Functional dentition and well-being among Chilean 80-year-olds.

BACKGROUND: The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016. OBJECTIVE: To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years. METHODS: Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]). RESULTS: The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (ß = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (ß = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (ß =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (ß = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively. CONCLUSION: Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.

Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study.

BACKGROUND: The co-occurrence of caries and periodontitis and a possible association is still a matter of debate. Thus, the aim of the study was to determine the co-occurrence of caries and periodontitis in Chilean adults. METHODS: Evaluation of periodontal and dental status in 994 adults (35-44 years old) based on the First Chilean National Examination Survey 2007-2008. The prevalence of caries was defined as the percentage of participants with one or more teeth with untreated caries by using the D component of the DMFT index (DT ≠ 0). The prevalence of periodontitis was determined using standard case definitions for population-based surveillance of periodontitis described by the CDC-AAP. RESULTS: Individuals with caries had an approximately 40% higher prevalence of severe (29.3% vs 20.8%, p < 0.05) and a 13% higher prevalence of total periodontitis (89.3% vs 78.4%, p < 0.05) than those without caries. Ordinal logistic regression revealed a positive association between periodontitis and the number of teeth with caries (DT ≠ 0; 3 or 4 teeth with caries: OR 1.74; CI = 1.12-2.29 p < 0.05; 5 or more teeth with caries: OR 2.47; CI = 1.66-3.67 p < 0.01). CONCLUSION: Dental caries is associated with the severity and prevalence of periodontitis in Chilean adults. Individuals with 3 or more teeth with untreated caries are more likely to suffer from periodontal disease.

Distribution of biopsied non plaque-induced gingival lesions in a Chilean population according to the classification of periodontal diseases.

BACKGROUND: Many gingival lesions are not induced by plaque. The aim of this study was to analyze the frequency of biopsied non-plaque-induced gingival lesions (NPIGL) in a Chilean population. METHODS: One thousand twelve cases of biopsied gingival lesions with confirmed anatomopathologic diagnosis were included, from the records of the Oral Pathology Referral Institute (OPRI), Faculty of Dentistry, University of Chile, between years 1990 and 2009. RESULTS: The most frequent non plaque-induced gingival lesions categories from biopsied cases included hyperplastic lesions, malignancies and benign neoplasms. The most frequent diagnoses in each category were fibrous hyperplasia (35.47%), squamous cell carcinoma (3.85%) and giant cell fibroma (2.08%), respectively. From all lesions, only 8.3% fitted in the specified categories of the current classification of periodontal diseases. CONCLUSIONS: The most frequent biopsied NPIGL were hyperplastic lesions and neoplasms. These categories represent relevant lesions to be included in a future periodontal classification system to improve the care needs of the patients, as well as early diagnosis and treatment.

Diagnostic accuracy for apical and chronic periodontitis biomarkers in gingival crevicular fluid: an exploratory study.

AIM: The aim of this study was to assess the levels and diagnostic accuracy of a set of potential biomarkers of periodontal tissue metabolism in gingival crevicular fluid (GCF) from patients with chronic periodontitis (CP) and asymptomatic apical periodontitis ( AAP). MATERIALS AND METHODS: Thirty one GCF samples from 11 CP patients, 44 GCF samples from 38 AAP patients and 31 GCF samples from 13 healthy volunteers were obtained (N = 106). Matrix metalloproteinases (MMPs) -2 and -9 were determined by zymography; levels of MMP-8 by ELISA and IFMA and MPO by ELISA. IL-1, IL-6, TNFα, DKK-1, Osteonectin, Periostin, TRAP-5 and OPG were determined by a multiplex quantitative panel. Statistical analysis was performed using linear mixed-effects models. RESULTS: The MMP-9 and MMP-8 were higher in CP, followed by AAP, versus healthy individuals (p < 0.05). ProMMP-2, MPO, IL-1, IL-6, PTN, TRAP-5 and OPG were significantly higher in CP when compared with AAP and healthy patients (p < 0.05). The highest diagnostic accuracies were observed for ProMMP-2, ProMMP-9, MMP-8 and TRAP-5 (AUC > 0.97) in CP, and for the active form of MMP-9 and MMP-8 (AUC > 0.90) in AAP. CONCLUSION: Gingival crevicular fluid composition is modified by CP and AAP. MMP-9 and MMP-8 show diagnostic potential for CP and AAP, whereas MMP-2 and TRAP-5 are useful only for CP.

