Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review.

Background: The aim of this review was to evaluate the effects of periodontal disease (PD) treatment in pregnant women to reduce the risk of preterm birth (PB) and low birth weight (LBW) by conducting an umbrella review. Methods: A comprehensive search for the literature up to April 2024 was conducted across multiple databases including PubMed, Cochrane Library, Scopus, EMBASE, Scielo, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We specifically targeted systematic reviews (SRs) with or without meta-analyses, irrespective of language or time constraints, focusing on primary studies examining the effect of PD treatment in pregnant women to reduce the risk of PB and LBW. Various types of non-systematic reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded from consideration. The quality and overall confidence of the included studies were assessed using the AMSTAR-2 tool. Results: After the initial search, 232 articles were identified, of which only 24 met the selection criteria after exclusion. The majority of these studies indicated that periodontal treatment reduces the risk of PB and LBW. Conclusions: According to the findings and conclusions drawn from the SRs with a high overall confidence level, PD treatment in pregnant women reduces the risk of PB and LBW.

Association between Periodontal Disease and Obesity: Umbrella Review.

Objective: Determine the association between periodontal disease (PD) and obesity through an umbrella review. Materials and Methods: A search for information until March 2024 was carried out in the following electronic databases: PubMed, Cochrane library, Scopus, SciELO, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We included studies that were systematic reviews (SR) with or without meta-analysis, without time or language restrictions, that evaluated primary studies that associated PD with obesity. Literary or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the quality and overall confidence of the included studies. Results: The preliminary search yielded a total of 419 articles, discarding those that did not meet the selection criteria, leaving only 14 articles. All studies reported that PD was associated with obesity, with an OR and RR ranging from 1.1 to 1.46 and 1.64 to 2.21, respectively. Conclusions: Based on the results and conclusions of the SR with a high overall confidence level, PD is associated with obesity.

Orofacial Anomalies in Kindler Epidermolysis Bullosa.

Importance: Kindler epidermolysis bullosa is a genetic skin-blistering disease associated with recessive inherited pathogenic variants in FERMT1, which encodes kindlin-1. Severe orofacial manifestations of Kindler epidermolysis bullosa, including early oral squamous cell carcinoma, have been reported. Objective: To determine whether hypoplastic pitted amelogenesis imperfecta is a feature of Kindler epidermolysis bullosa. Design, Settings, and Participants: This longitudinal, 2-center cohort study was performed from 2003 to 2023 at the Epidermolysis Bullosa Centre, University of Freiburg, Germany, and the Special Care Dentistry Clinic, University of Chile in association with DEBRA Chile. Participants included a convenience sampling of all patients with a diagnosis of Kindler epidermolysis bullosa. Main Outcomes and Measures: The primary outcomes were the presence of hypoplastic pitted amelogenesis imperfecta, intraoral wounds, gingivitis and periodontal disease, gingival hyperplasia, vestibular obliteration, cheilitis, angular cheilitis, chronic lip wounds, microstomia, and oral squamous cell carcinoma. Results: The cohort consisted of 36 patients (15 female [42%] and 21 male [58%]; mean age at first examination, 23 years [range, 2 weeks to 70 years]) with Kindler epidermolysis bullosa. The follow-up ranged from 1 to 24 years. The enamel structure was assessed in 11 patients, all of whom presented with enamel structure abnormalities. The severity of hypoplastic pitted amelogenesis imperfecta varied from generalized to localized pitting. Additional orofacial features observed include gingivitis and periodontal disease, which was present in 90% (27 of 30 patients) of those assessed, followed by intraoral lesions (16 of 22 patients [73%]), angular cheilitis (24 of 33 patients [73%]), cheilitis (22 of 34 patients [65%]), gingival overgrowth (17 of 26 patients [65%]), microstomia (14 of 25 patients [56%]), and vestibular obliteration (8 of 16 patients [50%]). Other features included chronic lip ulcers (2 patients) and oral squamous cell carcinoma with lethal outcome (2 patients). Conclusions and Relevance: These findings suggest that hypoplastic pitted amelogenesis imperfecta is a feature of Kindler epidermolysis bullosa and underscore the extent and severity of oral manifestations in Kindler epidermolysis bullosa and the need for early and sustained dental care.

