Periodontitis and Outer Retinal Thickness: a Cross-Sectional Analysis of the United Kingdom Biobank Cohort.

Purpose: Periodontitis, a ubiquitous severe gum disease affecting the teeth and surrounding alveolar bone, can heighten systemic inflammation. We investigated the association between very severe periodontitis and early biomarkers of age-related macular degeneration (AMD), in individuals with no eye disease. Design: Cross-sectional analysis of the prospective community-based cohort United Kingdom (UK) Biobank. Participants: Sixty-seven thousand three hundred eleven UK residents aged 40 to 70 years recruited between 2006 and 2010 underwent retinal imaging. Methods: Macular-centered OCT images acquired at the baseline visit were segmented for retinal sublayer thicknesses. Very severe periodontitis was ascertained through a touchscreen questionnaire. Linear mixed effects regression modeled the association between very severe periodontitis and retinal sublayer thicknesses, adjusting for age, sex, ethnicity, socioeconomic status, alcohol consumption, smoking status, diabetes mellitus, hypertension, refractive error, and previous cataract surgery. Main Outcome Measures: Photoreceptor layer (PRL) and retinal pigment epithelium-Bruch's membrane (RPE-BM) thicknesses. Results: Among 36 897 participants included in the analysis, 1571 (4.3%) reported very severe periodontitis. Affected individuals were older, lived in areas of greater socioeconomic deprivation, and were more likely to be hypertensive, diabetic, and current smokers (all P < 0.001). On average, those with very severe periodontitis were hyperopic (0.05 ± 2.27 diopters) while those unaffected were myopic (-0.29 ± 2.40 diopters, P < 0.001). Following adjusted analysis, very severe periodontitis was associated with thinner PRL (-0.55 µm, 95% confidence interval [CI], -0.97 to -0.12; P = 0.022) but there was no difference in RPE-BM thickness (0.00 µm, 95% CI, -0.12 to 0.13; P = 0.97). The association between PRL thickness and very severe periodontitis was modified by age (P < 0.001). Stratifying individuals by age, thinner PRL was seen among those aged 60 to 69 years with disease (-1.19 µm, 95% CI, -1.85 to -0.53; P < 0.001) but not among those aged < 60 years. Conclusions: Among those with no known eye disease, very severe periodontitis is statistically associated with a thinner PRL, consistent with incipient AMD. Optimizing oral hygiene may hold additional relevance for people at risk of degenerative retinal disease. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A novel method for the remote measurement of trismus in clinical trials using mobile phone cameras.

OBJECTIVE: To evaluate the reliability and validity of a novel method for remotely measuring trismus. MATERIALS AND METHODS: We recruited 60 volunteers who took three types of photographs at a fixed restricted jaw position mimicking limited mouth opening, including one selfie and one portrait with or without a reference frame. Additionally, the interincisal distance and the width of the upper central incisors were measured with a ruler, as per common practice. Measurements of trismus were made using image analysis software comparing different types of photos and calibration methods. Intraclass correlation coefficient (ICC) and 95% limits of agreement (LoA) with 95% confidence interval were calculated to evaluate reliability and validity. RESULTS: The proposed method demonstrated high reliability (ICC 0.998; 95% CI 0.997, 0.999). Calibration of photographs using at least a baseline photograph with an external reference frame yielded unbiased measurements and minimised variability. The use of selfies compared to portrait photos also increased variability. CONCLUSION: The measurement of trismus can be performed using images taken remotely by patients using their mobile phone cameras. The proposed method is highly accurate, with best results obtained by using a reference frame for calibration of portrait photographs. CLINICAL RELEVANCE: We propose an easy, cheap, and accurate method that allows for remote and frequent monitoring of trismus in clinical studies using patients' mobile phones.

Continuous real-time biofeedback in orthosis improves partial weight bearing on stairs.

