Occurrence of periodontal diseases according to the ACES 2018 Classification Framework and the CDC/AAP definition: A cross-sectional study in a major Brazilian city.

AIM: The occurrence of periodontal diseases is still to be determined in large samples of major Brazilian cities. This study aimed to assess the periodontal status of adults from Curitiba, Paraná, Brazil, using periodontitis definitions by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) and the recently published ACES 2018 Classification Framework. MATERIALS AND METHODS: A multi-stage probability sampling technique was applied to draw individuals aged 18 or older. A total of 566 individuals underwent a full-mouth periodontal examination. Periodontitis cases were defined according to the CDC/AAP and the ACES 2018 Classification Framework. Non-periodontitis cases were classified as healthy or gingivitis. The agreement between the two definitions was calculated. RESULTS: Periodontal health was present in 33.6% and 13.8% of individuals, and gingivitis was found in 11.7% and 7.5%, according to CDC/AAP and ACES, respectively. Mild, moderate and severe periodontitis (CDC/AAP) were present in 2.1%, 33.4% and 19.1% of individuals, respectively. Using ACES, 34.3% had Stages I/II and 43.3% had Stages III/IV. The occurrence of periodontitis was higher when a subgroup of individuals aged 30+ were analysed, ranging from 69.6% (CDC/AAP) to 90.1% (ACES). CDC/AAP and ACES agreement for health, gingivitis and periodontitis accounted for 68.8% of the observations. CONCLUSIONS: Periodontal diseases affect more than 66% of the population aged 18+ years. Classic definition by the CDC/AAP and the recently published ACES Framework yielded moderate agreement.

Performance of ChatGPT in classifying periodontitis according to the 2018 classification of periodontal diseases.

OBJECTIVES: This study assessed the ability of ChatGPT, an artificial intelligence(AI) language model, to determine the stage, grade, and extent of periodontitis based on the 2018 classification. MATERIALS AND METHODS: This study used baseline digital data of 200 untreated periodontitis patients to compare standardized reference diagnoses (RDs) with ChatGPT findings and determine the best criteria for assessing stage and grade. RDs were provided by four experts who examined each case. Standardized texts containing the relevant information for each situation were constructed to query ChatGPT. RDs were compared to ChatGPT's responses. Variables influencing the responses of ChatGPT were evaluated. RESULTS: ChatGPT successfully identified the periodontitis stage, grade, and extent in 59.5%, 50.5%, and 84.0% of cases, respectively. Cohen's kappa values for stage, grade and extent were respectively 0.447, 0.284, and 0.652. A multiple correspondence analysis showed high variance between ChatGPT's staging and the variables affecting the stage (64.08%) and low variance between ChatGPT's grading and the variables affecting the grade (42.71%). CONCLUSIONS: The present performance of ChatGPT in the classification of periodontitis exhibited a reasonable level. However, it is expected that additional improvements would increase its effectiveness and broaden its range of functionalities (NCT05926999). CLINICAL RELEVANCE: Despite ChatGPT's current limitations in accurately classifying periodontitis, it is important to note that the model has not been specifically trained for this task. However, it is expected that with additional improvements, the effectiveness and capabilities of ChatGPT might be enhanced.

Runs of homozygosity are associated with staging of periodontitis in isolated populations.

Periodontitis is a common inflammatory disease characterized by a complex etiology, which is the result of a combination of genetic and environmental factors. Genetic variants linked to the periodontitis disease were already investigated, however, little was known regarding the severity of this disease. Recently, long runs of homozygosity (ROH) were associated with several multifactorial diseases. Therefore, in our work, we tried to assess the role of ROH and periodontitis status. We found an association between the excess of homozygosity owing to ROH and staging of periodontitis. More in detail, the total amount of homozygosity owing to ROH is positively associated with an increased severity of periodontitis (P = 0.0001). Regression tree analysis showed the impact of ROH burden in discriminating individuals with mild periodontitis stages I and II and periodontitis stages III and IV (P < 0.001). Furthermore, ROH mapping highlights several regions associated with a severe status of periodontitis (odds ratio > 1). Among them, we found a total of 33 genes. Interestingly, some of these genes were previously associated with granulocyte or platelet measures, both linked to the onset and the progression of periodontal disease. Our results suggest the not only single variants association test could help to risk assessment but even individual genomic features; furthermore, our ROH mapping highlighted the possible role of multiple genes in periodontal development.