Impression technique modification and oral contracture release surgery for orthodontic treatment in a patient with severe microstomia due to recessive dystrophic epidermolysis bullosa.

INTRODUCTION: Epidermolysis bullosa (EB) is a group of genetic disorders characterized by fragility of the skin and mucosal membranes. Dystrophic EB (DEB) is caused by mutations in the gene coding for type VII collagen. Among the most frequent oral manifestations in Recessive DEB (RDEB) are oral ulcers and blisters, absence of tongue papillae and palatal rugae, ankyloglossia, oral vestibule obliteration, and microstomia. The following report describes a modified impression technique used in a patient with severe RDEB and severe microstomia to obtain models for orthodontic treatment with aligners. CASE REPORT: A 25-year-old female patient with severe RDEB was referred for orthodontic treatment. Severe microstomia (8 mm), hindered the use of conventional trays or intraoral scanners to design the aligners. Therefore, a contracture release surgery in combination with a modified impression technique was performed to obtain an optimal impression and subsequent aligners for orthodontic treatment. DISCUSSION: This case presents an alternative strategy to provide orthodontic treatment with aligners in patients with severe microstomia due to severe RDEB. Reports of orthodontic treatment in people living with EB, especially in RDEB, are still rare, with few publications about fixed braces, early teeth extraction and removable devices, and none using aligners. Most of the impression techniques reported are aimed at oral rehabilitation. The multidisciplinary approach and impression technique reported should broaden the alternatives of orthodontic techniques provided to patients with EB and severe microstomia. CONCLUSIONS: This article describes an oral contracture release surgery and modified impression technique for obtaining good quality impression for the design of orthodontic aligners in patients with severe microstomia due to severe RDEB.

Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study.

BACKGROUND: Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. METHODOLOGY: Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. RESULTS: In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. CONCLUSIONS: We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related "common risk factors".

Short implants compared to regular dental implants after bone augmentation in the atrophic posterior mandible: umbrella review and meta-analysis of success outcomes.

PURPOSE: To assess the body of evidence of short versus regular implants after bone augmentation (BA) in the atrophic posterior mandible in the context of implant treatment success outcomes. METHODS: Seven databases, two registries, and reference lists were searched for systematic reviews and meta-analysis (SR/MA), randomized controlled trials (RCTs) and longitudinal studies published in English, Spanish or German since 2012. Confidence in the SR/MA methodology was evaluated using AMSTAR-2 and the risk of bias of primary studies using Cochrane's RoB 2.0 and ROBINS-I. A random-effects meta-analysis and a meta-regression were performed for continuous and dichotomous outcomes. GRADE approach was used to assess the certainty of the evidence. RESULTS: Eighteen SRs/MAs, most of them "critically low" and "low" confidence with substantial overlap, included 14 relevant RCTs with a high risk of bias. A cohort study with moderate risk of bias was added. Quantitative synthesis of 595 implants and 281 hemiarches/patients indicates that the use of short implants (< 10 mm) compared to regular implants and BA may reduce implant failure at 1-year follow-up, and marginal bone loss (MBL) at 3-, 5-, and 8-year follow-up; is likely to reduce the risk of biological complications at 1-, 3-, 5-, and 8-year follow-up; and may be the patient's preferred alternative. There is a correlation between bone height, MBL and biological complications. CONCLUSIONS: The available evidence partially suggests that the use of short implants could decrease implant failure, MBL, and biological complications, and increase patient satisfaction. However, given the need for further RCTs and real-world evidence to fully evaluate short- and long-term outcomes, it would be prudent for clinicians to carefully consider the individual needs and circumstances of the patients before deciding whether to use short implants. Trial registration PROSPERO CRD42022333526.