Gastric adenocarcinoma and periodontal disease: A systematic review and meta-analysis.

BACKGROUND: The oral cavity is a link between of external environment with gastrointestinal tract. Studies are controversial on the presence of Periodontal Disease (PD) and its association with Gastric Adenocarcinoma (GAC). METHODS: The authors performed a systematic review and meta-analysis to verify the association between PD and GAC. Six electronic databases were evaluated between 1961 and 2022. Titles and abstracts were reviewed independently according to the eligibility criteria, assessing full texts of selected studies. The quality of the included research was verified using the Newcastle-Ottawa Scale for case-control and cohort studies. Statistical analyses were performed based on fixed and/or random effects models to calculate the summarized Relative Risk (RR) and its 95 % Confidence Interval (95 % CI). RESULTS: There were 639 studies, of which nine articles were included (3 case-controls and 6 cohorts). Overall, the authors identified 1,253 cases of GAC 2,501 controls in case-control studies, and 1,631 patients with GAC enrolled in cohort studies. Patients presenting PD increased the risk of developing GAC by 17 % (RR=1.17; 95 % CI 1.03‒1.32), which remained regardless of the diagnostic method for PD, i.e., clinical examination (RR = 1.19; 95 % CI 1.14‒1.24) and self-report (RR = 1.34; 95 % CI 1.06‒1.69). Moreover, Asian patients (RR=1.17; 95 % CI 1.00‒1.36) with PD had a higher risk of having GAC than American and European patients (RR = 1.18; 95 % CI 0.84‒1.66). CONCLUSIONS: The presence of PD the risk of GAC suggesting that its infectious-inflammatory process of PD may be related to GAC development. Further investigations on the oral-gastric microbiota and its role in the carcinogenesis of gastric cancer should be carried out, and the screening of patients with potential risk for GAC should be considered in the clinical practice of dentists.

Comparative Study on the Periodontal Parameters Used in Diagnosing Periodontitis in Puerperae and Periodontitis' Relationship with the Birth of Preterm Infants: A Case-Control Study.

To compare different criteria for the diagnosis of periodontitis and to evaluate the association of this condition with prematurity, this case-control study was conducted on 283 mothers of infants, divided into two groups based on gestational age (cases: <37 weeks, controls: ≥37 weeks), with 71 cases and 212 controls. The periodontal evaluation included probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing (BOP). Participants were classified regarding periodontitis per 14 criteria based on different periodontal parameters. The criterion selected as the gold standard was the presence of at least four teeth with one or more sites with a PD ≥ 4 mm, CAL ≥ 3 mm, and BOP at the same site. The prevalence of periodontal disease ranged from 8.1% to 55.1%. Moreover, compared to the gold standard, the sensitivities of the other criteria were 100%, while specificity ranged from 50.4% to 96.4%. Periodontitis, defined by six of the selected criteria, was associated with prematurity after multivariate adjustment, with OR ranging from 1.85 to 2.69 and 95% CI from 1.01 to 5.56; one of them was the gold standard mentioned above. Measurements using the clinical parameters of PD, CAL, and bleeding at the same site (criteria 5, 6, 7, 8), CPI (criterion 10), and at least four teeth with a PD ≥ 4 mm and CAL ≥ 3 mm (criterion 11) to define periodontitis showed a statistically significant association (p < 0.05). Given this study's limitations, we can conclude that the diagnostic criteria for a periodontitis definition using a PD ≥ 4 mm and CAL ≥ 3 mm in two or more teeth, with BOP at the same site, seem stronger when detecting an association between periodontitis and prematurity.

Association of Down syndrome with periodontal diseases: Systematic review and meta-analysis.

