Systemic Health Characteristics and Self-Reported Xerostomia among Nursing Facility Residents in Iowa-US and Sao Paulo-Brazil / Saúde Sistêmica e Xerostomia Auto-Reporada entre Residentes em Instituições de Longa Permanência em Iowa-EUA e São Paulo-Brasil

Objective: To describe and compare potential differences in systemic health characteristics and xerostomia among residents in American and Brazilian nursing facilities (NF). Material and Methods: This secondary analysis used data from a study in NF located in Iowa-USA (n=81) and Sao Paulo (SP)-Brazil (n=119). Recorded data included demographics, medications, comorbid conditions, and self-reported xerostomia. Results: The Iowa group mean age was 82.1 years (±12.9), 60.5% were females, and 100% were white, whereas the SP group mean age was 76.4 years (±8.7), 47.9% females, most participants identified as either white (42.0%) or as more than one race (45.4%). The median number of comorbid conditions and medications in the Iowa were 9 and 12, respectively, as compared to 2 and 6 in SP. Most common comorbidities in Iowa were hypertension, dementia (including Alzheimer), and depression. In SP, they were hypertension, unspecified diabetes mellitus (including type 2), and Parkinson. Most common prescription medications in Iowa were acetaminophen, acetylsalicylic acid, and magnesium hydroxide, while in SP, they were omeprazole, acetylsalicylic acid, and losartan. Xerostomia was reported by 32.1% (Iowa) and 59.7% (SP) of the participants. There was no association between age and dry mouth sensation in either Iowa (p=0.480) or SP (p=0.130) samples. However, there was an association between total medications and dry mouth sensation in Iowa (p=0.040), but not in SP (p=0.075) Conclusions: Iowans presented with higher numbers of comorbidities and prescription medications, however xerostomia was reported in a greater percentage in SP. Xerostomia was associated to higher number of medications in Iowa, but not in SP.(AU)

Objetivo: Descrever e comparar possíveis diferenças nas características de saúde sistêmica e xerostomia entre residentes em instituições de longa permanência (ILP) americanas e brasileiras. Materiais e Métodos: Esta análise utilizou dados de um estudo em ILPs localizadas em Iowa/EUA (n = 81) e São Paulo/Brasil (n = 119). Os dados avaliados incluíram dados demográficos, medicamentos, comorbidades e xerostomia autoreportada. Resultados: A idade média do grupo de Iowa foi de 82,1 anos (± 12,9), 60,5% eram do sexo feminino e 100% eram brancos, enquanto a idade média do grupo SP foi de 76,4 anos (± 8,7), 47,9% do sexo feminino, a maioria dos participantes identificados como brancos ( 42,0%) ou como mais de uma raça (45,4%). A média do número de comorbidades e medicamentos em Iowa foi de 9 e 12, respectivamente, em comparação com 2 e 6 em SP. Comorbidades mais comuns em Iowa foram hipertensão, demência (incluindo Alzheimer) e depressão. Em SP, foram hipertensão, diabetes mellitus (incluindo o tipo 2) e Parkinson. Os medicamentos de prescrição mais comuns em Iowa eram acetaminofeno, ácido acetilsalicílico e hidróxido de magnésio, enquanto em SP, foram omeprazol, ácido acetilsalicílico e losartana. A xerostomia foi reportada por 32,1% dos participantes em Iowa e 59,7% em SP. Não houve associação entre idade e sensação de boca seca nas amostras de Iowa (p = 0,480) ou SP (p = 0,130). No entanto, houve associação entre o total de medicamentos e a sensação de boca seca em Iowa (p= 0,040), mas não em SP (p = 0,075). Conclusões: Os residentes de Iowa apresentaram maior número de comorbidades e prescrição de medicamentos, porém a xerostomia foi relatada em maior percentual em SP. A xerostomia foi associada ao maior número de medicamentos em Iowa, mas não em SP.(AU)

Iowa nursing facility oral hygiene (INFOH) intervention: A clinical and microbiological pilot randomized trial.

PURPOSE/AIM: The aim of this pilot study was to evaluate feasibility and gather initial data for a definitive study to test the clinical and microbiological effectiveness of a nursing facility (NF) customized oral hygiene protocol, intended to be delivered by dental hygienists and NF personnel. MATERIALS AND METHODS: A convenience sample of 8 Eastern Iowa NFs was recruited, and each NF was assigned to one of three intervention groups: (1) control (current oral hygiene practice), (2) educational program only, and (3) educational program plus 1% chlorhexidine varnish monthly application. Demographic information, systemic health data, patient centered data, oral health data, and microbiology samples were collected at baseline and after 6 months. RESULTS: Recruitment response rates were 21% for NFs and 23% for residents. A total of 81 residents were examined at baseline and of those, 49 were examined at 6 months (39.5% attrition). There were no statistically or clinically significant differences among the intervention groups at 6 months for any of the recorded clinical or microbiological outcomes. CONCLUSIONS: Recruitment and retention posed a significant challenge to this trial, even with a relatively short observation period. Results from this pilot study did not encourage further investigation of this customized oral hygiene protocol.