Detección de Nuevas Tecnologías Sanitarias Para Mejorar el Control Metabólico de Pacientes Con Diabetes Tipo 2 Atendidos en el Programa de Salud Cardiovascular de Chile.

OBJECTIVES: In Chile, > 900,000 people with type 2 diabetes mellitus (DM2) are controlled in the Cardiovascular Health Program (PSCV). Even though the PSCV includes a set of interventions for the control of patients with DM2, the results are still insufficient, generating a high human, economic, and social cost. This study aimed to identify and select new health technologies for the control of patients with DM2 not currently incorporated into the PSCV to be proposed as candidates for an economic evaluation in the Chilean context. METHODS: For the identification of new health technologies, consultations with key informants and an umbrella review of updated scientific evidence were used as sources of information. In a second step, selection among those technologies was conducted based on the effectiveness of the intervention, target population, nature of the intervention, and international evidence of cost-effectiveness antecedents. RESULTS: Key informants identified 12 candidate health technologies not currently incorporated into the PSCV. From the umbrella review, an additional 9 health technologies were identified that were not identified by the key informants. Of the 21 new health technologies identified, finally 8 health technologies were selected (structured group education, pedometer use, periodontal treatment, cognitive-behavioral therapy, telemonitoring, sitagliptin, canagliflozin, and insulin degludec). CONCLUSIONS: The health technologies detected have a high potential to be studied through economic evaluations that allow guiding decision making around improving the health outcomes of patients with DM2 in Chile.

Performance of the 2017 AAP/EFP case definition compared with the CDC/AAP definition in population-based studies.

BACKGROUND: Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies. METHODS: Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from five countries; Argentina, Chile, Colombia, Ecuador, and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard. RESULTS: According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as Stage I (39.2%) or Stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis whereas the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.91 (95% CI = 0.89-0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as Stage IV (81.3%) whereas Stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity for moderate (99.7%) and severe periodontitis (100%), but low specificity for both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.57 (95% CI = 0.53-0.62). CONCLUSIONS: This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well when compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis.

Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology.

The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

Active MMP-8 Quantitative Test as an Adjunctive Tool for Early Diagnosis of Periodontitis.

Periodontitis is a host-mediated bacterial disease that affects the tooth attachment apparatus. Metalloproteinase-8 (MMP-8), a validated biomarker, could aid in clinical diagnosis. This study aimed to evaluate the diagnostic performance of active (a) MMP-8 immunotest versus total (t) MMP-8 ELISA for quantitative real-time diagnosis and assessment of periodontitis severity at the site level. Gingival crevicular fluid (GCF) was sampled from 30 healthy, 42 mild, and 59 severe periodontitis sites from thirty-one volunteers. MMP-8 concentrations were determined by time-resolved immunofluorometric assay (IFMA) and enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using the STATA package. Both active and total MMP-8-based methods discriminated among sites according to periodontal diagnosis and severity, with a positive correlation between the two tests (p < 0.001). (a) MMP-8 models showed the best performance in receiver operating characteristic (ROC) curves to discriminate between healthy and periodontitis sites (area under the curve [AUC] = 0.89), while (t) MMP-8 demonstrated a high diagnostic precision in the detection of mild from severe periodontitis sites (AUC ≥ 0.80). The use of (a) MMP-8 and (t) MMP-8 could represent a useful adjunctive tool for periodontitis diagnosis and severity. These results support the applicability of new point-of-care methods in the monitoring of high-risk periodontal patients.

Periodontal Treatment Protocol for Decompensated Diabetes Patients.