INTRODUCTION: Climbing up and down stairs with crutches is a particular challenge. The current study evaluates a commercially available insole orthosis device for weighing an affected limb and for biofeedback training of gait. This study was done on healthy, asymptomatic individuals before applying to the intended postoperative patient. The outcomes should demonstrate whether a continuous real-time biofeedback (BF) system is more effective on stairs than the current protocol involving a bathroom scale. MATERIALS AND METHODS: 59 healthy test subjects received both crutches and an orthosis and learned to apply a 3-point gait with a partial load of 20 kg using a bathroom scale. Thereafter, the participants were asked to complete an up-and-down course, first without (control group) and then with (test group) an audio-visual real-time biofeedback (BF). Compliance was evaluated using an insole pressure measurement system. RESULTS: Using the conventional therapy technique, 36.6% of the steps up and 39.1% of the steps down in the control group were loaded with < 20 kg. By activating continuous biofeedback, steps with < 20 kg could be increased significantly to 61.1% upstairs (p < 0.001) and 66.1% downstairs (p < 0.001). All subgroups profited from the BF system, independent of age, gender, side relieved, dominant or non-dominant side. CONCLUSIONS: Traditional training without biofeedback led to poor performance for partial weight bearing on stairs, even among young and healthy individuals. However, continuous real-time biofeedback clearly improved compliance, indicating its potential to enhance training and support future research in patient populations.

Periodontal health and patient-reported outcomes: A longitudinal analysis of data from non-specialist practice settings.

AIM: To explore the associations between periodontal health and patient-reported outcomes (PROs), accounting for changes over time, in a large, non-specialist dental practice patient cohort. MATERIALS AND METHODS: This longitudinal study used data from 13,162 dentate patients, collected by 162 dentists at routine appointments between May 2013 and April 2020, in 238 non-specialist dental practices across the United Kingdom. Dentists collected data, as part of routine clinical care, on periodontal probing pocket depths, alveolar bone loss, bleeding on probing, as well as a range of covariates. Patients inputted data on outcomes (oral pain/discomfort, dietary restrictions, and dental appearance). Mixed-effects logistic regression analysis was used to investigate the associations between periodontal health and PROs. Models accounted for clustering at the patient and dentist level and were adjusted for time and variables which were thought to confound these associations. RESULTS: The odds of all PROs tended to increase with worsening periodontal parameters. For example, the odds of reporting pain in the worst periodontal health category were 1.99 (95% confidence interval: 1.57-2.53) times higher than in the best periodontal health category. CONCLUSIONS: This study confirms, using a large longitudinal dataset from a unique non-specialist setting, the associations between poorer periodontal health and poorer PROs.

Outcomes of periodontal therapy in rheumatoid arthritis: The OPERA feasibility randomized trial.

AIM: Periodontitis is independently associated with rheumatoid arthritis (RA); however, there is limited data on whether periodontal treatment improves overall RA disease activity. We conducted a pilot feasibility randomized controlled clinical trial to test whether intensive periodontal therapy reduces RA disease activity in patients with active RA and periodontitis. MATERIALS AND METHODS: The following inclusion criteria were applied: patients with RA and periodontitis, aged 18+, stable on treatment with disease-modifying anti-rheumatic drugs for ≥3 months, disease activity score (DAS28) ≥3.2, and DAS28 >5.1 only if patient unwilling to take biologics. Participants meeting the inclusion criteria were randomized to immediate intensive periodontal therapy or to delayed therapy (control group) administered by a dental hygienist in a secondary care setting. Data were collected at baseline and at 3 and 6 months of follow-up. Participants randomized to the control group (delayed therapy) received the standard of care for the duration of the trial, including oral hygiene instructions delivered by a dental hygienist, and the same periodontal therapy as the intervention group after study completion (i.e., 6 months after randomization). The periodontal inflammation surface area was calculated using clinical attachment loss (CAL), periodontal probing pocket depth, and bleeding on probing. Cumulative probing depth was also measured. We examined the effect of periodontal therapy on periodontal outcomes and on clinical markers of disease activity in RA, as measured by the DAS28-C-reactive protein score as well as musculo-skeletal ultrasound grey scale and power Doppler scores. RESULTS: A total of 649 patients with RA were invited to participate in the study. Of these, 296 (46%) consented to participate in the screening visit. A sample of 201 patients was assessed for eligibility, of whom 41 (20%) did not meet the RA inclusion criteria and 100 (50%) did not meet the periodontal disease criteria. Among the 60 (30%) eligible participants, 30 were randomized to immediate periodontal therapy and 30 were allocated to the control group. The loss to follow-up was 18% at the end of the trial. There were no major differences with regard to baseline characteristics between the groups. Periodontal therapy was associated with reduced periodontal inflamed surface area, cumulative probing depths, RA disease activity scores, and ultrasound scores over the course of the trial. There was no change in CAL. CONCLUSIONS: Overall, the trial was feasible and acceptable to the study participants. Recruitment to and satisfactory retention in a randomized controlled trial on the effect of periodontal treatment on RA patients is possible, albeit challenging. In this feasibility study of patients with RA and periodontitis, periodontal treatment resulted in significant improvements in periodontal disease outcomes and overall RA disease activity, although complete resolution of periodontal inflammation was difficult to achieve in some cases.

