Effect of short-term vitamin D supplementation after nonsurgical periodontal treatment: A randomized, double-masked, placebo-controlled clinical trial.

OBJECTIVES: This trial aimed to evaluate the efficacy and safety of vitamin D supplementation on the residual moderate and deep pockets following nonsurgical periodontal therapy. BACKGROUND: Vitamin D supplementation has potential effects on periodontitis, but current evidence remains inconclusive. METHODS: After 3 months of nonsurgical periodontal treatment, 360 patients with moderate or severe periodontitis were randomly assigned to 2000 international unit (IU)/d vitamin D3, 1000 IU/d vitamin D3, or placebo. Clinical periodontal examinations, including probing depth (PD), bleeding index (BI), plaque index (PLI), attachment loss (AL), and alveolar crest height (ACH), were performed at baseline and after 3 months of intervention. RESULTS: There was a slight but significant decrease in AL and PD in both vitamin D groups compared with placebo group for moderate and deep pockets. About 2000 IU/d vitamin D3 group, 1000 IU/d vitamin D3 group, and placebo group all decreased the AL for both moderate pockets (-0.4 mm vs -0.4 mm vs -0.3 mm) and deep pockets (-1.1 mm vs -1.1 mm vs -1.0 mm) (all P < .05). Similarly, PD was also decreased in these three groups for both moderate pockets and deep pockets (all P < .05). In addition, vitamin D supplementation was well tolerated, and no adverse events were reported. CONCLUSIONS: Although statistically significant differences were observed in favor to vitamin D supplementation, the magnitude of effect size tended to be modest with limited clinical relevance and the long-term efficacy and safety warrant further investigation.

Efficacy of Er:YAG laser on periodontitis as an adjunctive non-surgical treatment: A split-mouth randomized controlled study.

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.

Periodontal health: A national cross-sectional study of knowledge, attitudes and practices for the public oral health strategy in China.

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.

Reversible Interactions of Proteins with Mixed Shell Polymeric Micelles: Tuning the Surface Hydrophobic/Hydrophilic Balance toward Efficient Artificial Chaperones.

Molecular chaperones can elegantly fine-tune its hydrophobic/hydrophilic balance to assist a broad spectrum of nascent polypeptide chains to fold properly. Such precious property is difficult to be achieved by chaperone mimicking materials due to limited control of their surface characteristics that dictate interactions with unfolded protein intermediates. Mixed shell polymeric micelles (MSPMs), which consist of two kinds of dissimilar polymeric chains in the micellar shell, offer a convenient way to fine-tune surface properties of polymeric nanoparticles. In the current work, we have fabricated ca. 30 kinds of MSPMs with finely tunable hydrophilic/hydrophobic surface properties. We investigated the respective roles of thermosensitive and hydrophilic polymeric chains in the thermodenaturation protection of proteins down to the molecular structure. Although the three kinds of thermosensitive polymers investigated herein can form collapsed hydrophobic domains on the micellar surface, we found distinct capability to capture and release unfolded protein intermediates, due to their respective affinity for proteins. Meanwhile, in terms of the hydrophilic polymeric chains in the micellar shell, poly(ethylene glycol) (PEG) excels in assisting unfolded protein intermediates to refold properly via interacting with the refolding intermediates, resulting in enhanced chaperone efficiency. However, another hydrophilic polymer-poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) severely deteriorates the chaperone efficiency of MSPMs, due to its protein-resistant properties. Judicious combination of thermosensitive and hydrophilic chains in the micellar shell lead to MSPM-based artificial chaperones with optimal efficacy.

Effects of periodontal treatment on lung function and exacerbation frequency in patients with chronic obstructive pulmonary disease and chronic periodontitis: a 2-year pilot randomized controlled trial.