BACKGROUND: Down syndrome (DS) is distinguished by cognitive disability, a concave profile, and systemic complications. Oral diseases have been reported to be common in DS patients. OBJECTIVE: To investigate the association between DS and periodontal diseases. METHODS: Two independent reviewers searched six bibliographic databases up to January 2023 and used additional search methods to identify published studies on gingivitis or periodontitis in people with and without DS. Meta-analysis, risk of bias, sensibility analysis, publication bias, and evidence grading were all carried out. RESULTS: Twenty-six studies were included for analysis. There was a tendency for increased plaque accumulation, periodontal probing, periodontal attachment level, bleeding on probing and indices in DS individuals. Meta-analysis of 11 studies showed a significant association between DS and periodontitis (OR 3.93; 95% CI 1.81-8.53). Probing depth was significantly high in individuals with DS as compared to controls (mean difference 0.40 mm; 95% CI 0.09-0.70). Gingivitis was significantly associated (OR 1.93; 95% CI 1.09-3.41) with DS in four studies. The evidence was classified as 'moderate certainty'. CONCLUSION: Medium/low-quality studies demonstrate that Down syndrome is strongly associated with periodontitis and moderately associated with gingivitis.

Hyposalivation and periodontal disease as oral non-articular characteristics in rheumatoid arthritis.

OBJECTIVE: To investigate the association among rheumatoid arthritis (RA), saliva production, and periodontal status. METHODS: An observational study was carried out on 103 subjects with RA and 103 without RA matched by sex and age. Rheumatologic evaluation included serological and clinical variables. A full mouth periodontal examination was performed according to the American Academy of Periodontology (1999). Resting and stimulated whole salivary flows were determined after spiting during 5 min. RESULTS: RA was associated with a higher prevalence of severe periodontitis (12% vs. 4%), with a marked reduction in resting and stimulated saliva production, and with a higher prevalence of resting (19% vs. 0%) and also stimulated hyposalivation (54% vs. 10%), compared with the control group. The differences in mean resting and stimulated salivary flows between RA and control groups persisted after the exclusion of people with hyposalivation. Saliva production was not associated with the presence or the severity of periodontal disease, or with the rheumatic clinical characteristics of the patients. CONCLUSIONS: More than 50% of people with RA have some degree of reduction in their salivary flows, an affection not associated with the periodontal status or rheumatic activity, which are the expression of the two related inflammatory diseases. The influence of autonomic dysfunction on hyposalivation can be considered. While periodontitis would be a disease-associated comorbidity of RA, poor saliva production should be included among the extra-articular manifestations. Key Points • Rheumatoid arthritis patients are more prone to suffer from periodontitis and/or hyposalivation. • Periodontal disease is more prevalent in people with rheumatoid arthritis and also an association was found between the severities of both pathologies. • More than 50% of people with RA would have some degree of reduction in their salivary flows, an affection not associated with the periodontal status or rheumatic activity. • Reduced saliva production in rheumatoid arthritis patients should be included among the extra-articular manifestations.

Clinical and socio-demographic factors associated with dental extractions in a clinical sample.

The objective of the present study was to identify the reasons for dental extractions in patients seeking dental care in a university dental clinic in Mexico. This is a cross-sectional study that assessed 284 consecutive patients at the School of Dentistry, Autonomous University of the State of Mexico between August 2017 and November 2018. In total, 505 extractions were performed. The dependent variable was the reason for extraction: 0) dental caries and ensuing sequels (reference category); 1) periodontal disease and ensuing sequels; and 2) other reasons. Sociodemographic, socioeconomic, and clinical variables were included as independent variables. The analysis was done with multinomial logistic regression (Stata 14.0). Out of all extractions, 63.6% (n=321) were due to dental caries and ensuing sequels; 22.0% (n=111) were due to periodontal disease and ensuing sequels; 5.3% (n=27) endodontic failure; 5.1% (n=26) prosthetic indications; 1.6% (n=8) orthodontic indications; and the rest (2.4%) were due to other reasons. In the multivariate model extractions due to periodontal disease vs dental caries were associated with occasionally smoking tobacco (Odds Ratio, OR=3.90) or daily tobacco use (OR=3.19); the tooth to be extracted having been previously restored (OR=2.35); extracted anterior as opposed to posterior teeth (OR =2.63); and patients with multiple extractions (OR=2.68). In the case of extractions due to "other reasons", no variable was significant. Dental caries and periodontal disease were the main reasons for dental extraction in this sample. Several variables, mostly clinical, were associated with extractions for periodontal reasons.