SARS-CoV-2 Spike- and Nucleoprotein-Specific Antibodies Induced After Vaccination or Infection Promote Classical Complement Activation.

Antibodies specific for the spike glycoprotein (S) and nucleocapsid (N) SARS-CoV-2 proteins are typically present during severe COVID-19, and induced to S after vaccination. The binding of viral antigens by antibody can initiate the classical complement pathway. Since complement could play pathological or protective roles at distinct times during SARS-CoV-2 infection we determined levels of antibody-dependent complement activation along the complement cascade. Here, we used an ELISA assay to assess complement protein binding (C1q) and the deposition of C4b, C3b, and C5b to S and N antigens in the presence of antibodies to SARS-CoV-2 from different test groups: non-infected, single and double vaccinees, non-hospitalised convalescent (NHC) COVID-19 patients and convalescent hospitalised (ITU-CONV) COVID-19 patients. C1q binding correlates strongly with antibody responses, especially IgG1 levels. However, detection of downstream complement components, C4b, C3b and C5b shows some variability associated with the subject group from whom the sera were obtained. In the ITU-CONV, detection of C3b-C5b to S was observed consistently, but this was not the case in the NHC group. This is in contrast to responses to N, where median levels of complement deposition did not differ between the NHC and ITU-CONV groups. Moreover, for S but not N, downstream complement components were only detected in sera with higher IgG1 levels. Therefore, the classical pathway is activated by antibodies to multiple SARS-CoV-2 antigens, but the downstream effects of this activation may differ depending the disease status of the subject and on the specific antigen targeted.

Cell Retention as a Viable Strategy for PHA Production from Diluted VFAs with Bacillus megaterium.

The production of biodegradable and biocompatible materials such as polyhydroxyalkanoates (PHAs) from waste-derived volatile fatty acids (VFAs) is a promising approach towards implementing a circular bioeconomy. However, VFA solutions obtained via acidification of organic wastes are usually too diluted for direct use in standard batch or fed-batch processes. To overcome these constraints, this study introduces a cell recycle fed-batch system using Bacillus megaterium uyuni S29 for poly(3-hydroxybutyrate) (P3HB) production from acetic acid. The concentrations of dry cell weight (DCW), P3HB, acetate, as well as nitrogen as the limiting substrate component, were monitored during the process. The produced polymer was characterized in terms of molecular weight and thermal properties after extraction with hypochlorite. The results show that an indirect pH-stat feeding regime successfully kept the strain fed without prompting inhibition, resulting in a dry cell weight concentration of up to 19.05 g/L containing 70.21% PHA. After appropriate adaptations the presented process could contribute to an efficient and sustainable production of biopolymers.

Exploring periodontitis misclassification mechanisms under partial-mouth protocols.

AIM: To investigate the sources of periodontitis misclassification under partial-mouth protocols (PMPs) and to explore possible approaches to enhancing protocol validity. MATERIALS AND METHODS: Using data from 10,680 adults with 244,999 teeth from the National Health and Nutrition Examination Survey, we compared tooth-, site-, and quadrant-specific periodontal parameters and case identification under full-mouth protocols and PMPs. Separately, we utilized population measures of tooth-specific periodontal severity to generate PMPs with tooth selection based on the population ranking of clinical severity and assessed the sensitivity of case identification. RESULTS: Symmetry of clinical severity was generally confirmed, with the exception of lingual inter-proximal sites, which yielded greater sensitivity in identifying periodontitis compared to buccal sites due to more severe pocketing and attachment loss on average. Misclassification of severe periodontitis occurred more frequently under commonly implemented PMPs compared to ranking-based selection of teeth, which yielded sensitivity estimates of 70.1%-79.4% with the selection of 8 teeth and reached 90% with the selection of only 14 teeth. CONCLUSIONS: Clinical symmetry and sources of periodontitis misclassification were confirmed. The proposed selection of teeth based on population rankings of clinical severity yielded optimal sensitivity estimates for the detection of severe periodontitis and may present a favourable alternative to current options.