Erythrocyte indices and localized stage II/III periodontitis in military young men and women: CHIEF oral health study.

BACKGROUND: Prior studies have shown an association between generalized periodontitis and anemia in older or undernourished adults. The aim of the study was to examine the associations of erythrocyte indices with localized periodontitis in robust young adults, which has never been reported before. METHODS: The study included 1286 military participants, aged 19-40 years, with regular exercise training in Hualien, Taiwan. Localized periodontitis was grouped to healthy/stage I and stage II/III (n = 803 and 325) in men and (n = 130 and 28) in women according to the 2017 criteria of the world workshop. Systemic inflammation was evaluated by leukocyte counts. Multiple logistic regression analysis with adjustment for age, tobacco smoking status, betel nut chewing status, body mass index and leucocyte counts were used to determine the associations. RESULTS: Greater mean corpuscular volume in young men [odds ratio (OR) and 95% confidence intervals 1.03 (1.01-1.06)], and greater hematocrit and hemoglobin levels in young women were associated with a higher risk of localized stage II/III periodontitis [OR: 1.17 (1.02-1.34) and 1.60 (1.06-2.41), respectively]. However, there were no associations for erythrocyte counts. CONCLUSIONS: The localized stage II/III periodontitis risk increased with greater erythrocyte indices in robust young adults. This finding could be explained in part by that localized periodontitis may promote physical stress, possibly resulting in an increase of erythrocyte indices. On the other side, greater physical fitness associated with a lower risk of periodontitis may consume iron storage in the body, leading to exercise-induced anemia or smaller erythrocyte volume.

FOXP3+ and CD25+ cells are reduced in patients with stage IV, grade C periodontitis: A comparative clinical study.

BACKGROUND AND OBJECTIVE: Some studies suggest that regulatory T cells (Tregs) have suppressive effects on inflammatory osteolysis. The aim of this study was to evaluate Treg immunomarkers in periodontitis-affected tissues from patients with periodontitis and clinically healthy gingiva (control). MATERIAL AND METHODS: The presence and distribution of positive cells for CD4, CD25 and FOXP3 (Treg immunomarkers) in periodontitis-affected tissues (epithelium and lamina propria) of 30 patients (ten per group) with a diagnosis of stage IV, grade C periodontitis (IV-C), stage III, grade B periodontitis (III-B) and the control were evaluated. A two-way ANOVA followed by Fisher's LSD test was used to demonstrate differences between the groups and immunomarkers; Student's t test was used to demonstrate differences between the epithelium and the lamina propria. RESULTS: Both IV-C and III-B periodontitis presented a significantly high proportion of immune-stained cells for all immunomarkers when compared to the control group. Notably, CD25+ and FOXP3+ cells were detected in a significantly higher number in III-B than IV-C periodontitis (P < .05). CONCLUSION: Our results suggest the participation of Tregs on the osteoimmunological mechanisms in IV-C and III-B periodontitis patients, notably contributing to strategies for alveolar bone regeneration in clinical treatment decisions.

Prevalence of periodontitis: misclassification, under-recognition or over-diagnosis using partial and full-mouth periodontal examination protocols.

OBJECTIVE: The aim of this cross-sectional study was to assess the bias in estimating the prevalence of periodontitis due to partial-mouth periodontal examination protocols (PMPE) and to relate the severity and extent of periodontal damage to periodontitis misclassification when applying case definitions by Centres of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIALS AND METHODS: A full-mouth periodontal examination (FMPE) was performed in 721 adults living in North Italy to identify moderate and severe periodontitis. These results were compared with those obtained with two PMPE protocols analyzing two interproximal sites on all teeth (fMB-DL) or four interproximal sites in two random diagonal quadrants (pMDB-MDL). RESULTS: Both PMPE systems estimated the prevalence of moderate periodontitis with limited bias (-2.79% for pMDB-MDL and -3.49% for fMB-DL), whereas produced larger relative biases for severe periodontitis (-28.74% versus - 14.55%). The percentage of under-recognition of existing periodontal disease was 8.9% under fMB-DL and 15.5% under pMDB-MDL. The diagnosis of moderate and severe periodontal disease was correctly assigned to individuals with on average 8% and 30% of pathological sites, respectively. CONCLUSION: These findings suggest that PMPE systems provide high level of bias when using CDC/AAP case definitions.