Non-alcoholic fatty liver disease and periodontal disease: A systematic review and meta-analysis of cross-sectional studies.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, comprising hepatic steatosis, and non-alcoholic steatohepatitis. Periodontal disease (PD) may be a risk factor for the evolution of liver cirrhosis. This study aimed to evaluate the association between NAFLD and PD.We searched in Pubmed, Scopus, Cochrane, and Lilacs databases with descriptors (Non-alcoholic Fatty Liver Disease OR (non-alcoholic AND Fatty Liver AND disease) OR Nonalcoholic Steatohepatitis) AND (Periodontal Disease OR Gingivitis OR Periodontitis) from January 2021 to September 2021. We selected, by the abstract, cross-sectional, cohort (prospective and retrospective), and case-control studies that address periodontal disease in patients with Non-alcoholic Fatty Liver Disease, and aged ≥ 18 years. The search was without the restriction of language and publication time.The search resulted in 954 articles. After applying the selection criteria, five cross-sectional studies remained. A metanalysis combined the study estimates of periodontal disease in NAFLD, by using the random effects. The Odds Ratio (1.91; 95% CI 1.21-3.02; P = 0.006) indicates that the chance of presenting Periodontal disease is 91% higher in individuals with NAFLD when compared with individuals without NAFLD. There are few studies with appropriate methodology to produce sound evidence about the causal relationship between the use of NAFLD and PD, however, studies support the association. So, dental staff must be aware of this association for better management of periodontal disease in patients with NAFLD.

Is there an association between periodontal disease and root caries? A systematic review and meta-analysis.

Some periodontal diseases can be associated with cariogenic bacterial growth due to various oral health imbalances. This fact may be linked to a greater development of root caries. Thus, this systematic review analyzed the evidence on the association between periodontal disease and root caries. An electronic search was performed in five databases (Cochrane Library, LILACS, MedLine via PubMed, Scopus, and Web of Science) and two additional sources (Google Scholar and Open Grey) to partially capture the grey literature. The PECO strategy was used to identify prospective or retrospective observational studies assessing root caries in patients with periodontal disease without language or year publication restrictions. Two reviewers extracted data and evaluated the individual risk of bias in the eligible studies. Random effects meta-analyses were performed to calculate the Odds Ratio (OR). The risk of bias was assessed by the NIH tool, and the certainty of evidence was classified according to the GRADE tool. There were 1,725 studies retrieved, of which four met the eligibility criteria. All of them were evaluated for the control statements for possible confounders, bias consideration, and confounding factors because they had multivariate analysis. Adults with periodontal disease had a greater chance of presenting root caries than adults without, with OR 1.38 [CI 1.25, 1.53]. The certainty of evidence was classified as very low. Within the limits presented in this review, there was an association between periodontal disease and root caries, highlighted in the qualitative synthesis and the meta-analysis results.

Untreated osteoporosis and higher FRAX as risk factors for tooth loss: a 5-year prospective study.

INTRODUCTION: Studies have shown that an impaired bone condition, represented by osteoporosis and increased fracture risk, may potentially aggravate periodontal disease and, consequently, the risk of tooth loss. This 5-year prospective study aimed to investigate whether systemic bone condition represents risk factor for tooth loss due to periodontal disease amongst elderly women. MATERIAL AND METHODS: Seventy-four participants, aged ≥ 65 years, who attended the 5-years recall for periodontal evaluation were involved. Baseline exposures were osteoporosis and fracture risk probabilities (FRAX). Women were grouped according to bone mineral density (BMD) and years of bone treatment for osteoporosis. The primary outcome at a 5-year follow-up was the number of tooth loss due to periodontal disease. Periodontitis staging and grading, and causes of tooth loss were recorded. RESULTS: The multivariate Poisson regression models showed that women with untreated/shortly treated osteoporosis were 4 times more likely to present higher number of tooth loss due to periodontal disease than those with normal BMD or treated for ≥ 3 years (risk ratio (RR) = 4.00, 95% CI 1.40-11.27). Higher FRAX was also linked to tooth loss (RR = 1.25, 95% CI 1.02-1.53). Receiver-operating characteristic (ROC) curve suggested that women with history of ≥ 1 tooth losses have higher chances of worse major FRAX (sensitivity = 72.2%; specificity = 72.2%). CONCLUSION: In this 5-year study, higher FRAX and untreated osteoporosis were risk factors for tooth loss. Women with normal BMD or treated for osteoporosis for ≥ 3 years did not show increased risk. Management of skeletal conditions should be emphasized with periodontal care for the prevention of tooth loss in elderly women.