Prognostic performance of the 2017 World Workshop classification on staging and grading of periodontitis compared with the British Society of Periodontology's implementation.

BACKGROUND: The British Society of Periodontology (BSP) implemented a simplified version of the 2017 World Workshop Classification (WWC) on staging and grading of periodontitis, for use in UK clinical practice. The aim of this study was to assess the long-term (>10 years) prognostic capability of BSP's implementation (BSP-i) compared with the 2017 WWC, using periodontal-related tooth loss (TLP) as a disease outcome. METHODS: Data on medical history, smoking status, and clinical periodontal parameters were retrieved from 270 patients who received non-surgical and surgical periodontal therapy from 1966 to 2007. Each patient received a baseline diagnosis according to the 2017 WWC and the BSP-i guidelines for implementation. Univariate multilevel Cox regression frailty models were performed to analyze the association between variables with TLP. A post-hoc comparison with Bonferroni correction was performed to analyze interclass comparisons. The prognostic performance of both systems was analyzed using Harrell C index. RESULTS: The prognostic performance of both systems was very similar (0.922 for the 2017 WWC and 0.925 for the BSP-i). The singular prognostic performance of BSP stage was slightly higher than that of 2017 WWC stage (0.9212 versus 0.9188), while the 2017 WWC grade showed a slightly better performance than BSP grade (0.9175 versus 0.9155). BSP-i's extent performed better than the 2017 WWC extent (0.9203 versus 0.9098); however, in the 2017 WWC extent, the class "localized" was associated with a better prognosis than "generalized." CONCLUSION: The overall prognostic performance of the two systems was excellent, with both systems having a Harrell C index score of >0.92.

Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK).

BACKGROUND: Risk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain. METHODS: We undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19. RESULTS: We recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0-30.0 kg/m2 and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2 versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use. CONCLUSIONS: After rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04330599).

Influence of soft tissue augmentation procedures around dental implants on marginal bone level changes-A systematic review.

OBJECTIVES: This systematic review assessed the influence of soft tissue augmentation procedures on marginal bone level changes in partial or fully edentulous patients. MATERIAL AND METHODS: We identified three relevant PICO questions related to soft tissue augmentation procedures and conducted a systematic search of four major electronic databases for clinical studies in systemically healthy patients receiving at least one dental implant and a minimum follow-up of one year after implant placement. The primary outcome was mean difference in marginal bone levels, and secondary outcomes were clinical and patient-related outcomes such as thickness of peri-implant mucosa, bleeding indices, and Pink Esthetic Score. RESULTS: We identified 20 publications reporting on 16 relevant comparisons. Studies varied considerably and thus only two meta-analyses could be performed. This systematic review showed that: Soft tissue augmentation either for augmentation of keratinized mucosa or soft tissue volume inconsistently had an effect on marginal bone level changes when compared to no soft tissue augmentation, but consistently improved secondary outcomes. The combination soft and hard tissue augmentation showed no statistically significant difference in terms of marginal bone level changes when compared to hard tissue augmentation alone, but resulted in less marginal soft tissue recession as shown by a meta-analysis. Soft or hard tissue augmentation performed as contour augmentations resulted in comparable marginal bone level changes. CONCLUSIONS: Peri-implant soft and hard tissues seem to have a bidirectional relationship: "Bone stands hard, but soft tissue is the guard".

Bioplastics and Carbon-Based Sustainable Materials, Components, and Devices: Toward Green Electronics.