Association between height and periodontitis in Korean adults: Results from KNHANES IV and V.

BACKGROUND AND OBJECTIVE: Evidence shows that a short stature in adulthood is associated with chronic diseases. However, few studies have investigated the association between height and periodontitis. The purpose of this study was to examine the relationship between adult height and periodontitis and to assess the roles of covariates in different birth cohorts of Korea. MATERIAL AND METHODS: This was a cross-sectional study using the data from the 4th and 5th Korea National Health and Nutritional Examination Survey. The subjects were grouped into 2 birth cohorts based on their historical and social context: born from 1946 to 1962 and from 1963 to 1978. The dependent variables were periodontitis and severe periodontitis, while the independent variable was the height quartile. Demographic factors (age and gender), socioeconomic position (own education, region and income), health behaviors (frequency of daily tooth brushing and smoking) and medical status (diabetes) were included. Logistic regression analyses estimated the association of adult height with periodontitis after sequential adjustments. RESULTS: The sample size of the final analysis was 18 010. The shortest quartile was associated with severe periodontitis (OR = 1.55, 95% CI 1.11-2.16) in the 1963-1978 birth cohort. The association remained after full adjustment in the 1963-1978 birth cohort (OR = 1.41, 95% CI 1.01-1.97). CONCLUSION: Our study shows that there is an inverse association between height and severe periodontitis only in the younger Korean birth cohort. Our results support the impact of height, as an early childhood environmental indicator, on severe periodontitis in adulthood.

Periodontal inflamed surface area and periodontal case definition classification.

OBJECTIVE: To assess whether a higher periodontal inflamed surface area (PISA) may reflect more severe periodontitis, and if so, to calculate which cut-off point should be used to classify a patient as suffering from periodontitis. MATERIAL AND METHODS: Eighty subjects were selected based on their periodontal status and were divided into 4 groups of 20 each; periodontally healthy, mild periodontitis, moderate periodontitis and severe periodontitis. In addition, demographic data, smoking status and socioeconomic status were also recorded. RESULTS: The highest mean PISA value was obtained for the severe periodontitis group (2309.42 ± 587.69 mm2) and the least for the periodontally healthy (34.30 ± 16.48 mm2). The PISA values corresponding to the three categories of periodontitis severity were significantly higher than the periodontally healthy group. When receiver operating characteristic (ROC) analysis was performed, a PISA value ≥130.33 mm2 predicted the presence of periodontitis with a sensitivity of 98% and a specificity of 100%. CONCLUSIONS: PISA is a periodontal parameter that may be used in conjunction with the Centers for Disease Control and Prevention - American Academy of Periodontology case definition classification in periodontal medicine research.

At least three phenotypes exist among periodontitis patients.

AIM: To identify phenotypes of periodontitis patients by the use of an unsupervised modelling technique (clustering), based on pre-treatment radiographic and microbiological characteristics. MATERIALS AND METHODS: This retrospective study included data from 392 untreated periodontitis patients. Co-regularized spectral clustering algorithm was used to cluster the patients. The resulting clusters were subsequently characterized based on their demographics, radiographic bone loss patterns and microbial data. RESULTS: The vast majority of patients fitted into one of the three main clusters (accuracy 90%). Cluster A (n = 18) was characterized by high prevalence and high proportions of Aggregatibacter actinomycetemcomitans, a trend for a more localized pattern of alveolar bone loss and young individuals. Clusters B (n = 200) and C (n = 135) differed clearly in disease severity patterns and smoking habits, but not in microbiological characteristics. CONCLUSION: On the basis of alveolar bone loss patterns and microbiological data, untreated periodontitis patients can be clustered into at least three phenotypes. These results should be validated in other cohorts, and the clinical utility needs to be explored on the basis of periodontal treatment outcomes and/or disease progression.

