis.

BACKGROUND: The endodontic treatment of teeth with immature root has always been a challenge. To achieve a better prognosis, regenerative endodontic treatment may become a treatment trend for teeth with apical periodontitis and immature roots. METHODS: Clinical and radiographic data were collected from 38 endodontic treated immature teeth (21 apexification and 17 regeneration). Measure the radiographic outcome by quantifying the apical lesion. RESULTS: There was no statistical difference between the two treatments regarding PAI scores at the 1-, 3-, 6-, and 12-month follow-up (p > 0.05). In addition, different operators and the different stages of root development for both techniques showed no significant statistical difference on the final treatment results. CONCLUSIONS: In this study, assessment of the radiographic outcomes indicated that regenerative endodontic treatment were identical to the apexification technique.

[Comparison of the effectiveness of two types of filter papers on gingival crevicular fluid collection].

PURPOSE: To compare the effectiveness of whatman3MM chromatographic filter paper and whatman3# qualitative filter paper on gingival crevicular fluid collection and protein extraction,in order to provide the evidence of using appropriate filter paper for collection of gingival crevicular fluid in clinical researches. METHODS: Whatman3MM chromatographic filter paper was used in group A and whatman3# qualitative filter paper in group B. Both types of filter papers were clipped into 2mm±8mm strips, then added into 15 incremental volumes of the fuchsine solution with serum, respectively, and each volume was repeated for 4 times. The length of infiltration on each filter paper was measured. Both groups were added into 5 incremental volumes of normal human serum separately and each volume was repeated for five times. The concentration of total protein in the extraction liquid of each group was measured. Both two groups were added into 5 incremental concentrations of 1µL normal human serum which were diluted to the corresponding multiples with 0.9% NaCl solution, and each concentration was repeated for 5 times. SPSS17.0 software package was used to conduct statistical analysis. RESULTS: The linear relation between the length of infiltration and volume of the solution were good and significant difference (P<0.05) was found between the two groups. With the exception of 0.1µL,the lengths of infiltration in group A were all larger than that in group B. No significant difference (P>0.05) was found in two groups when considering the protein extraction yield. CONCLUSIONS: The two filter papers were both effective to measure the volume of gingival crevicular fluid which was collected according to its infiltration length on the paper. When there was a large volume of gingival crevicular fluid, Whatman3# qualitative filter paper was more applicable than whatman3MM chromatographic filter paper. However, no significant difference was found between the two filter papers in consideration of protein extraction.

[Evaluation of the coronal leakage of fiber posts using different adhesive approaches].

PURPOSE: To test and compare the marginal leakage of radicular dentin cemented with three resin cements. METHODS: Nine extracted maxillary incisors after endodontically treated were divided into 3 groups(n=3).Fiber posts were inserted using three resin cements: One-Step Plus/DuoLink (OD),ParaCore Automix (PA) and RelyXTM Unicem(RU).All teeth were subjected to thermocycling for 5000 cycles. All teeth were stained in 0.1% basic fuchsin for 24h and then longitudinally sectioned into four parts.Coronal leakage was evaluated. SAS 6.0 software package was used for Kruskal-Wallis test. RESULTS: Different resin cements significantly affected the coronal leakage of fiber posts(P<0.001). CONCLUSION: The system RU, which represents a new simplified self-adhesive protocol, performs the best sealing capacity.

[Preliminary study on DNA damage of ZrO(2)/LaPO(4) diphase ceramics on human peripheral blood lymphocytes in vitro].

PURPOSE: To detect the genotoxicity of dental machinable ZrO(2)/LaPO(4) diphase ceramics on human peripheral blood lymphocytes in vitro. METHODS: The evaluation of DNA damage on human lymphocytes was performed by comet assay for three groups of ZrO(2)/LaPO(4) diphase ceramics with 30wt% of LaPO(4) (with 3wt% and 5wt% of Y(2)O(3)) and 40wt% of LaPO(4) (with 5wt% of Y(2)O(3)). The results were analyzed with SPSS16.0 software package for one-factor ANOVA and LSD. RESULTS: Three experimental groups with different concentration of LaPO(4) of ZrO(2)/LaPO(4) diphase ceramics, the negative control of IPS Empress II ceramics and the blank behaved little migration of the DNA strands respectively after six-day test, and there was no significant difference in all the groups except the positive control (P>0.05). CONCLUSION: The study indicates little effect of DNA damage of ZrO(2)/LaPO(4) diphase ceramics.

Comprehensive dental treatment under general anesthesia in healthy and disabled children.

BACKGROUND: Differences in dental treatment under general anesthesia (GA) in healthy and disabled children are rarely reported. This retrospective study evaluated the characteristics and treatment modalities performed under general anesthesia in pediatric dental patients at Taipei Chang Gung Memorial Hospital between 2004 and 2005, and compared the different treatment patterns performed in healthy children and children with special health care needs. METHODS: The data were reviewed in pediatric patients from 1 to 18 years old who underwent dental treatment performed under general anesthesia from January 2004 to December 2005. Patients with special health care needs who had at least one type of mental or physical disability were assigned to the disabled group (Group D) and the other healthy patients were assigned to the healthy group (Group H). The treatment modalities of operative restoration, crowns, pulp therapy, sealant and extracted teeth were compared in the two groups. RESULTS: A total of 185 patients were assigned to group H and 112 to group D. The patients in group D were significantly older than those in group H. There were no significant differences in the mean number of teeth treated between the two groups. However, there was a significantly greater mean total number of teeth extracted in group D patients (p < 0.001). In addition, there were more stainless steel crown reconstructions (p < 0.05) and pulp therapies (p < 0.001) performed in group H patients. In group D, there were no significant differences in the total number of teeth extracted between the 1-3 year old patients and the 3-6 year-old patients (p = 0.99). CONCLUSIONS: For very young children or those with special health care needs, dental treatment performed under general anesthesia is beneficial and efficient. The findings of this study suggest that underlying medical or mental conditions may influence the dental condition and treatment modality provided.

[The experimental study of the relationship between preparation height and retention of complete crowns].

PURPOSE: This study was to discuss the influence of preparation height on retention of complete crown. METHODS: In this study we measured the retention of complete crown with the preparation height 2 mm, 3 mm, 4 mm and 5 mm. All crowns had no preparation taper and no bonding agent was used. The retention of crowns was measured and the data was statistically analyzed by t test. RESULTS: The preparation height was directly proportional to the retention of complete crown. And the crown with the height of 2 mm had enough retention when the crown had no preparation taper. CONCLUSION: In order to get enough retention of short height molar, we should induce the preparation taper.

[The fluctuation of anterior teeth colouration during the period of growth puberty in children and adolescents].

OBJECTIVE: This study was designed to examine the fluctuation tendency of the anterior teeth coloration during the period of growth puberty. METHODS: One hundred children with average age of 13.3 years, and 100 adolescents with average age of 23.4 years were divided into two groups. The upper left incisors were selected for color matching using computerized spectrophotometery system (Shade-eye, Shofu). The measurements depicting color properties, including hue, value and chroma were quantitatively analyzed. Statistical evaluation was conducted for the comparison of the color measurements between the two groups. RESULTS: The following trends were indicated during the period of growth puberty: (1)The hue of the coloration changed from redness into mixture of redness and grayness. (2)The magnitude of value of the coloration was in decline. (3)The intensity of chroma increased significantly. CONCLUSIONS: The teeth coloration fluctuates within the period spanning the initial and final stages of growth puberty, characterized by a decrease in hue and value and an increase in chroma.