The continuously growing number of short-life electronics equipment inherently results in a massive amount of problematic waste, which poses risks of environmental pollution, endangers human health, and causes socioeconomic problems. Hence, to mitigate these negative impacts, it is our common interest to substitute conventional materials (polymers and metals) used in electronics devices with their environmentally benign renewable counterparts, wherever possible, while considering the aspects of functionality, manufacturability, and cost. To support such an effort, in this study, we explore the use of biodegradable bioplastics, such as polylactic acid (PLA), its blends with polyhydroxybutyrate (PHB) and composites with pyrolyzed lignin (PL), and multiwalled carbon nanotubes (MWCNTs), in conjunction with processes typical in the fabrication of electronics components, including plasma treatment, dip coating, inkjet and screen printing, as well as hot mixing, extrusion, and molding. We show that after a short argon plasma treatment of the surface of hot-blown PLA-PHB blend films, percolating networks of single-walled carbon nanotubes (SWCNTs) having sheet resistance well below 1 kΩ/□ can be deposited by dip coating to make electrode plates of capacitive touch sensors. We also demonstrate that the bioplastic films, as flexible dielectric substrates, are suitable for depositing conductive micropatterns of SWCNTs and Ag (1 kΩ/□ and 1 Ω/□, respectively) by means of inkjet and screen printing, with potential in printed circuit board applications. In addition, we exemplify compounded and molded composites of PLA with PL and MWCNTs as excellent candidates for electromagnetic interference shielding materials in the K-band radio frequencies (18.0-26.5 GHz) with shielding effectiveness of up to 40 and 46 dB, respectively.

Providing sealants at the general anaesthetic assessment visit for children requiring caries-related dental extractions under general anaesthetic: a pilot randomised controlled trial.

Introduction Children experiencing a caries-related dental general anaesthetic (GA) are at high risk of developing new caries. It is thus important to maximise opportunities for prevention.Aim To undertake a pilot randomised controlled clinical trial (RCT) to assess the feasibility of delivering and evaluating the effectiveness of sealing sound permanent molars at the pre-GA assessment appointment in children needing caries-related extractions under GA.Methods Children (5-15 years) scheduled for GA extractions at Birmingham Dental Hospital were randomised to control or sealant groups. At the pre-GA assessment appointment, sound permanent molars were sealed. Participants were followed up at two years.Results In total, 132 children were assessed for eligibility and 100 randomised (50 control, 50 sealant). Forty-nine children in the intervention group had sealants applied. At two years, 82 children returned for follow-up (43 control, 39 sealant). Sealants were retained on 93.5% (244/261) of surfaces sealed at baseline. Overall, 42% (n = 18) of control group participants had dentine caries in at least one permanent molar that was sound at baseline compared with none in the sealant group.Conclusion Following caries-related extractions under GA, children are at high risk of developing new caries in permanent molars that were sound at the time of the GA. Sealant placement during the pre-GA assessment visit is feasible and may reduce caries incidence in this vulnerable group. High-risk families were found to be reliable study participants.

Waste-derived volatile fatty acids as carbon source for added-value fermentation approaches.

The establishment of a sustainable circular bioeconomy requires the effective material recycling from biomass and biowaste beyond composting/fertilizer or anaerobic digestion/bioenergy. Recently, volatile fatty acids attracted much attention due to their potential application as carbon source for the microbial production of high added-value products. Their low-cost production from different types of wastes through dark fermentation is a key aspect, which will potentially lead to the sustainable production of fuels, materials or chemicals, while diminishing the waste volume. This article reviews the utilization of a volatile fatty acid platform for the microbial production of polyhydroxyalkanoates, single cell oil and omega-3 fatty acids, giving emphasis on the fermentation challenges for the efficient implementation of the bioprocess and how they were addressed. These challenges were addressed through a research project funded by the European Commission under the Horizon 2020 programme entitled 'VOLATILE-Biowaste derived volatile fatty acid platform for biopolymers, bioactive compounds and chemical building blocks'.

Oxidative stress links periodontal inflammation and renal function.