Distinguishing the Signals of Gingivitis and Periodontitis in Supragingival Plaque: a Cross-Sectional Cohort Study in Malawi.

UNLABELLED: Periodontal disease ranges from gingival inflammation (gingivitis) to the inflammation and loss of tooth-supporting tissues (periodontitis). Previous research has focused mainly on subgingival plaque, but supragingival plaque composition is also known to be associated with disease. Quantitative modeling of bacterial abundances across the natural range of periodontal severities can distinguish which features of disease are associated with particular changes in composition. We assessed a cross-sectional cohort of 962 Malawian women for periodontal disease and used 16S rRNA gene amplicon sequencing (V5 to V7 region) to characterize the bacterial compositions of supragingival plaque samples. Associations between bacterial relative abundances and gingivitis/periodontitis were investigated by using negative binomial models, adjusting for epidemiological factors. We also examined bacterial cooccurrence networks to assess community structure. The main differences in supragingival plaque compositions were associated more with gingivitis than periodontitis, including higher bacterial diversity and a greater abundance of particular species. However, even after controlling for gingivitis, the presence of subgingival periodontitis was associated with an altered supragingival plaque. A small number of species were associated with periodontitis but not gingivitis, including members of Prevotella, Treponema, and Selenomonas, supporting a more complex disease model than a linear progression following gingivitis. Cooccurrence networks of periodontitis-associated taxa clustered according to periodontitis across all gingivitis severities. Species including Filifactor alocis and Fusobacterium nucleatum were central to this network, which supports their role in the coaggregation of periodontal biofilms during disease progression. Our findings confirm that periodontitis cannot be considered simply an advanced stage of gingivitis even when only considering supragingival plaque. IMPORTANCE: Periodontal disease is a major public health problem associated with oral bacteria. While earlier studies focused on a small number of periodontal pathogens, it is now accepted that the whole bacterial community may be important. However, previous high-throughput marker gene sequencing studies of supragingival plaque have largely focused on high-income populations with good oral hygiene without including a range of periodontal disease severities. Our study includes a large number of low-income participants with poor oral hygiene and a wide range of severities, and we were therefore able to quantitatively model bacterial abundances as functions of both gingivitis and periodontitis. A signal associated with periodontitis remains after controlling for gingivitis severity, which supports the concept that, even when only considering supragingival plaque, periodontitis is not simply an advanced stage of gingivitis. This suggests the future possibility of diagnosing periodontitis based on bacterial occurrences in supragingival plaque.

The effects of periodontal therapy on gingival crevicular fluid matrix metalloproteinase-8, interleukin-6 and prostaglandin E2 levels in patients with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6) and prostaglandin E2 (PGE2 ) in patients with rheumatoid arthritis (RA) with periodontal disease. MATERIAL AND METHODS: Twenty-seven patients with gingivitis and periodontitis with RA, 26 patients with gingivitis and periodontitis that were systemically healthy and 13 periodontally and systemically healthy volunteers (control group) were included in this study. RA activity was assessed by disease activity score test. The clinical periodontal parameters, fasting venous blood and gingival crevicular fluid samples were obtained and gingival crevicular fluid MMP-8, IL-6 and PGE2 levels were evaluated at baseline and at 3 mo follow-up after non-surgical periodontal treatment. RESULTS: Gingival crevicular fluid MMP-8, PGE2 and IL-6 levels were higher in all groups than the control group. Following periodontal therapy, there were significant decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels from patients with RA with periodontitis (p < 0.05). Plaque index, gingival index and bleeding on probing were significantly correlated with IL-6 and PGE2 at baseline and at 3 mo follow-up after non-surgical periodontal treatment. CONCLUSION: Non-surgical periodontal therapy of patients with RA with periodontitis may provide beneficial effects on local inflammatory control via decreases in gingival crevicular fluid MMP-8, PGE2 and IL-6 levels.