AIM: To evaluate the direct effects of periodontal therapy in Chronic Obstructive Pulmonary Disease (COPD) patients with chronic periodontitis (CP). MATERIALS AND METHODS: In a pilot randomized controlled trial, 60 COPD patients with CP were randomly assigned to receive scaling and root planing (SRP) treatment, supragingival scaling treatment, or oral hygiene instructions only with no periodontal treatment. We evaluated their periodontal indexes, respiratory function, and COPD exacerbations at baseline, 6 months, 1, and 2 years. RESULTS: Compared with the control group, measurements of periodontal indexes were significantly improved in patients in two treatment groups at 6-month, 1-year, and 2-year follow-up (all p < 0.05). Overall, the means of forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) and FEV1 were significantly higher in the two therapy groups compared with the control group during the follow-up (p < 0.05). In addition, the frequencies of COPD exacerbation were significantly lower in the two therapy groups than in the control group at 2-year follow-up (p < 0.05). CONCLUSIONS: Our preliminary results from this pilot trial suggest that periodontal therapy in COPD patients with CP may improve lung function and decrease the frequency of COPD exacerbation.

Serum levels of 25-hydroxyvitamin D, oral health and chronic obstructive pulmonary disease.

AIM: To evaluate the associations of serum 25-Hydroxyvitamin D [25(OH)D] levels with periodontal health and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We conducted a case-control study of 193 COPD patients and 181 controls. Their periodontal status and lung function were examined, and serum 25(OH)D levels were measured. RESULTS: Mean serum 25(OH)D concentrations were significantly lower in the COPD group than in the controls (32.1 versus 35.8 nmol/l; p = 0.002). Serum 25(OH)D concentrations were positively correlated with lung function among non-smokers and negatively correlated with plaque index (PLI) among former smokers. After adjustment for age, gender, body mass index, season and smoking status, periodontal indexes were significantly associated with serum 25(OH)D concentrations (number of remaining teeth among all groups; probing depth, clinical attachment level, bleeding index, PLI and alveolar bone loss among COPD group). Lower serum 25(OH)D concentrations were significantly associated with an increased risk of COPD among former smokers (Odd ratio 4.11; 95% confidence interval 1.47-11.5; p = 0.007) after adjustment for periodontal indexes and other variables. CONCLUSIONS: Lower serum 25(OH)D concentrations were significantly associated with poor periodontal health and an increased risk of COPD.

Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations.

AIM: To assess the associations of oral hygiene and periodontal health with chronic obstructive pulmonary disease (COPD) exacerbations. MATERIAL AND METHODS: In total, 392 COPD patients were divided into frequent and infrequent exacerbation (≥2 times and <2 times in last 12 months) groups. Their lung function and periodontal status were examined. Information on oral hygiene behaviours was obtained by interview. RESULTS: In the univariate analysis, fewer remaining teeth, high plaque index (PLI) scores, low tooth brushing times, and low regular supra-gingival scaling were significantly associated with COPD exacerbations (all p-values <0.05). After adjustment for age, gender, body mass index, COPD severity and dyspnoea severity, the associations with fewer remaining teeth (p = 0.02), high PLI scores (p = 0.02) and low tooth brushing times (p = 0.008) remained statistically significant. When stratified by smoking, fewer remaining teeth (OR = 2.05, 95% CI: 1.04-4.02) and low tooth brushing times (OR = 4.90, 95% CI: 1.26-19.1) among past smokers and high PLI scores (OR = 3.43, 95% CI: 1.19-9.94) among never smokers were significantly associated with COPD exacerbations. CONCLUSIONS: Fewer remaining teeth, high PLI scores, and low tooth brushing times are significant correlates of COPD exacerbations, indicating that improving periodontal health and oral hygiene may be a potentially preventive strategy against COPD exacerbations.

Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control Study.