Novel biomarkers of periodontitis and/or obesity in saliva-An exploratory analysis.

OBJECTIVE: Recent studies point to the clinical and research utility of saliva as a valuable diagnostic aid for monitoring periodontal health. The objectives of this study were to detect novel biomarkers attributed to chronic inflammation in saliva and to determine if the levels of these markers correlate with severity of periodontitis and with standard obesity measures in participants in a periodontal maintenance program. DESIGN: In this cross-sectional assessment of 63 participants, unstimulated whole saliva was collected after recording anthropometric and clinical parameters of obesity and periodontitis, respectively. The levels of interleukin-1 receptor antagonist (IL-1ra), sCD40L, granzyme B and alpha-fetoprotein (AFP) in saliva were determined using multiplex proteomic immunoassays. The correlation between the four tested biomarker concentrations and obesity/periodontal measures was determined. RESULTS: Positive correlation between fat% and granzyme B levels (r=0.292; p=0.020) and negative correlation between BMI and sCD40L (r=0.256; p=0.043) was observed. In addition, positive correlation between severity of periodontal disease and levels of IL1-ra (r=0.253; p=0.046) and negative correlation between periodontitis severity and sCD40L salivary levels (r=0.272; p=0.031) was noted. None of the above correlations remained statistically significant after multiple comparisons adjustment. After adjustment for clinical covariates, the relationship between sCD40L and periodontal severity remained suggestive (p=0.081). CONCLUSIONS: Levels of four novel biomarkers of periodontitis were detectable in saliva of subjects enrolled in a periodontal maintenance program. Prospective studies with larger sample sizes and other populations are warranted to explore the diagnostic applicability of these markers.

A cross-sectional assessment of biomarker levels around implants versus natural teeth in periodontal maintenance patients.

BACKGROUND: Recent studies point to the clinical utility of using peri-implant sulcular fluid (PISF) as a valuable diagnostic aid for monitoring peri-implant tissue health. The objectives of this study are to determine the levels of key biomarkers in PISF in periodontal maintenance participants and compare them with their corresponding levels in gingival crevicular fluid (GCF) obtained from the same participants. METHODS: PISF and GCF were collected from an implant and a contralateral natural tooth after the clinical examination of 73 participants. The levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17A, tumor necrosis factor (TNF)-α, C-reactive protein, osteoprotegerin, leptin, and adiponectin were determined using multiplex proteomic immunoassays. The correlation of biomarker concentrations between GCF versus PISF, within GCF or PISF, and with several covariates (age, brushing frequency, days since professional cleaning, probing depth [PD], and plaque index) were also determined. RESULTS: Significantly higher levels of IL-17A (P = 0.02) and TNF-α (P = 0.03) were noted in PISF when compared with their levels in GCF. Significant positive correlations were noted between the concentrations of cytokines in PISF versus their levels in GCF. Among the covariates, a significant positive correlation was noted between mean PDs around implants and levels of IL-1ß (P <0.05) and IL-8 (P <0.05) in PISF. CONCLUSION: The results of this study point to the differential expression of specific biomarkers in GCF versus their levels in PISF in periodontal maintenance patients, which is critical information before establishing PISF as a diagnostic fluid to monitor peri-implant health.

Comparison of pro-inflammatory cytokines and bone metabolism mediators around titanium and zirconia dental implant abutments following a minimum of 6 months of clinical function.

OBJECTIVES: Dental implant abutments are fundamental prosthetic components within dentistry that require optimal biocompatibility. The primary aim of this cross-sectional study was to preliminarily assess differences in the pro-inflammatory cytokine and bone metabolism mediator protein expression in the peri-implant crevicular fluid (PICF) adjacent to transmucosal abutments. MATERIAL AND METHODS: Abutments were fabricated from either titanium or zirconia in patients previously receiving single-tooth implant therapy. All subjects sampled in this study had an identical implant system and implant-abutment connection. Participants (n = 46) had an average time of clinical function for 22 months (6.2-72.8 months, ±SD 17 months) and received a clinical and radiographic examination of the implant site at the time of PICF sampling using a paper strip-based sampling technique. Cytokine, chemokine, and bone metabolism mediator quantities (picograms/30 s) were determined using a commercial 22-multiplexed fluorescent bead-based immunoassay instrument. A total of 19 pro-inflammatory cytokines and seven bone metabolism mediators were evaluated. RESULTS: Multivariable analyses provided no evidence of a group (titanium or zirconia), gender, or age effect with regard to the expression of pro-inflammatory mediators evaluated. Significant (P = 0.022) differences were observed for the bone mediator leptin, with titanium abutments demonstrating significantly elevated levels in comparison with zirconia. Osteopontin demonstrated a significant (P = 0.0044) correlation with age of the subjects. CONCLUSIONS: No significant differences in pro-inflammatory cytokine or bone metabolism mediator profiles were observed biochemically, with the exception of leptin, for the abutment biomaterials of titanium or zirconia The molecular PICF findings support the observed clinical biocompatibility of both titanium and zirconia abutments.