Sense of coherence and periodontal health outcomes.

OBJECTIVE: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. MATERIALS AND METHODS: The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. RESULTS: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). CONCLUSIONS: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Comparison of different criteria for periodontitis case definition in head and neck cancer individuals.

PURPOSE: Different periodontitis case definitions have been used in clinical research and epidemiology. The aim of this study was to determine more accurate criterion for the definition of mild and moderate periodontitis case to be applied to head and neck cancer individuals before radiotherapy. METHODS: The frequency of periodontitis in a sample of 84 individuals was determined according to different diagnostic criteria: (1) Lopez et al. (2002);(2) Hujoel et al. (2006); (3) Beck et al. (1990); (4) Machtei et al. (1992); (5) Tonetti and Claffey (2005); (6) and Page and Eke (2007). All diagnosis were based on the clinical parameters obtained by a single calibrated examiner (Kw = 0.71). The individuals were evaluated before radiotherapy. They received oral hygiene instructions, and the cases diagnosed with periodontitis (Page and Eke 2007) were treated. The gold standard was the definition 6, and the others were compared by means of agreement, sensitivity (SS), specificity (SP), and the area under ROC curve. The kappa test evaluated the agreement between definitions. RESULTS: The frequency of periodontitis at baseline was 53.6 % (definition 1), 81.0 % (definition 2), 40.5 % (definition 3), 26.2 % (definition 4), 13.1 % (definition 5), and 70.2 % (definition 6). The kappa test showed a moderate agreement between definitions 6 and 2 (59.0 %) and definitions 6 and 1 (56.0 %). The criterion with higher SS (0.92) and SP (0.73) was definition 1. CONCLUSION: Definition 1 was the most accurate criterion to case periodontitis definition to be applied to head and neck cancer individuals.

Periodontitis and retinal microcirculation in the Atherosclerosis Risk in Communities study.

AIM: The aim of this cross-sectional study is to explore if periodontitis is associated with alterations of the retinal microcirculation, a predictive marker of cardiovascular events. MATERIAL AND METHODS: Of 457 subjects aged 52 years and more from the ARIC cohort were included. Retinal vascular diameters were measured and summarized as central retinal arteriolar/venular equivalents (CRAE/CRVE). Periodontitis was determined by using the CDC/AAP definition. Multivariable linear regression models were used to estimate the relationships between CRAE, CRVE and periodontitis. RESULTS: No association was found between CRAE and periodontal status. However, CRVE and severe periodontitis were positively and significantly associated. Mean CRVE (±SD) was 187.0 ± 17.2 µm in the health-gingivitis group, and, respectively, 188.5 ± 16.3 µm (p = 0.39) and 191.6 ± 16.8 µm (p = 0.04) in moderate and severe periodontitis groups, after adjustment for a propensity score based on confounders. Results were consistent when analyses were restricted to participants with diabetes mellitus (n = 66), but not diabetes-free subjects. CONCLUSIONS: Severe periodontitis is associated with larger retinal venular diameter in patients with type 2 diabetes. Further studies are needed to explore the impact of diabetes mellitus on the association between periodontitis and retinal microcirculation.

Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates.

OBJECTIVE: To assess whether partial-mouth protocols (PRPs) result in biased estimates of the associations between smoking, alcohol, obesity and diabetes with periodontitis. METHODS: Using a sample (n = 6129) of the 1996-1998 Atherosclerosis Risk in Communities study, we used measures of probing pocket depth and clinical attachment level to identify moderate-severe periodontitis. Adjusting for confounders, unconditional binary logistic regression estimated prevalence odds ratios (POR) and 95% confidence limits. Specifically, we compared POR for smoking, alcohol, obesity and diabetes with periodontitis derived from full-mouth to those derived from 4-PRPs (Ramfjörd, National Health and Nutrition Examination survey-III, modified-NHANES-IV and 42-site-Random-site selection-method). Finally, we conducted a simple sensitivity analysis of periodontitis misclassification by changing the case definition threshold for each PRP. RESULTS: In comparison to full-mouth PORs, PRP PORs were biased in terms of magnitude and direction. Holding the full-mouth case definition at moderate-severe periodontitis and setting it at mild-moderate-severe for the PRPs did not consistently produce POR estimates that were either biased towards or away from the null in comparison to full-mouth estimates. CONCLUSIONS: Partial-mouth protocols result in misclassification of periodontitis and may bias epidemiologic measures of association. The magnitude and direction of this bias depends on choice of PRP and case definition threshold used.