Purpose: To evaluate clinical periodontal status and microbiologic pathogens in patients with chronic obstructive pulmonary disease (COPD) and periodontitis. Patients and Methods: We conducted a case-control study of 60 periodontitis patients with COPD (case group) and 60 periodontitis patients with normal pulmonary function (control group). Their periodontal status and respiratory function were clinically examined. Real-time polymerase chain reaction assays were used to measure five dental pathogens and four respiratory pathogens in subgingival dental plaque. Spearman's rank correlation coefficients (r2) were calculated to assess correlations of pathogens. Principal component analysis (PCA) was employed to assess the similarity of bacterial diversity between the two groups. Logistic regression was performed to examine the associations of periodontal variables and pathogens with COPD risk. Results: COPD patients had fewer remaining teeth, higher plaque index (PLI), and more severe site percentages of clinical attachment level (CAL) than the controls. Although COPD patients tended to have relatively higher ranked means of Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Haemophilus influenza than control participants, the differences were not significant. Some periodontal pathogens and respiratory pathogens were positively correlated with each other (r2 =0.29 to 0.47, all P < 0.05). The PCA graph showed that the distributions of pathogens were more dispersed but less discriminated in the COPD group than those in the control group. PLI (P = 0.045) and CAL ≥ 5mm site percentages (P = 0.01) were significantly associated with an increased risk of COPD, while pathogens were not associated with COPD. Conclusion: Our results from this study do not indicate periodontal pathogens as potential predictors of COPD risk, despite significantly poor periodontal status associated with COPD.

Saliva Microbiome Changes in Patients With Periodontitis With and Without Chronic Obstructive Pulmonary Disease.

Objective: The oral microbiota plays a key part in the initial colonization by pathogens and the chronic inflammatory reaction of the host. We measured variations in the salivary microbiota and evaluated their potential associations with periodontitis and chronic obstructive pulmonary disease (COPD). Methods: We investigated the salivary microbiota of patients with COPD and periodontitis (n = 21) compared with that in patients with periodontitis alone (n = 36) and with healthy controls (HCs; n = 14), using pyrosequencing of polymerase chain reaction-amplified 16s rRNA genes. Results: Bacterial richness and diversity were significantly higher in patients suffering from COPD, and the bacterial family Lachnospiraceae was observed frequently only among patients with COPD and periodontitis. Veillonella, Rothia, Actinomyces, and Fusobacterium were the core bacterial genera that showed significant differences among patients with coincident COPD and periodontitis, patients with periodontitis alone, and HCs (p < 0.05). Veillonella, Rothia, and Actinomyces were observed much more frequently in patients with COPD and periodontitis, compared with that in HCs. All tested populations were divided into subgroups based on sex, smoking, or periodontitis index. In the subgroup with a bleeding index >2, Rothia was significantly different in periodontitis with and without COPD groups compared with HCs. In the subgroup with a plaque index >2.5, Rothia and Veillonella showed significant differences in periodontitis with and without COPD groups compared with HCs. Conclusion: Variations in salivary microbiota may be associated with COPD and periodontitis.

Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease.

AIM: To evaluate the associations of periodontal health status and oral health behaviours with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: We conducted a case-control study of 306 COPD patients and 328 controls with normal pulmonary function. Their periodontal status and respiratory function were clinically examined and information on oral health behaviours was obtained using a validated questionnaire. RESULTS: Patients with COPD had fewer teeth and a higher plaque index than the controls. Univariate analysis showed that tooth brushing times and method, experience of dental floss use, dental visit and regular supra-gingival scaling, and oral health knowledge were significantly related to the risk of COPD. After adjusting for age, sex, and body mass index and stratifying by smoking status, inappropriate tooth brushing method (p=0.025 among non-smokers), lower regular supra-gingival scaling (p=0.027 among non-smokers and p<0.0001 among former smokers), and poorer oral health knowledge (p<0.0001 among non-smokers and p=0.019 among former smokers and p=0.044 among current smokers) remained significantly associated with COPD. CONCLUSIONS: Poor periodontal health, dental care, and oral health knowledge were significantly associated with an increased risk of COPD. Our findings indicate the importance of promoting dental care and oral health knowledge that can be integrated into the prevention and treatment of COPD.

Systemic oxidative stress biomarkers in chronic periodontitis: a meta-analysis.

