The Effect of Different Electric Toothbrush Technologies on Interdental Plaque Removal: A Systematic Review with a Meta-Analysis.

The removal of dental plaque from the gingival margins of the teeth is essential to maintaining periodontal health. Whilst it has been established that electric toothbrushes demonstrate a greater ability to remove plaque, no systematic review has specifically investigated which technology is better for removing plaque from the interdental tooth surfaces, where plaque control may be more difficult. Three databases were searched until October 2023: MEDLINE and DOSSS via EBSCOhost and Embase. Data extraction was carried out on studies which met the inclusion criteria, and a risk of bias assessment was completed. The study findings were combined via a narrative synthesis and a meta-analysis where appropriate. A total of 77 studies were found, out of which 14 were selected and included in the analysis. The mean difference in interproximal plaque reduction, measured using the Rustogi Modified Naval Plaque Index (RMNPI) at 8 weeks, was 0.09 (p < 0.00001) in favor of the oscillating-rotating toothbrush. At 6 and 12 weeks, the mean difference in plaque reduction (RMNPI) was 0.05 (p = 0.0008) and 0.04 (p = 0.0001) in favor of the oscillating-rotating toothbrush, respectively. The studies show a tendency for oscillating-rotating toothbrushes to remove more interproximal plaque than oscillating toothbrushes, especially in a short time (8 weeks).

Effect of Dental Practicality Index training using an online video on decision-making and confidence level in treatment planning by dental undergraduates.

Objectives: The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Materials and Methods: Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. Results: DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Conclusions: Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

Let us talk about it: An exploratory qualitative study of older adults' priorities for oral health in North West England.

OBJECTIVES: The aim of this study was to explore oral health experiences and priorities in a diverse group of adults aged over 60 in North West England, an area with high oral health inequality. METHODS: Participants were selected using purposive sample from multiple settings across the North West: community, primary dental care and residential care home. Data were collected between October 2018 and March 2019 and involved eight focus groups and three individual interviews with a total of 47 participants. The data were analysed using thematic analysis. RESULTS: Four key themes were identified. The first was issues important to people over 60, which included the appearance of one's teeth, communication, continuity of care and the treatment experience. These were informed by two further themes, past experiences of treatment, which were not always favourable, and perceived barriers, such as accessing NHS dentistry, cost, physical access and oral care in institutional settings. The fourth, connected theme focussed on how oral healthcare messages for different audiences should be disseminated. CONCLUSIONS: There are shortfalls in the provision of oral healthcare to older adults in the UK. Communication and continuity of care with a trusted oral healthcare provider are key priorities for this population. However, our participants felt that current public provision of dental services is not meeting their needs.

Evaluating YouTube as a Patient Information Source for the Risks of Root Canal Treatment.

INTRODUCTION: YouTube is one of the most used social media platforms for health care information. Misinformation and poor educational content on this platform can exacerbate public anxiety and fear of root canal treatment. This study aimed to investigate the quality of videos examining risks of root canal treatment on YouTube. METHODS: YouTube was searched using a combination of keywords relating to endodontic complications to replicate goal-orientated browsing. Video quality was assessed using a modified DISCERN score and global quality score by 2 authors independently. Manifest quantitative content analysis was used to capture information about the video and extent of interactions. The 10 most viewed videos were further analyzed in terms of the messaging and format of the videos. RESULTS: The mean overall quality of the videos was relatively low (2.20). Videos produced by regulatory bodies had the highest mean score (3.00) and the shortest mean length (2 minutes 23 seconds) but had the fewest views and interactions. The poorest quality videos (mean 1.5) were produced by nonclinicians and news/media, which tended to be longer (mean 8 minutes 49 seconds) and received more engagement. Across all videos, information related to patient decision making tended to be poorly presented. CONCLUSIONS: The dental community, particularly institutions and organizations, need to strategically create engaging videos to redress patients' concerns about root canal treatment. This can counterbalance the existing misleading information and improve access to evidence-based content, which will ultimately affect patient decision making.

Porphyromonas gingivalis Conditioned Medium Induces Amyloidogenic Processing of the Amyloid-ß Protein Precursor upon in vitro Infection of SH-SY5Y Cells.