Association between sickle cell disease and periodontal disease: A systematic review.

Previous studies have evaluated the association between sickle cell disease (SCD) and periodontal disease; however, their effect on the periodontal parameters remains unclear. This systematic review aimed to investigate whether individuals with sickle cell disease (SCD) increase the risks of periodontal disease more than those without. For the selection of eligible studies, an electronic search was conducted in the MEDLINE/PubMed, Web of Science, Cochrane Library, and Scopus databases. The meta-analysis was based on the inversion of variance using the mean difference (MD) of the continuous outcomes. The quality assessment of included studies was performed using the JBI Critical Appraisal Tools. In total, 13 studies and 2381 participants were included in the qualitative analysis, while 9 studies were considered for the meta-analysis. The meta-analysis indicated that patients with SCD present similar Plaque Index, Clinical Attachment Level, Bleeding on Probing, and Probing Depth when compared to healthy patients (p > .05). However, the Gingival Index was higher for patients with SCD (p = .0002; MD: 0.20). Compared to healthy patients, patients with SCD did not have an increase in periodontal parameters, except for the gingival index. However, further well-designed studies are recommended to reassess the association between SCD and periodontal diseases.

Systemic Profile and Periodontal Condition of Hospitalized Women with High-Risk Pregnancy: A Cross-Sectional Study.

INTRODUCTION: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. OBJECTIVE: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. METHODS: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). RESULTS: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy.

Digital Form for Assessing Dentistry Undergraduates Regarding Periodontal Disease Associated with Cardiovascular Diseases.

Background: Throughout recent years, periodontal disease (PD) has been linked to innumerable medical systemic conditions, such as cardiovascular disease (CVD). This association could negatively impact oral health, so the knowledge of dentists who have graduated must follow modern dentistry in order to promote oral health, mainly in systemically compromised patients. Therefore, the present study aimed to determine and evaluate the knowledge level of dentistry undergraduate students (DUS) regarding the correct periodontal treatment and management of cardiac patients with PD. Methods: This cross-sectional and populational-based study was conducted between March and June 2022 in northern Brazil. A total of 153 DUS received an anonymous digital form (Google Forms Platform) using a non-probabilistic "snowball" sampling technique. The digital form was composed of four blocks of dichotomous and multiple-choice questions. After signing the informed consent term, DUS were divided into three groups according to their period/semester in dentistry graduation during the study time (G1: 1st period/semester; G2: 5th period/semester and G3: 10th period/semester). A total of 25 questions referring to demographic, educational and knowledge data about the dental and periodontal care of cardiac patients with PD were asked, and all data were presented as descriptive percentages and then analyzed using the Kappa test. Results: From a total of 153 (100%) DUS, the sample was mostly composed of 104 (68%) female participants, with an average age of 21.1 years. Regarding basic knowledge, the majority of answers were no, with G1 being higher than G2 and G3. Regarding clinical questions, 1247 (58.3%) answers were no. Additionally, regarding fundamental clinical questions 1, 2, 3, 7, 9, 11, 13 and 14, the majority of G1, G2 and G3 answered no, demonstrating a major lack of knowledge. Conclusions: In our study, DUS demonstrated a low knowledge level of the dental and periodontal care of cardiac patients with PD and its bi-directional link. Thus, according to our results, an improvement in dentistry educational programs regarding periodontal medicine must be implemented.

Periodontal disease and COVID-19: Prognosis and potential pathways of association in their pathogenesis.