AIMS: Patients with chronic kidney disease (CKD) are also susceptible to periodontitis. The causal link between periodontitis and CKD may be mediated via systemic inflammation/oxidative stress. Using structural equation modelling (SEM), this cross-sectional study aimed to explore the causal relationship between periodontal inflammation (PI) and renal function. MATERIALS AND METHODS: Baseline data on 770 patients with stage 3-5 (pre-dialysis) CKD from an ongoing cohort study were used. Detailed, bioclinical data on PI and renal function, as well as potential confounders and mediators of the relationship between the two, were collected. SEMs of increasing complexity were created to test the causal assumption that PI affects renal function and vice versa. RESULTS: Structural equation modelling confirmed the assumption that PI and renal function are causally linked, mediated by systemic oxidative stress. The magnitude of this effect was such that a 10% increase in PI resulted in a 3.0% decrease in renal function and a 10% decrease in renal function resulted in a 25% increase in PI. CONCLUSIONS: Periodontal inflammation represents an occult source of oxidative stress in patients with CKD. Further clinical studies are needed to confirm whether periodontal therapy, as a non-pharmacological approach to reducing systemic inflammatory/oxidative stress burden, can improve outcomes in CKD.

Patient acceptability of targeted risk-based detection of non-communicable diseases in a dental and pharmacy setting.

BACKGROUND: Non-communicable diseases [NCDs] are the major cause of mortality globally and are increasing in prevalence. Different healthcare professionals' access different population groups; and engaging allied healthcare professionals in risk-driven early case detection of certain NCDs may be beneficial, especially those who have not been tested for NCDs within the previous 12 months. The objectives of this study were to determine: whether NCD case finding in dental/community pharmacy settings is feasible in terms of patient acceptability, barriers to recruitment, impact on the existing service. Determine time taken to test for: type 2 diabetes risk [T2DM], chronic obstructive pulmonary disease [COPD], hypertension, vitamin D deficiency and chronic kidney disease [CKD]. Determine whether there is added benefit of point of care testing [POCT] to identify diabetes risk compared to a validated screening questionnaire alone. METHODS: An exploratory study was undertaken to explore issues associated with NCD assessment in one dental practice and one community pharmacy within the West-Midlands, UK. Fifty patients > 40 years-of-age were recruited per site. Participants undertook: a questionnaire providing demographic data, any previous NCD diagnosis or positive family history. Validated questionnaires for determining NCD risk [T2DM/COPD]. Chair-side capillary blood [finger-prick] samples for HbA1C, creatinine/eGFR, Vitamin-D. Prior work had been undertaken to measure the agreement between point of care testing [POCT] devices and a central laboratory method, and to gauge the opinions of participants regarding discomfort experienced using venous (antecubital fossa) and capillary (finger-prick) blood collection, via a 10 cm Visual-Analogue-Scale. The POCT devices demonstrated good concordance with laboratory testing and were acceptable methods of blood collection for participants. RESULTS: Recruitment rates demonstrated that 8 days were needed to recruit 50 participants and 60% of those approached opted to participate. The principal barrier to participation was time, with average time taken to test being 19mins. Utilising dental and pharmacy settings identified potential cases of previously undiagnosed disease. CONCLUSIONS: Risk-targeted testing for NCDs in high street dental and community pharmacies is both attractive and acceptable to patients.

Extraction force and its determinants for minimally invasive vertical tooth extraction.

BACKGROUND: Minimally invasive vertical extraction devices have been developed to minimise the need for flap surgery and trauma to alveolar bone during tooth extraction. The objective of this study was to measure the forces required for vertical tooth extraction and evaluate the determinants of these forces. METHODS: The investigators coupled a precision load cell with a Benex® extractor to record extraction forces for 59 consecutive routine extractions of tooth roots. Age, sex, tooth type, root surface attachment area (RSAA) and whether or not the tooth was in functional occlusion were evaluated as determinants of extraction forces using linear mixed models. RESULTS: Maximum extraction forces (Fmax) varied widely from 41N to 629N. On average, maximum extraction forces were 104N (95% CI: 38N, 169N) higher for teeth/roots in occlusion vs. teeth not in occlusion. An increase in RSSA by one standard deviation was associated with a marked increase in Fmax by 64N (95% CI: 34N, 94N). Extraction forces were not associated with age, sex or tooth type (maxillary vs. mandibular). CONCLUSIONS: Extraction forces using the Benex® vertical extraction system vary widely and can be less than 50N or exceed 600N. On average, higher extraction forces are required to extract teeth with longer and thicker roots, as well as for teeth that are in functional occlusion.

Periodontitis and cardiovascular diseases: Consensus report.

BACKGROUND: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease. MATERIAL AND METHODS: There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations RESULTS AND CONCLUSIONS: The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.