Background: Cleavage of the amyloid-ß protein precursor (AßPP) mediated by host secretase enzymes, releases several fragments including amyloid-ß (Aß40 and Aß42). Objective: To determine if Porphyromonas gingivalis conditioned medium cleaved AßPP to release Aß40 and Aß42. Methods: The SH-SY5Y cell line was challenged, in vitro, with P. gingivalis (Pg381) conditioned medium in the presence/absence of cytokines. The cells and their supernatants were assessed for AßPP cleavage fragments by immunoblotting and transmission electron microscopy. Results: Western blotting of the cell lysates with the anti-AßPP C-terminal antibody demonstrated variable molecular weight bands corresponding to full length and fragmented AßPP in lanes treated with the following factors: Tryptic soy broth (TSB), Pg381, IL-6, Pg381 + IL-1ß, and Pg381 + TNF-α. The low molecular weight bands corresponding to the C99 dimerized fragment were observed in the Pg381 and interlukin-6 (IL-6) treated groups and were significantly more intense in the presence of Pg381 with either IL-6 or TNF-α. Bands corresponding to the dimerized C83 fragment were observed with cells treated with TNF-α alone and with Pg381 combined with IL-1ß or IL-6 or TNF-α. The anti-Aß antibody detected statistically significant Aß40 and Aß42, levels when these two Aß species were pooled across test samples and compared to the untreated group. Electron microscopic examination of the supernatants demonstrated insoluble Aß40 and Aß42. Conclusion: These observations strongly imply that AßPP is an infection responsive protein cleaved via the amyloidogenic pathway on exposure to conditioned medium and in the presence of pro-inflammatory mediators.

Antimicrobial, Polarizing Light, and Paired Helical Filament Properties of Fragmented Tau Peptides of Selected Putative Gingipains.

BACKGROUND: Tau is an established substrate for gingipains secreted by Porphyromonas gingivalis. Hyperphosphorylation of tau and neurofibrillary tangle (NFT) formation is a defining lesion of Alzheimer's disease (AD) where NFT distribution is related to Braak stage and disease severity. OBJECTIVE: To assess gingipains'-fragmented tau peptides for their antimicrobial properties and for the likelihood of paired helical/straight filament (PHF/SF) formation with implications for the NFT lesion. METHODS: Seven non-phosphorylated (A-G) and three phosphorylated (A-C) tau peptides, were tested for antimicrobial properties against P. gingivalis. Polarizing light properties were determined using Congo Red staining. Secondary and tertiary structures of peptides B-F were determined using transmission electron microscopy (TEM) and circular dichroism (CD) was undertaken for the soluble peptides A in phosphorylated and non-phosphorylated states. RESULTS: Phosphorylated tau peptide A displayed a significant effect against planktonic P. gingivalis. The CD results demonstrated that both peptides A, in phosphorylated and non-phosphorylated states, in aqueous solution, adopted mainly ß-type structures. Non-phosphorylated peptides B-F and phosphorylated peptides B-C were insoluble and fibrillar under the TEM. The secondary and tertiary structures of the non-phosphorylated peptide B demonstrated fewer helical twists, whereas peptide C displayed significantly more helical twists along the whole fiber(s) length following its phosphorylation. CONCLUSION: Phosphorylated peptide A reduced P. gingivalis viability. CD spectroscopy demonstrated the phosphorylated and the non-phosphorylated peptide A predominantly formed from ß-sheet structures in aqueous solution with potential antimicrobial activity. Phosphorylation of tau peptides physically changed their tertiary structure into PHFs with potential for self-aggregation and binding to the NFT lesion.

Periodontitis as a Risk Factor for Alzheimer's Disease: The Experimental Journey So Far, with Hope of Therapy.

Periodontitis and Alzheimer's disease (AD) exist globally within the adult population. Given that the risk of AD incidence doubles within 10 years from the time of periodontal disease diagnosis, there is a window of opportunity for slowing down or preventing AD by risk-reduction-based intervention. Literature appraisal on the shared risk factors of these diseases suggests a shift to a healthy lifestyle would be beneficial. Generalised (chronic) periodontitis with an established dysbiotic polymicrobial aetiology affects the tooth supporting tissues with eventual tooth loss. The cause of AD remains unknown, however two neurohistopathological lesions - amyloid-beta plaques and neurofibrillary tangles, together with the clinical history, provide AD diagnosis at autopsy. Historically, prominence was given to the two hallmark lesions but now emphasis is placed on cerebral inflammation and what triggers it. Low socioeconomic status promotes poor lifestyles that compromise oral and personal hygiene along with reliance on poor dietary intake. Taken together with advancing age and a declining immune protection, these risk factors may negatively impact on periodontitis and AD. These factors also provide a tangible solution to controlling pathogenic bacteria indigenous to the oral and gastrointestinal tract microbioes in vulnerable subjects. The focus here is on Porphyromonas gingivalis, one of several important bacterial pathogens associated with both periodontitis and AD. Recent research has enabled advances in our knowledge of the armoury of P. gingivalis via reproduction of all clinical and neuropathological hallmark lesions of AD and chronic periodontal disease in vitro and in vivo experimental models, thus paving the way for better future management.