Monitoring for periodontal inflammatory disease in the third molar region.

PURPOSE: To assess changes at 2-year intervals in the periodontal status of the third molar region in participants enrolled with asymptomatic third molars and no clinical evidence of third molar region periodontal pathology. PARTICIPANTS AND METHODS: The included participants who presented with a healthy periodontal status (all probing depths [PDs], <4 mm) in the third molar region, defined as distal of second molars and around adjacent third molars, were from a larger longitudinal study of participants with asymptomatic third molars. Full-mouth periodontal PD data from 6 sites per tooth were obtained clinically at enrollment and at subsequent 2-year intervals. Data were aggregated to the patient level. Outcome variables were the presence or absence of periodontal pathology, defined as at least 1 PD of at least 4 mm in the third molar region. RESULTS: One hundred twenty-nine participants had a third molar region PD shallower than 4 mm at enrollment. Most participants were Caucasian (85%), women (60%), younger than 25 years (62%), educated beyond high school (84%), and with good oral health habits. At 6 years, excluding the 61 participants lost to follow-up, 47% participants had had third molars removed, 21% had developed at least 1 PD of at least 4 mm in the third molar region since enrollment, and 32% retained the periodontal status at enrollment (all PDs in third molar region, <4 mm). Demographic characteristics were not statistically different for participants followed for 6 years compared with those lost to follow-up. CONCLUSIONS: Although not all participants could be followed for 6 years after enrollment or chose to retain third molars, one third of participants maintained the third molar region periodontal status assessed at baseline for 6 years after enrollment; no clinical evidence of pathology developed over time.

Periodontal disease and cancer patients undergoing chemotherapy.

OBJECTIVE: The aim of this study was to evaluate periodontal status after periodontal treatment in patients with different malignant solid tumours submitted to chemotherapy. METHODS: Fifty-four patients with newly diagnosed early-stage solid tumour malignancy treated by surgery and eligible for adjuvant chemotherapy were enrolled in this study. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated before chemotherapy (T0), 21 days after chemotherapy (T1) and 210 days after chemotherapy (T2). Patients were grouped into healthy or periodontally diseased subjects. All patients received oral hygiene instructions, and the diseased patients received periodontal treatment at baseline. Comparisons between the groups were performed using the McNemar test (P>0.05) and the Wilcoxon test with Bonferroni correction (P<0.02) using spss software. RESULTS: Of 54 patients enrolled in the study, two did not present to the third assessment (T2). The prevalence of periodontitis was 35.2% at baseline and no significant difference was found in the follow-up assessments. There was a statistically significant reduction in probing depth (PD), plaque index (PI) and bleeding on probing (BOP) between baseline and follow-up assessments. The attachment level (AL) did not vary significantly between the different follow-up periods (P≥0.06). CONCLUSIONS: Periodontal treatment was effective in reducing PI, BOP and PD and in maintaining AL in periodontitis cancer patients undergoing chemotherapy.

Oral health and apraxia among institutionalized elderly people--a pilot study.