Oxidative stress biomarkers have been observed in peripheral blood of chronic periodontitis patients; however, their associations with periodontitis were not consistent. This meta-analysis was performed to clarify the associations between chronic periodontitis and oxidative biomarkers in systemic circulation. Electronic searches of PubMed and Embase databases were performed until October 2014 and articles were selected to meet inclusion criteria. Data of oxidative biomarkers levels in peripheral blood of periodontitis patients and periodontal healthy controls were extracted to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) by using random-effects model. Of 31 eligible articles, 16 articles with available data were included in meta-analysis. Our results showed that periodontitis patients had significantly lower levels of total antioxidant capacity (SMD = -2.02; 95% CI: -3.08, -0.96; P = 0.000) and higher levels of malondialdehyde (SMD = 0.99; 95% CI: 0.12, 1.86; P = 0.026) and nitric oxide (SMD = 4.98; 95% CI: 2.33, 7.63; P = 0.000) than periodontal healthy control. Superoxide dismutase levels between two groups were not significantly different (SMD = -1.72; 95% CI: -3.50, 0.07; P = 0.059). In conclusion, our meta-analysis showed that chronic periodontitis is significantly associated with circulating levels of three oxidative stress biomarkers, indicating a role of chronic periodontitis in systemic diseases.

Association between periodontitis and chronic obstructive pulmonary disease in a Chinese population.

BACKGROUND: A relationship between periodontitis and chronic respiratory disease has been suggested by recent studies. The aim of this study is to explore the association between periodontitis and chronic obstructive pulmonary disease (COPD) in a Chinese population. METHODS: We conducted a case-control study of 581 COPD cases and 438 non-COPD controls. Lung function examination, a 6-minute walk test, and the British Medical Research Council questionnaire were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PI), and alveolar bone loss. A validated index for predicting COPD prognosis, the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, was also calculated. RESULTS: Participants with more severe COPD were more likely to have severe periodontal disease. PD, AL, PI, alveolar bone loss, and the number of teeth were significantly associated with all stages of COPD (all P <0.001). When compared to controls (BODE = 0), participants with higher BODE scores had significantly higher AL (P <0.001), BI (P = 0.027), PI (P <0.001), alveolar bone loss (P <0.001), and the number of teeth (P <0.001). PI appeared to be the main periodontal health-related factor for COPD, with an odds ratio (OR) = 9.01 (95% CI = 3.98 to 20.4) in the entire study population OR = 8.28 (95% CI = 2.36 to 29.0), OR = 5.89 (95% CI = 2.64 to 13.1), and OR = 2.46 (95% CI = 1.47 to 4.10) for current, smokers, and non-smokers, respectively. CONCLUSION: Our study found a strong association between periodontitis and COPD, and PI seemed to be a major periodontal factor for predicting COPD among Chinese adults.

Periodontal health and quality of life in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the association of periodontal health and parameters of quality of life assessed in 306 Chinese patients with chronic obstructive pulmonary disease (COPD). METHODS: Periodontal status and respiratory function in 306 COPD patients were clinically evaluated and their quality of life was assessed using the standardized St George's Respiratory Questionnaire (SGRQ). RESULTS: The SGRQ scores were all significantly correlated with major lung function parameters (r(2) = -0.37 to -0.28; all p < 0.0001) and Medical Research Council dyspnoea scale (r(2) = 0.23 to 0.30; all p < 0.0001). The SGRQ scores also correlated with the 6-min walk test (r(2) = -0.15 to -0.13; all p < 0.05). Of periodontal health parameters, missing tooth number and plaque index appeared to be related to the scores of quality of life. The age- and gender-adjusted Pearson's correlation coefficients between missing teeth and total score, symptoms score, and activity score were 0.09, 0.12, and 0.12, respectively (all p < 0.05). The Pearson's correlation coefficients between plaque index and symptoms score and activity score were 0.09 and 0.09 (p < 0.05). After adjusting for age, gender, body mass index, and smoking status, missing teeth remained significantly associated with symptom score (p = 0.030) and activity score (p = 0.033) while plaque index was significantly associated with symptom score (p = 0.007). CONCLUSIONS: Poor periodontal health as reflected by missing teeth and plaque index was significantly associated with lower quality of life in COPD patients. Our findings indicate the importance of promoting dental care in current public health strategies to improve the quality of life in COPD patients.