Clinical decision-making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study.

INTRODUCTION: Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision-making process. MATERIALS AND METHODS: Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire-based cross-sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple-choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics. RESULTS: There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision-making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only. CONCLUSION: Considerable inter-clinician variability was noted whereby specialty postgraduate training impacted on clinical decision-making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision-making. Evidence-based treatment guidelines and dental curricula should be reviewed to enhance inter-clinician agreement in clinical decision-making, ultimately improving patient care.

Ex vivo Detection of Amyloid-ß in Naturally Formed Oral Biofilm.

Background: Oral infection has been implicated in the possible etiology of Alzheimer's disease. Objective: To detect amyloid-ß (Aß) within microbial biofilms. Methods: Freshly extracted teeth (N = 87) with periodontal disease were separated into Group A (N = 11), with primary root canal infection and Group B (N = 21) with failed endodontic treatment identified by the presence of, gutta percha root filling. Biofilm characteristics were observed by scanning electron microscopy (SEM). Demineralized paraffin wax embedded tooth sections and mineralized calculus biofilm were immunostained with the anti-Aß antibody. The gutta perchas were processed either for on-section acrylic resin tissue immunocolloidal gold silver staining (IGSS) using the anti-Aß antibody or in Araldite resin for ultrastructure. Results: SEM demonstrated calculus and gutta percha in situ harboring a polymicrobial biofilm featuring extracellular polymeric substance (EPS) and water channels. Immunohistochemistry on rehydrated paraffin wax tooth sections from Group A, demonstrated Aß staining on external (calculus and plaque) and all intracanal infected regions. In Group B, the gutta percha biofilm IGSS gave an inconclusive result for Aß. Transmission electron microscopy of selected teeth with infected intra-canals (Group A) and 20% of gutta percha biofilm (Group B) EPS contained electron dense fibrils of variable sizes, some of which were typical of human Aß fibrils. Conclusion: This study detected both soluble and insoluble Aß fibrils within the EPS of periodontal and endodontic natural biofilm, strongly suggesting its role as an antimicrobial peptide in combatting local infection, with potential risk for cross-seeding into the brain for AD development.

Sensationalist social media usage by doctors and dentists during Covid-19.

INTRODUCTION: Many doctors and dentists took to social media to raise alarm and/or express professional opinion, dissatisfaction, anger and/or incredulity associated with the Covid-19 pandemic. Although most of these social media posts involved practitioners from abroad, this article explores whether they would attract fitness to practise investigations had they been posted by UK-based medical and dental practitioners. In particular, it asks whether such conduct comes into conflict with the existing professional standards issued by the General Medical Council (GMC) and the General Dental Council (GDC). It questions also whether those guidelines should be updated and/or further clarified in view of the extraordinary circumstances posed by the pandemic. METHOD: An exploratory study was conducted using sensationalist pandemic-related social media posts by doctors and dentists discovered during the first half of 2020 (n = 11). The contents were analysed qualitatively using documentary analysis using coding terms based on the professional standards on social media published by both the GMC and the GDC. The codes generated common and recurring themes that were used to structure discussion. FINDINGS: This study provides a partial insight as to the likely motivations of doctors and dentists to use social media in a manner that may not necessarily lend well to the professional standards expected. In a majority of instances, doctors and dentists who posted social media material with a sensationalist outlook tended to focus on single-issue campaigns pertaining to specific aspects of the Covid-19 pandemic. These issues included controversial commentary on acute shortages of personal protective equipment and attendant occupational risks to clinical staff to Covid-19 infection; criticisms directed towards regulatory bodies in the handling of the pandemic; and professional advice to the general public which was later found to be inaccurate. CONCLUSIONS: Social media offer opportunities for healthcare professionals to play a constructive role in raising awareness, disseminating information, and promoting solidarity in the management of the Covid-19 pandemic. However, doctors and dentists must carefully consider the ethical and professional pitfalls involved in sensationalist social media posts. The GMC and the GDC should, at the same time, regularly update and clarify their social media guidance in response to major global events like a pandemic as well as advances in social media technology.