Objective: The objective of this narrative review is to determine if periodontal disease is a factor in the development of a poor prognosis for COVID-19. Method: A bibliographic search was conducted in PubMed, Virtual Health Library, Google Scholar, and in the databases of Science Direct, Scopus, Lilacs, Bireme, Scielo, and Web of Science, using the following keywords: "COVID-19," "SARS-CoV-2," and "periodontal diseases." Results: Fifty-six records were retrieved from the database searches. After screening, 39 articles were selected for study: 13 reviews, 2 case-control studies, 1 systematic review, 8 letters to the editor, 2 cohort studies, 1 thesis, 7 hypotheses, 1 short communication, 3 commentaries, and 1 scoping review. Discussion: Both periodontal disease and COVID-19 produce an inflammatory response. This immune response generates an over-production of inflammatory cytokines that can harm overall health. Conclusion: The mouth serves as the entryway for many microorganisms that can harm health in general, among them SARS-CoV-2. It is important to maintain good oral health to lower the inflammatory load present in periodontal disease, lessening the possibility of complications from COVID-19.

Objectif: L'objectif de cette revue narrative est de déterminer si la maladie parodontale est un facteur dans le développement d'un mauvais pronostic de la COVID-19. Méthodologie: Une recherche bibliographique a été effectuée dans PubMed, la bibliothèque virtuelle de la santé, Google Scholar, et dans les bases de données de Science Direct, Scopus, Lilacs, Bireme, Scielo, et Web of Science, en utilisant les mots-clés suivants : « COVID-19 ¼, « SRAS-CoV-2 ¼ et « maladie parodontale ¼ (en anglais). Résultats : Cinquante-six dossiers ont été extraits à partir des recherches dans les bases de données. Après la sélection, 39 articles ont été choisis pour l'étude : 13 revues, 2 études cas-témoins, 1 revue systématique, 8 lettres à l'éditeur, 2 études de cohorte, 1 thèse, 7 hypothèses, 1 courte communication, 3 commentaires et 1 examen de la portée. Discussion: La maladie parodontale et la COVID-19 produisent toutes deux une réponse inflammatoire. Cette réponse immunitaire produit une surproduction de cytokines inflammatoires qui peuvent nuire à la santé globale. Conclusion: La bouche sert de voie d'entrée à de nombreux micro-organismes qui peuvent nuire à la santé en général, parmi lesquels le SRAS-CoV-2. Il est important de préserver une bonne santé buccodentaire pour diminuer la charge inflammatoire présente dans la maladie parodontale, réduisant ainsi la possibilité de complications de la COVID-19.

Associated oral manifestations with HIV southeastern Brazilian patients on antiretroviral therapy.

OBJECTIVES: This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. METHODS: A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. RESULTS: Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p=0.04), as well duration of treatment (p=1.53e-3) and age (p=0.02). Hyperpigmentation was related to race (p=0.01) and smoking (p=1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [-2.27 to -0.25]; p-value=0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR=8.47 [1.18-3.10], p= 1.31e-5), without race or type and duration of treatment. CONCLUSION: Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. LEVEL OF EVIDENCE: Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").

High prevalence of periodontal disease in patients with NASH- possible association of poor dental health with NASH severity.

INTRODUCTION AND OBJECTIVES: Recent translational research indicated a bidirectional relationship between NASH (non-alcoholic steatohepatitis) and periodontitis; however, few clinical cohorts have studied this in detail. Thus we investigated this assumed association in a well-defined cohort. MATERIALS AND METHODS: Data were generated prospectively for 132 patients (32 patients with NASH and 100 unselected, consecutively collected, anonymized controls from a local dental practice): detailed periodontal parameters, i.e., pocket-probing-depths (PPD), bleeding-on-probing (BOP), plaque-index, and utilization of dental care were assessed and correlated with relevant hepatic parameters (liver stiffness via fibroscan, AST, ALT, bilirubin, and MELD-score). Gingiva samples were tested for Porphyromonas gingvalis (P.g.) and Actinobacillus actinomyctemcomitans (A.a.) by PCR. RESULTS: 87.5% of NASH patients and 47% of controls suffered from moderate to severe periodontitis (p=0.01). Liver stiffness was significantly correlated with elevated PPD (p=0.02) and BOP (p=0.03). 34 % of the NASH patients did not make use of regular dental health care. In these patients, AST (p=0.04), MELD score (p<0.01), and liver stiffness (p=0.01) were significantly elevated compared to those who see a dentist regularly. The severity of NASH was not associated with the intraoral detection of P.g. and A.a. CONCLUSIONS: The present study suggests that NASH might be associated with periodontitis, irrespective of the intraoral presence of P.g. and A.a. Moreover, regular dental care utilization might mitigate the course of NASH, and patients should be reminded by their hepatologists of the importance of regular dental visits. Future studies should investigate the role of regular dental care and additional anti-inflammatory treatments of the oral cavity.