Background: Decompensated diabetes is associated with a higher prevalence and severity of periodontitis and poorer response to periodontal therapy. It is conceivable that periodontal therapy may cause systemic and local complications in this type of patients. The aim of the present study was to identify and describe the best available evidence for the treatment of periodontitis in decompensated diabetics. Material and methods: An expert committee including participants from different areas gathered to discuss and develop a treatment guideline under the guidance of the Cochrane Associate Center, Faculty of Dentistry, University of Chile. In total, four research questions were prepared. The questions prepared related to decompensated diabetic patients (glycated hemoglobin >8) were, (1) Does the exposure to periodontal treatment increase the risk of infectious or systemic complications? (2) Does the antibiotic treatment or prophylaxis, compared to not giving it, reduce infectious complications? (3) Does the exposure to periodontal treatment, compared to no treatment, reduce the glycated hemoglobin levels (HbA1c)? Last question was related to diabetic patients, (4) Does the exposure to a higher level of HbA1c, compared to stable levels, increase the risk of infectious complications? Based on these questions, a search strategy was developed using MEDLINE and EPISTEMONIKOS. Only systematic reviews were considered. Results: For question 1, the search yielded 12 records in EPISTEMONIKOS and 23 in MEDLINE. None of these studies addressed the question. For question 2, the search yielded 58 records in EPISTEMONIKOS and 11 in MEDLINE. None of these studies addressed the question. For question 3, the search yielded 16 records in EPISTEMONIKOS and 11 in MEDLINE. Thirteen addressed the question. For question 4, the search yielded 7 records in EPISTEMONIKOS and 9 in MEDLINE. One addressed the question. Conclusions: In decompensated diabetic patients, there is lack of scientific information about risk of infectious or systemic complications as a result of periodontal treatment and about the impact of antibiotic treatment or prophylaxis on reduction if infectious complications. A defined HbA1c threshold for dental and periodontal treatment in diabetic patients has yet to be determined. Finally, periodontal treatment does have an impact on HbA1c levels.

Impact of COVID-19 Pandemic on Quality of Life of Type II Diabetes Patients With Periodontitis.

Background: Confinement due to the COVID-19 pandemic has made dental treatments impossible in Chile and many other countries, including diabetic patients with periodontitis. The aim of the present study was to evaluate the impact of periodontal therapy in terms of oral health-related quality of life (OHRQoL) during the COVID-19 pandemic in a cohort of diabetic patients with periodontitis. Material and Methods: Thirty-eight diabetic patients with stage III-IV periodontitis, enrolled for periodontal therapy, were screened. Periodontal clinical parameters including clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP) as well as glycated hemoglobin (HbA1c) were evaluated at baseline and 3 months follow-up prior the pandemic. The OHRQoL changes by means of Oral Health Impact Profile (OHIP-14) and a self-reported oral health questionnaire were assessed at baseline (prior pandemic) and during the pandemic via telemonitoring. Results: Thirty-one patients received non-surgical periodontal therapy prior to the pandemic. Out of the 31 patients, four died due to COVID-19 resulting in 27 patients available for telemonitoring at the time of the pandemic. Periodontal therapy significantly improved CAL, PPD and BOP (p < 0.05) but not HbA1c (p > 0.05) between baseline and 3 months follow-up pior to the pandemic. Total OHIP-14 scores significantly improved between baseline and the middle of pandemic (intragroup comparison p = 0.00411). In particular, OHIP-14 scores related to the "Physical pain" (intragroup comparison p = 0.04) and "Psychological disability" (intragroup comparison p = 0.00) significantly improved between baseline and the middle of pandemic. Conclusions: In diabetic type II patients with periodontitis periodontal therapy tends to improve the oral health-related quality of life despite the COVID-19 pandemic.

MMP-8, TRAP-5, and OPG Levels in GCF Diagnostic Potential to Discriminate between Healthy Patients', Mild and Severe Periodontitis Sites.