Porphyromonas gingivalis (W83) Infection Induces Alzheimer's Disease-Like Pathophysiology in Obese and Diabetic Mice.

BACKGROUND: Periodontal disease(s) and metabolic illnesses negatively impact the quality of life and, eventually mental health. OBJECTIVE: This study investigated the effect of Porphyromonas gingivalis (W83) oral infection on the development of Alzheimer's disease (AD) pathophysiology in a wild-type obese, diabetic (db/db) mouse model. METHODS: The db/db mice were either orally infected with P. gingivalis and Fusobacterium nucleatum or sham infected for 16 weeks. The presence of amyloid-ß (Aß) and neurofibrillary tangles (NFTs) were assessed using a silver impregnation technique and subsequently by immunohistochemistry for tau and neuroinflammation. The mRNA abundance of a panel of 184 genes was performed using quantitative real-time PCR, and the differentially expressed genes were analyzed by Ingenuity Pathway Analysis. RESULTS: While no Aß plaques and NFTs were evident by silver impregnation, immunohistochemistry (glial cell markers) of the P. gingivalis-infected mice tissue sections exhibited neuroinflammation in the form of reactive microglia and astrocytes. Anti-tau immunopositivity, in addition to cells, was prominent in thickened axons of hippocampal CA neurons. The mRNA abundance of crucial genes in the insulin signaling pathway (INSR, IGF1, IRS, IDE, PIK3R, SGK1, GYS, GSK3B, AKT1) were upregulated, potentially exacerbating insulin resistance in the brain by P. gingivalis oral infection. Increased mRNA abundance of several kinases, membrane receptors, transcription factors, and pro-inflammatory mediators indicated hyperactivation of intracellular cascades with potential for tau phosphorylation and Aß release in the same infection group. CONCLUSION: P. gingivalis W83 infection of db/db mice provides a disease co-morbidity model with the potential to reproduce AD pathophysiology with induced periodontal disease.

Micro-computed tomography evaluation of dentinal microcracks following canal preparation with thermomechanically heat-treated engine-driven files.

This study aimed to evaluate and compare the frequency of microcracks and its severity at different root canal dentin locations, after preparation with thermomechanically heat-treated engine-driven nickel-titanium instruments. Forty mandibular premolars were assigned to four experimental groups (n = 10): ProTaper Next, ProTaper Gold, WaveOne Gold and Reciproc Blue. After pre-instrumentation micro-computed tomography scans, the root canals were prepared to size 25. Following post-instrumentation scans, pre- and post-instrumentation scanned images were analysed for the presence and extent of dentinal defects. A total of 56 500 cross-sectional images were obtained, showing that less than 2.3% with pre-existing dentinal microcracks. No new microcracks were identified during the post-instrumentation analyses. No significant association was found between the types of dentinal defects, file motions and sequences. Thermomechanically heat-treated rotary files did not induce the formation of new microcracks. There was also no association between the kinematic motions and sequences of the rotary instruments to the types of dentinal defects.

The impact of the Dental Practicality Index on treatment planning.

Aim To compare the treatment planning decisions made by undergraduate and postgraduate dental students before and after training on the use of the Dental Practicality Index (DPI).Methodology One hundred and eight undergraduate and postgraduate dental students were randomly assigned to test (DPI) or control groups. The baseline knowledge was assessed in the first session; both groups were shown 15 clinical scenarios and asked to assign one of four treatment plan options (no treatment, simple treatment, complex treatment or extract). The most appropriate treatment plan had been agreed by a consensus panel of experienced dentists. The test group was then trained on the use of the DPI. In the second session, both groups were shown the same clinical scenarios again in a different order and asked to assign one of the four treatment plan options. Both groups completed the confidence questionnaire.Results Training with the DPI improved the test (DPI) group mean scores from 9.1 in the first session to 10.3 out of 15 in the second session, which was a statistically significant difference (p = 0.005) when compared to the control group mean scores of 8.9 in the first session to 9.2 out of 15 in the second session. The mean confidence score of the students was 6.5 out of 10. There was no correlation between self-reported confidence scores of the students and the treatment planning result scores.Conclusions The DPI aids in the systematic assessment and appropriate treatment planning of dental restorative problems by dental students.

Comparing endocrown restorations on permanent molars and premolars: a systematic review and meta-analysis.