Body fat indices and biomarkers of inflammation: a cross-sectional study with implications for obesity and peri-implant oral health.

PURPOSE: To examine the relationships between three measures of body fat-body mass index (BMI), waist circumference (WC), and total body fat percent-and markers of inflammation around dental implants in stable periodontal maintenance patients. MATERIALS AND METHODS: Seventy-three subjects were enrolled in this cross-sectional assessment. The study visit consisted of a physical examination that included anthropologic measurements of body composition (BMI, WC, body fat %); intraoral assessments were performed (full-mouth plaque index, periodontal and peri-implant comprehensive examinations) and peri-implant sulcular fluid (PISF) was collected on the study implants. Levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17, tumor necrosis factor-α, C-reactive protein, osteoprotegerin, leptin, and adiponectin in the PISF were measured using multiplex proteomic immunoassays. Correlation analysis with body fat measures was then performed using appropriate statistical methods. RESULTS: After adjustments for covariates, regression analyses revealed statistically significant correlation between IL-1ß in PISF and WC (R = 0.33; P = .0047). CONCLUSION: In this study in stable periodontal maintenance patients, a modest but statistically significant positive correlation was observed between the levels of IL-1ß, a major proinflammatory cytokine in PISF, and WC, a reliable measure of central obesity.

Histatin 5 binds to Porphyromonas gingivalis hemagglutinin B (HagB) and alters HagB-induced chemokine responses.

Histatins are human salivary gland peptides with anti-microbial and anti-inflammatory activities. In this study, we hypothesized that histatin 5 binds to Porphyromonas gingivalis hemagglutinin B (HagB) and attenuates HagB-induced chemokine responses in human myeloid dendritic cells. Histatin 5 bound to immobilized HagB in a surface plasmon resonance (SPR) spectroscopy-based biosensor system. SPR spectroscopy kinetic and equilibrium analyses, protein microarray studies, and I-TASSER structural modeling studies all demonstrated two histatin 5 binding sites on HagB. One site had a stronger affinity with a KD1 of 1.9 µM and one site had a weaker affinity with a KD2 of 60.0 µM. Binding has biological implications and predictive modeling studies and exposure of dendritic cells both demonstrated that 20.0 µM histatin 5 attenuated (p < 0.05) 0.02 µM HagB-induced CCL3/MIP-1α, CCL4/MIP-1ß, and TNFα responses. Thus histatin 5 is capable of attenuating chemokine responses, which may help control oral inflammation.

Defensin DEFB103 bidirectionally regulates chemokine and cytokine responses to a pro-inflammatory stimulus.

Human ß defensin DEFB103 acts as both a stimulant and an attenuator of chemokine and cytokine responses: a dichotomy that is not entirely understood. Our predicted results using an in silico simulation model of dendritic cells and our observed results in human myeloid dendritic cells, show that DEFB103 significantly (p < 0.05) enhanced 6 responses, attenuated 7 responses, and both enhanced/attenuated the CXCL1 and TNF responses to Porphyromonas gingivalis hemagglutinin B (HagB). In murine JAWSII dendritic cells, DEFB103 significantly attenuated, yet rarely enhanced, the Cxcl2, Il6, and Csf3 responses to HagB; and in C57/BL6 mice, DEFB103 significantly enhanced, yet rarely attenuated, the Cxcl1, Csf1, and Csf3 responses. Thus, DEFB103 influences pro-inflammatory activities with the concentration of DEFB103 and order of timing of DEFB103 exposure to dendritic cells, with respect to microbial antigen exposure to cells, being paramount in orchestrating the onset, magnitude, and composition of the chemokine and cytokine response.

Human ß-defensin-3 alters, but does not inhibit, the binding of Porphyromonas gingivalis haemagglutinin B to the surface of human dendritic cells.

Human ß-defensin-3 (HBD3) is a small, cationic, host defence peptide with broad antimicrobial activities and diverse innate immune functions. HBD3 binds to many microbial antigens and, in this study, we hypothesised that the known binding of HBD3 to Porphyromonas gingivalis recombinant haemagglutinin B (rHagB) alters, but does not inhibit, the binding of rHagB to human dendritic cells. To test this, human myeloid dendritic cells were incubated for 5 min with rHagB, HBD3 + rHagB (10:1 molar ratio), HBD3 or 0.1 M phosphate-buffered saline (PBS) (pH 7.2) and were then rapidly fixed and processed for confocal microscopy and ultramicrotomy. rHagB and HBD3 could be detected with primary monoclonal mouse antibody to rHagB (MoAb 1858) or polyclonal rabbit antibody to HBD3 (P241) and secondary fluorescent-labelled anti-mouse or anti-rabbit antibodies (confocal microscopy) or protein A-colloidal gold (immunoelectron microscopy). In cells incubated with rHagB only, fluorescence and protein A-colloidal gold were seen at the cell surface and throughout the cytoplasm. In cells incubated with HBD3+rHagB, fluorescence was observed only at the cell surface in a 'string of pearls' configuration. Overall, these results suggest that HBD3 binding to rHagB alters, but does not inhibit, the binding of rHagB to human myeloid dendritic cells.