Biological Evaluation of Oral Care Products Using 3D Tissue-Engineered In Vitro Models of Plaque-Induced Gingivitis.

BACKGROUND: The aim of this study was to investigate and visualize the anti-inflammatory and anti-bacterial effects of different oral care products using an infected and inflamed 3D tissue-engineered gingival mucosal model. METHODS: A 3D full-thickness oral mucosal model was engineered inside tissue culture inserts using collagen hydrogels populated with human gingival fibroblasts and THP-1 monocytes and layered with oral epithelial cell lines. Oral saliva bacteria were cultured and added to the surface of the models and inflammation was further simulated with lipopolysaccharide (LPS) of Escherichia coli. The 3D models were exposed to three different types of toothpastes, a chlorhexidine antiseptic mouthwash, different antibiotics, and a mechanical rinse with phosphate-buffered saline (PBS) prior to biological evaluation using the PrestoBlue tissue viability assay, histology, optical coherence tomography (OCT), confocal microscopy, and measurement of the release of the inflammatory markers IL-1ß, IL-6, and IL-8 with ELISA. RESULTS: Multiple-endpoint analyses of the infected oral mucosal models treated with different anti-bacterial agents showed consistent outcomes in terms of tissue viability, histology, OCT, and confocal microscopy findings. In terms of anti-inflammatory testings, the positive control group showed the highest level of inflammation compared with all other groups. Depending on the anti-bacterial and anti-inflammatory potential of the test groups, different levels of inflammation were observed in the test groups. CONCLUSIONS: The inflamed 3D oral mucosal model developed in this study has the potential to be used as a suitable in vitro model for testing the biocompatibility, anti-inflammatory, and anti-bacterial properties of oral care products including mouthwashes and toothpastes. The results of this study indicate that the chlorhexidine mouthwash has both anti-bacterial and cytotoxic effects on the 3D oral mucosal model. Hyaluronic-acid-containing toothpaste has significant anti-bacterial and anti-inflammatory effects on the 3D oral mucosal model.

Prevalence of periodontitis in Saudi Arabia: A systematic review and meta-analysis.

Objective: The aim of this systematic review was to assess the prevalence of periodontal disease among Saudi Arabian adults based on studies conducted from 1992 to 2023. Methods: The study protocol was registered in PROSPERO. Three databases (MEDLINE, EMBASE and Cochrane library) and the Saudi Dental Journal were searched for published literature up to June 2023 using prespecified search strategy. Quality of included studies was checked using the risk of bias in population-based prevalence studies tool. Results: The systematic review included 15 studies that assessed the prevalence of periodontal disease in Saudi Arabia. Most of the studies used non-confident case definitions. The pooled estimate of periodontal disease prevalence in Saudi Arabia based on the data of 14 which included 6,596 individuals is 51% (95% CI: 35.99, 73.05). Conclusion: Periodontal disease is a significant public health issue in Saudi Arabia, with a substantial prevalence among the included participants. Nevertheless, the existing studies exhibit methodological disparities and regional limitations. Therefore, while the results shed light on the pressing nature of periodontal disease in Saudi Arabia, further comprehensive research is imperative. A more accurate estimate, coupled with effective strategies, can be achieved through broader, multidisciplinary collaborations and the prioritization of a national oral health survey in Saudi Arabia.

Does smoking explain the association between use of e-cigarettes and self-reported periodontal disease?

OBJECTIVE: Many studies have been conducted to understand the association between e-cigarette use and different periodontal parameters, but the effect of conventional smoking in explaining this association remain to be elucidated. This study aimed to assess the association between e-cigarettes and self-reported periodontal disease, and whether smoking status explains this association. METHODS: This cross-sectional study was based on secondary data analysis of 8,129 participants of the National Health and Nutrition Survey (NHANES) 2015 -2018. E-cigarette use and smoking status were collected through questionnaires. Self-reported periodontal diseases and bone loss were derived from the 8-item CDC/AAP questionnaire. The associations between e-cigarette use and self-reported periodontal diseases were tested in logistic regression models adjusting for demographic factors, socioeconomic indicators, smoking status, diabetes and dental visits. Additionally, to test the effect of smoking on the relationship, three fully adjusted logistic regression models stratified by smoking status were constructed. RESULTS: E-cigarettes ever users and current users had higher odds of self-reported periodontal disease (OR = 1.43, 95% CI: 1.18, 1.73) and bone loss (OR = 1.80, 95% CI: 1.30, 2.49) respectively compared to non-users after adjusting for smoking and potential confounders. In the regression models stratified by smoking status, e-cigarette was only significantly associated with self-reported periodontal disease variables among current smokers, but not among previous or never smokers. CONCLUSION: E-cigarette use is associated with self-reported periodontal disease. However, smoking status appears to explain the relationship between e-cigarette use and periodontal disease. CLINICAL SIGNIFICANCE: This population-based cross-sectional study shows that e-cigarette use is associated with self-reported periodontal disease. Smoking status appears to explain the association. Dental professionals should consider the effect of conventional smoking and comprehend the risks of e-cigarette on oral health and its benefits when used as a smoking cessation aid.