Objectives The objective of this systematic review was to evaluate the success of endocrown restorations on molars in comparison with endocrown restorations on premolars.Registration number The methodology for this review is registered with the PROSPERO database (CRD42019149543).Data sources Medline, Embase, Dentistry & Oral Sciences Source and Cochrane CENTRAL were searched through January 2020, supplemented with hand searching of additional relevant journals.Data selection and data extraction Two independent reviewers screened studies against predefined inclusion criteria and extracted data.Data analysis Narrative analysis was carried out and random-effects meta-analysis was performed where possible.Results Out of the selected eight studies, reported success rate of endocrown restoration in molars varied from 72.73% to 99.57% and in premolars ranged from 68.75% to 100%, with a follow-up range of 3-19 years. The pooled odds ratio and 95% confidence intervals for failure rates in molars compared to premolars in four studies selected for meta-analysis were 1.096 (95% CI: 0.280, 4.292).Conclusions These findings showed similar success rates and no difference in the rate of endocrown failures between molars and premolars, thus suggesting that premolars may be considered suitable candidates for endocrowns. However, the findings should be interpreted with caution due to methodological limitations of the included studies. Further better quality and specifically designed controlled trials directly comparing the clinical performance of endocrowns on molars and premolars are required.

A Review on COVID-19 Mediated Impacts and Risk Mitigation Strategies for Dental Health Professionals.

In the light of coronavirus disease 2019 (COVID-19), dentistry is facing unprecedented challenges. The closure of clinics has impacted dental health professionals (DHPs) not only financially but also psychologically. In this review, these consequences are discussed in detail to highlight the challenges that DHPs are facing thus far, in both developing and developed nations. Compromised mental health among DHPs is an important area that requires attention during this difficult period. Although, in previous pandemics, dentists have not worked on the frontline, the article discusses how their wide range of skillsets can be leveraged if another wave of COVID-19 pandemic appears. Finally, guidelines to reopen clinics and patient management have been discussed in detail that could serve as a quick reference guide for DHPs.

Regenerative Endodontic Procedures, Disinfectants and Outcomes: A Systematic Review.

AIMS: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. METHODS: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). MAIN FINDINGS: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. PRINCIPLE CONCLUSIONS: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.

Sodium Hypochlorite Extrusion Accidents: Management and Medico-Legal Considerations.

Sodium hypochlorite is considered the most widely used irrigant in endodontics as it exhibits effective antimicrobial activity and has potent tissue-dissolving ability. Whilst it is considered safe when used within the confines of the root canal system, it can cause serious complications when inadvertent periradicular extrusion occurs. This article outlines the complications of sodium hypochlorite extrusion and reviews the appropriate management based on the contemporary evidence. Preventive measures are suggested and the relevant medico-legal considerations are outlined.

Porphyromonas gingivalis is a Strong Risk Factor for Alzheimer's Disease.

Porphyromonas gingivalis (P. gingivalis) is one of the several important bacterial pathogens associated with the sporadic Alzheimer's disease (AD). Different serotypes are either capsulated or are non-capsulated. It has been demonstrated that P. gingivalis (non-capsulated) can reproduce the neurodegenerative AD-like changes in vitro, and a capsular P. gingivalis (strain W83) could reproduce the cardinal hallmark lesions of AD in a wild-type mouse model. All P. gingivalis forms express proteolytically active proteases that enable cleavage of the amyloid-ß protin precursor (AßPP) and tau resulting in the formation of amyloid-ß and neurofibrillary tangles. Tau is an established substrate for gingipains, which can cleave tau into various peptides. Some of the P. gingivalis fragmented tau protein peptides contain "VQIINK" and "VQIVYK" hexapeptide motifs which map to the flanking regions of the microtubule binding domains and are also found in paired helical filaments that form NFTs. P. gingivalis can induce peripheral inflammation in periodontitis and can also initiate signaling pathways that activate kinases, which in turn, phosphorylate neuronal tau. Periodontal disease related inflammation has metabolic implications for an individual's peripheral and brain health as patients suffering from generalized periodontitis often have related co-morbidities and are "at risk" of developing AD. The aim here is to discuss the role of P. gingivalis behind such associations with the backdrop of huge efforts to test P. gingivalis virulence factors clinically (GAIN Trial: Phase 2/3 Study of COR388 in Subjects with AD) with inhibitors, which may lead to an intervention by reducing the pathogenic bacterial load.