Biomarkers represent promising aids in periodontitis, host-mediate diseases of the tooth-supporting tissues. We assessed the diagnostic potential of matrix metalloproteinase-8 (MMP-8), tartrate-resistant acid phosphatase-5 (TRAP-5), and osteoprotegerin (OPG) to discriminate between healthy patients', mild and severe periodontitis sites. Thirty-one otherwise healthy volunteers with and without periodontal disease were enrolled at the Faculty of Dentistry, University of Chile. Periodontal parameters were examined and gingival crevicular fluid was sampled from mild periodontitis sites (M; n = 42), severe periodontitis sites (S; n = 59), and healthy volunteer sites (H; n = 30). TRAP-5 and OPG were determined by commercial multiplex assay and MMP-8 by the immunofluorometric (IFMA) method. STATA software was used. All biomarkers showed a good discrimination performance. MMP-8 had the overall best performance in regression models and Receiver Operating Characteristic (ROC) curves, with high discrimination of healthy from periodontitis sites (area under the curve (AUC) = 0.901). OPG showed a very high diagnostic precision (AUC ≥ 0.95) to identify severe periodontitis sites (S versus H + M), while TRAP-5 identified both healthy and severe sites. As conclusions, MMP-8, TRAP-5, and OPG present a high precision potential in the identification of periodontal disease destruction, with MMP-8 as the most accurate diagnostic biomarker.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis.

OBJECTIVE: The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Following the Inca's path to successful oral aging... no sacrifices, just nutrition

Inca civilization is a subject of great fascination due to its rapid development and successful oral aging centuries ago. Their diet was primarily plant-based, with lean animal protein, nuts, and seeds, and lacked fermentable sugars, preventing non-communicable diseases, such as caries and periodontal diseases. Developing national ageing policies and strategies to improve oral functionality and tackle economic barriers to a balanced diet, ensuring better nutrition and quality of life for older people are necessary to achieve Sustainable Development Goals (SDGs), with the World Health Organization estimating its necessity in meeting 12 of the 17 SDGs. Such policies would also honor our native ancestors.

Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study

Abstract Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. Methodology Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. Results In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. Conclusions We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related "common risk factors".

Molecular signatures associated with tumor-specific immune response in melanoma patients treated with dendritic cell-based immunotherapy.

PURPOSE: We previously showed that autologous dendritic cells (DCs) loaded with an allogeneic heat shock (HS)-conditioned melanoma cell-derived lysate, called TRIMEL, induce T-cell-mediated immune responses in stage IV melanoma patients. Importantly, a positive delayed-type hypersensitivity (DTH) reaction against TRIMEL after vaccination, correlated with patients prolonged survival. Furthermore, we observed that DTH reaction was associated with a differential response pattern reflected in the presence of distinct cell subpopulations in peripheral blood. Detected variations in patient responses encouraged molecular studies aimed to identify gene expression profiles induced after vaccination in treated patients, allowing the identification of new molecular predictive markers. METHODS: Gene expression patterns were analyzed by microarrays during vaccination, and some of them confirmed by quantitative real-time reverse transcriptase PCR (qRT-PCR) in the total leukocyte population of a representative group of responder and non-responder patients. New candidates for biomarkers with predictive value were identified using bioinformatics, molecular analysis, and flow cytometry. RESULTS: Seventeen genes overexpressed in responder patients after vaccination respect to non-responders were identified after a mathematical analysis, from which ten were linked to immune responses and five related to cell cycle control and signal transduction. In immunological responder patients, increased protein levels of the chemokine receptor CXCR4 and the Fc-receptor CD32 were observed on cell membranes of CD8+ T and B cells and the monocyte population, respectively, confirming gene expression results. CONCLUSIONS: Our study contributes to finding new molecular markers associated with clinical outcome and better understanding of clinically relevant immunological responses induced by anti-tumor DC-vaccines.

Laterotrusive occlusal schemes and jaw posture tasks effects on supra- and infrahyoid EMG activity in the lateral decubitus position.