Implant Soft-Tissue Attachment Using 3D Oral Mucosal Models-A Pilot Study.

PURPOSE: The aim of this study was to investigate soft-tissue attachment to different metal, ceramic, and polymer implant surfaces using an inflamed, three-dimensional (3D), tissue-engineered, human oral mucosal model, as well as multiple-endpoint qualitative and quantitative biological approaches. METHODS: Normal human oral fibroblasts, OKF6/TERT-2 keratinocytes and THP-1 monocytes were cultured, and full-thickness, 3D oral mucosal models were engineered inside tissue culture inserts. Sand-blasted and acid-etched (SLA) and machined (M) titanium-zirconium alloy (TiZr; commercially known as Roxolid; Institut Straumann AG, Switzerland), ceramic (ZrO2), and polyether ether ketone (PEEK) rods (Ø 4 mm × 8 mm) were inserted into the center of tissue-engineered oral mucosa following a Ø 4mm punch biopsy. Inflammation was simulated with addition of the lipopolysaccharide (LPS) of Escherichia coli (E. coli) and tumor necrosis factor (TNF)-alpha to the culture medium. Implant soft-tissue attachment was assessed using histology, an implant pull-test with PrestoBlue assay, and scanning electron microscopy (SEM). RESULTS: Inflamed, full-thickness, 3D human oral mucosal models with inserted implants were successfully engineered and histologically characterized. The implant pull-test with PrestoBlue assay showed higher viability of the tissue that remained attached to the TiZr-SLA surface compared to the other test groups. This difference was statistically significant (p < 0.05). SEM analysis showed evidence of epithelial cell attachment on different implant surfaces. CONCLUSIONS: The inflamed, 3D, oral mucosal model has the potential to be used as a suitable in vitro test system for visualization and quantification of implant soft-tissue attachment. The results of our study indicate greater soft tissue attachment to TiZr-SLA compared to TiZr-M, ceramic, and PEEK surfaces.

The association between periodontal disease and root/coronal caries.

OBJECTIVES: To examine whether there is an association between periodontal disease and each of root caries and coronal caries among adults (aged 35 and over), using a nationally representative sample of adults in England, Northern Ireland and Wales. MATERIAL AND METHODS: In this cross-sectional study, data from the Adult Dental Health Survey 2009 were used. Adults aged 35 years or older who had periodontal and caries assessment were included. Two sets of negative binomial regression were conducted for each of coronal caries and root caries adjusting for periodontal diseases, dental visits, country, sex, age, education, job classification, oral hygiene and smoking. RESULTS: Overall, 4738 were included in the analysis. Periodontal disease was significantly associated with each of coronal and root caries. In the fully adjusted model, those with PD/ LoA ≥ 4 mm had 1.03 rate ratio (RR) for coronal caries (95% CI: 1.01-1.05). In the model pertaining to root caries, the RR for those with periodontitis was 1.23 (95% CI: 1.16-1.30). Smoking, sex, age and oral hygiene were the variables that showed a consistent and significant association with coronal and root caries. CONCLUSION: Individuals with periodontal diseases appeared to be at higher risk of coronal and root caries. While root exposure could be a plausible explanation for the relationship between periodontitis and root caries, the association with coronal caries could be attributed to the irritation of carious cavities, or common risk factors such as poor oral hygiene, or co-occurrence of different health risk behaviours related to both caries and periodontitis and socioeconomic conditions.