OBJECTIVE: Poor oral hygiene and dental health are very common among the institutionalized elderly. The purpose of this study was to evaluate the association of apraxia with oral hygiene and/or health. MATERIALS AND METHODS: Ninety-two residents of 13 long-term care homes in southwest Germany participated in the study. For each participant, ideomotor apraxia scoring (AS) was conducted and demographic variables were collected. Participants underwent a comprehensive dental examination to assess the oral health indices gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). Statistical comparison of dental indices among apraxic and non-apraxic individuals (cut-off < 45) was performed by use of t-tests. In addition, linear regression models were constructed with the dental indices as dependent variables. Each model was fitted with the dichotomized variable AS (pathologic or healthy) and adjusted for age and sex. RESULTS: Mean (SD) GBI of 48.5 (25.9), CPITN of 2.9 (0.7) and DHI of 82.6 (14.6) were observed among the participants. Statistical analysis revealed AS was significantly associated with all oral health indicators (p < 0.05). Linear regression models showed apraxia is a predictor of GBI (p = 0.002) and CPITN (p = 0.027), but not of denture hygiene (p = 0.916). CONCLUSIONS: Although this pilot investigation has limitations, the results suggest the presence of apraxia should be considered when planning oral healthcare strategies. Further research with larger samples is encouraged to confirm these relationships.

Self-reported Oral Hygiene Habits in Smokers and Nonsmokers Diagnosed with Periodontal Disease.

PURPOSE: To determine whether smokers report having less adequate oral hygiene habits than nonsmokers. MATERIALS AND METHODS: Using a 24-item questionnaire addressing both smoking and oral hygiene habits, patients from three periodontal practices in Spain were evaluated. In order to assess the periodontal status of all patients, immediately following the survey, the patients were examined clinically and categorised according to the American Dental Association (ADA) classification for periodontal diseases. RESULTS: 762 patients with ADA type I gingivitis (4.1%), type II early periodontitis (31.2%), type III moderate periodontitis (39.2%) and type IV advanced periodontitis (25.5%) were surveyed. A total of 289 smokers (38.0%) and 402 (52.8%) nonsmokers participated in the study: 77 (10.1%) participants were identified as heavy smokers (>20 cigarettes/day), along with 122 (16.0%) moderate smokers (10-20 cigarettes/day) and 90 (11.8%) light smokers (<20 cigarettes/day). A greater proportion of nonsmokers brushed their teeth two (37.8%) or more (22.9%) times a day compared with moderate smokers (twice: 32.0%, more: 15.6%) and heavy smokers (twice: 32.5%, more: 15.6%), respectively (p < 0.05). Heavy smokers used dental floss statistically significantly less frequently (10.4%) than nonsmokers (21.6%) (p < 0.05). No statistically significant differences were found between smokers and nonsmokers regarding the use of mouthwashes (p > 0.05). CONCLUSIONS: This study revealed comparable oral hygiene habits in nonsmokers and light smokers. However, heavy smokers were found to have worse oral hygiene habits than nonsmokers.

Comparative analysis of blood and saliva expression profiles in chronic and refractory periodontitis patients.

BACKGROUND: This study aimed to identify characteristic representative genes through a comparative analysis of gene expression profiles in the blood and saliva of chronic periodontitis (CP) and refractory periodontitis (RP) patients to provide new treatment strategies that may be helpful in the treatment of different forms of periodontitis. METHODS: GSE43525 was downloaded from Gene Expression Omnibus. In the dataset, thirteen samples were from blood including 4 controls, 4 CP and 5 RP samples, and ten samples were from saliva including 3 controls, 4 CP and 3 RP samples. After comparing the CP and RP samples, differentially expressed genes (DEGs) between these two types of periodontitis in the blood and saliva samples were identified by an LIMMA package. Then, functional and pathway enrichment analyses were performed by DAVID and KOBAS, respectively. The significantly associated miRNAs in CP and RP were searched by WebGestalt. RESULTS: In total, 213 DEGs in CP and 45 DEGs in RP were identified. Functional enrichment showed that the DEGs of CP were mainly enriched in ribosome and regulation of apoptosis-related pathways in blood as well as saliva, while the DEGs of RP were significantly enriched in immune responses and response to organic substance-related pathways. Several miRNAs, such as miR-381 and miR-494, were identified as being closely associated with CP. In addition, CD24, EST1, MTSS1, ING3, CCND2 and SYNE2 might be potential targets for diagnosis and treatment of CP. CONCLUSION: The identified DEGs and miRNAs might be potential targets for the treatment of chronic and refractory periodontitis.