The purpose of this study was to determine the effect of canine guidance and group function on supra- and infrahyoid EMG activity in the lateral decubitus position at different jaw posture tasks. The sample included 40 healthy subjects with natural dentition and bilateral molar support, 20 with bilateral canine guidance and 20 with bilateral group function. An inclusion criterion was that subjects had to be free of signs and symptoms of any dysfunction of the masticatory system. Bipolar surface electrodes were located on the left supra- and infrahyoid muscles for EMG recordings. In the lateral decubitus position, EMG activity was recorded in subjects with canine guidance or group function, during the following jaw posture tasks: A. maximal clenching in the edge-to edge lateral contact position; B. grinding from intercuspal position to edge-to-edge lateral contact position, and C. grinding from edge-to-edge lateral contact position to intercuspal position. Supra- and infrahyoid EMG activity was not significantly different with canine guidance or group function (mixed model with unstructured covariance matrix). Overall comparison of suprahyoid or infrahyoid EMG activity among the three jaw posture tasks studied showed a significantly higher activity during jaw posture task A (clenching) than jaw posture tasks B and C (grinding). Suprahyoid EMG activity was significantly higher during jaw posture task C than B, whereas infrahyoid EMG activity did not present a significant difference between jaw posture tasks C and B. These EMG patterns observed could be of clinical importance in the presence of parafunctional habits, i.e., clenching and/or grinding. The neurophysiological mechanisms involved are discussed.

Panorama OCDE sobre el rol de la salud oral en las estrategias nacionales y politicas para el manejo y control de diabetes mellitus tipo 2: Una revisión sistemática / OECD overview on the role of oral health in national strategies and policies for the management and control of type 2 diabetes mellitus: A systematic review

RESUMEN: Objetivo: Describir el rol de la Salud Oral en las estrategias nacionales y políticas sanitarias para el manejo integral y control de Diabetes Mellitus Tipo 2 (DM2) en los 38 Estados miembros de la Organización para la Cooperación y Desarrollo Económico (OCDE). Materiales y Método: Se realizó una revisión sistemática exploratoria, siguiendo la pauta PRISMA-ScR. Se incluyeron reportes gubernamentales, guías de práctica clínica, documentos oficiales OMS y OCDE, y artículos identificados en PubMED y LiLACS hasta diciembre de 2020. Se sintetizó: 1) Inclusión de la Salud Oral en planes nacionales o guías clínicas de DM2, 2) Prestaciones y cobertura odontológica para DM2 y 3) Indicadores de salud asociados al control de DM2. Resultados: 84 documentos fueron incluidos. 1) La Salud Oral está incorporada en los planes nacionales de 22 países OCDE para el control de DM2. 2) De estos, 8 garantizan la atención odontológica con alta cobertura para DM2. 3) Países OCDE con alta cobertura odontológica presentan los mejores indicadores de control metabólico de DM2. Conclusiones: En el marco de la Salud Global, países que no tienen integrada la salud oral podrían beneficiarse si incorporan la atención odontológica con cobertura universal en el manejo integral y control de la DM2.

ABSTRACT: Aim: To describe the role of Oral Health in national strategies and health policies for the comprehensive management and control of Type 2 Diabetes Mellitus (T2DM) in the 38 member states of the Organization for Economic Cooperation and Development (OECD). Method: A scoping review was carried out, according to the PRISMA-ScR guideline. Government reports, clinical practice guidelines, official WHO and OECD documents, and review articles identified in PubMED and LiLACS were included up to December 2020. The following were synthesized: 1) Inclusion of Oral Health in national plans or clinical guidelines for DM2, 2) Dental benefits and coverage for DM2 and 3) Health indicators associated with the control of DM2. Results: 84 documents were included. 1) Oral Health is incorporated in the national plans of 22 OECD countries for the control of DM2. 2) Of these, 8 provide dental care with high coverage for DM2. 3) OECD countries with high dental coverage have the best indicators of metabolic control of DM2. Conclusions: In the framework of Global Health, countries that do not have Oral Health integrated could benefit if they add dental care in the comprehensive management and control of DM2.