Knowledge of bidirectional relationship between diabetes and periodontal disease among diabetes patients: A systematic review.

INTRODUCTION: The bidirectional relationship between diabetes mellitus and periodontal disease has been reported in the literature, suggesting that poor glycemic control is strongly associated with increased risk of developing periodontal disease. Therefore, this systematic review evaluated the level of knowledge of this bidirectional relationship among patients with diabetes. METHODS: This systematic review (protocol CRD42018117902) was conducted according to PRISMA guidelines. The following databases were considered: Medline/PubMed, Scopus, and Web of Science. Search strategy (April 05th , 2021) considered proper combination of keywords and eligibility criteria. The quality of studies was evaluated using the Appraisal tool for Cross-Sectional Studies (AXIS). RESULTS: Among the 328 records identified in the initial search, 24 studies were selected, considering a total of 8,693 patients. All studies used a cross-sectional design. Among the included studies, only five showed prevalence of knowledge higher than 50%, ranging from 5.8% to 75.9%. Interestingly, 58.0% of patients reported that they brush their teeth at least 1x/day, but only four studies reported that the dentist was the main source of information. In terms of methodology and result quality, just one study clearly showed all information evaluated by the AXIS tool. Most of studies did not report sample size calculations and did not used validated questionnaires to assess patient knowledge. CONCLUSION: The results show that less than half of people with diabetes have knowledge about their increased risk for periodontal disease, and often the dentist is not the main source of information to motivate them.

Relación entre la enfermedad periodontal y complicaciones en el Embarazo / Relationship between periodontal disease and complications in pregnancy

Resumen La periodontitis es una enfermedad multifactorial caracterizada por una respuesta inflamatoria desarrollada por el huésped frente a los microorganismos de la biopelícula bacteriana. El proceso localizado en la cavidad oral puede influir en el huésped a nivel sistémico provocando resultados adversos en el embarazo como parto prematuro, hipertensión materna y bajo peso del niño al nacer. Objetivo: Analizar el estado actual del conocimiento sobre los mecanismos probables que vinculan la periodontitis con resultados adversos en el embarazo. Material y métodos: Se efectuó una revisión de la literatura y una búsqueda de artículos publicados durante el periodo comprendido entre los años 2016 y 2021 en las bases de datos MEDLINE, PUBMED, SciELO, LILACS, idioma inglés y/o español. Las búsquedas se realizaron utilizando los siguientes términos: Periodontitis, mediadores de inflamación, complicaciones del embarazo, parto prematuro. Resultados: Se analizaron un total de 24 publicaciones, incluidas revisiones de la literatura, revisiones sistemáticas, estudios de cohorte, estudios de casos y controles y estudio observacionales, que cumplieron con los criterios de inclusión. Conclusión: La periodontitis es un factor de riesgo evitable por lo que se recomienda intensificar las medidas de prevención y tratamiento, en embarazadas y en mujeres en edad fértil.

Abstract Periodontitis is a multifactorial disease characterized by an inflammatory response developed by the host against the microorganisms of the bacterial biofilm. The localized process in the oral cavity can influence the host systemically causing adverse pregnancy outcomes such as premature delivery, maternal hypertension, and low birth weight. Objective: To analyze the current state of knowledge about the probable mechanisms that link periodontitis with adverse pregnancy outcomes. Material and methods: A literature review and a search for articles published during the period between 2016 and 2021 was carried out in the MEDLINE, PUBMED, SciELO, LILACS, English and / or Spanish databases. Searches were conducted using the following terms: Periodontitis, inflammatory mediators, pregnancy complications, preterm delivery. Results: 24 publications were analyzed, including literature reviews, systematic reviews, cohort studies, case-control studies, and observational studies, which met the inclusion criteria. Conclusion: Periodontitis is an avoidable risk factor, therefore it is recommended to intensify prevention and treatment measures in pregnant women and women of childbearing age.