Patient-reported understanding and dentist-reported management of periodontal diseases - a survey: do you know what gum disease is?

Introduction Mild-to-moderate gingivitis is treatable by effective toothbrushing with appropriate over-the-counter oral health care products; however, rates remain high.Aim To determine patient knowledge of gingivitis and dentists' views on management.Methods Surveys were completed by dentists and dental hospital patients.Results In total, 224 patients and 50 dentists participated. Clinical health, gingivitis, or periodontitis was detected in 2%, 33% and 56% of patients, respectively; 32% reported never suffering gingival bleeding. Moreover, 74% of patients reported gingival health as very important but only 53.7% with gingivitis occasionally/often were moderately-extremely worried about their symptoms. More than 50% of patients knew gingivitis causes poor oral health but <20% knew it elevated risks of other systemic conditions. Patients thought education on risks associated with poor oral health and product recommendations were most likely, and daily reminders least likely, to improve compliance with oral health advice (OHA). Also, 40% of dentists thought their patients were relatively unaware of the importance of gingival health, 76.9% of their patient-base had gingivitis, and 96% give OHA to these patients but only 30% thought this effected improvement. The most useful tools for improving oral health were better patient knowledge of the consequences and one-to-one instruction.Conclusion Patients struggle to attain oral health following OHA. Education about gingivitis-associated risks might improve OHA compliance.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis.

OBJECTIVES: This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain. STUDY SELECTION: Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions. CONCLUSIONS: Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies. CLINICAL RELEVANCE: This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Clinical trials evaluating desensitising agents. Some design and analysis issues.

INTRODUCTION: The purpose of this short communication is to draw attention to an efficient design for trials to evaluate desensitising agents, and an appropriate statistical analysis. METHODS: Two recent sensitivity trials conducted by the Bristol Dental School Clinical Trials Group are reviewed. RESULTS: The methodology used was effective to establish efficacy of the products evaluated. CONCLUSIONS: This methodology is recommended for wider use. CLINICAL SIGNIFICANCE: Effective clinical trial methodology enables establishment of efficacy of desensitising products leading to patient benefit.

High resolution 16S rRNA gene Next Generation Sequencing study of brain areas associated with Alzheimer's and Parkinson's disease.

Introduction: Alzheimer's (AD) and Parkinson's disease (PD) are neurodegenerative conditions characterized by incremental deposition of ß-amyloid (Aß) and α-synuclein in AD and PD brain, respectively, in relatively conserved patterns. Both are associated with neuroinflammation, with a proposed microbial component for disease initiation and/or progression. Notably, Aß and α-synuclein have been shown to possess antimicrobial properties. There is evidence for bacterial presence within the brain, including the oral pathobiont Porphyromonas gingivalis, with cognitive impairment and brain pathology being linked to periodontal (gum) disease and gut dysbiosis. Methods: Here, we use high resolution 16S rRNA PCR-based Next Generation Sequencing (16SNGS) to characterize bacterial composition in brain areas associated with the early, intermediate and late-stage of the diseases. Results and discussion: This study reveals the widespread presence of bacteria in areas of the brain associated with AD and PD pathology, with distinctly different bacterial profiles in blood and brain. Brain area profiles were overall somewhat similar, predominantly oral, with some bacteria subgingival and oronasal in origin, and relatively comparable profiles in AD and PD brain. However, brain areas associated with early disease development, such as the locus coeruleus, were substantially different in bacterial DNA content compared to areas affected later in disease etiology.

A pilot study to evaluate the impact of digital imaging on the delivery of oral hygiene instruction.

AIMS: To determine whether personalised Oral Hygiene Advice (OHA) using an intra-oral-camera (IOC) combined with standard OHA as provided in general dental practice reduces plaque levels after 4 weeks more than the provision of standard OHA. MATERIALS AND METHODS: 22 healthy adult participants diagnosed with gingivitis took part in this pilot parallel-designed, randomised, examiner-blind, 2x-treatment, study regarding their home-care oral hygiene habits and attitudes to oral health. An IOC-image was taken and plaque, gingival and bleeding scores were recorded. Test group participants received standard OHA with IOC-images to indicate areas for improvement, control group participants received standard OHA. Questionnaires and plaque, gingival and bleeding scores were repeated after 4 weeks. Plaque was scored from the IOC-images and scores compared to clinical plaque scores. RESULTS: Lifestyle habits, attitudes to oral health, plaque (0.63vs0.61, control vs test) and bleeding scores (1.17vs0.96, control vs test) were similar at baseline. After 4-weeks, plaque scores improved more in test as compared to control group (39.4vs20.6%, p<0.05, while gingival and bleeding scores approached significance. There was no difference in lifestyle habits between groups, but the test group reported significantly greater confidence in adhering to their bespoke oral health plan. Agreement between the clinical and IOC plaque scores was good. CONCLUSIONS: Use of IOC further personalises the prevailing standard of oral hygiene advice and generates great patient engagement with pictorial reports to facilitate a more in-depth patient explanation of their gingival health, resulting in significant plaque reduction and improved gingival health compared to the standard OHA alone.

European Federation of Periodontology Survey of Postgraduate and Specialist Training in Europe in 2020.

AIMS: The survey's aim was to establish which universities and other educational organisations deliver postgraduate and specialist training in Periodontology in the 31 countries who are members of the European Federation of Periodontology (EFP) and to obtain details of how these programmes are organised, funded, regulated and evaluated. METHODS: A questionnaire and covering letter were emailed to all national periodontal societies. The questions were on the name of country, official recognition, training programmes, entry to specialist training, specialist training assessment and recognition after completion of training. RESULTS: Twenty-nine (93%) of national periodontal societies responded. Key findings included the following: Periodontology was reported as being recognised at a national level in 17 countries, there was a three-year full-time programme in 12 countries, no fees were charged for specialist training in 10 countries, in 14 countries trainees received annual salaries, end of training (summative) assessments varied from country to country, 12 countries reported that they had a requirement for specialists in Periodontology to complete continuing education to maintain registration as specialists. CONCLUSIONS: This survey has established which universities and other educational organisations deliver postgraduate and specialist training in Periodontology and how these programmes are organised, funded, regulated and evaluated. To provide uniformly high-quality periodontal care for patients in all European countries, further harmonisation of postgraduate and specialty training in Periodontology would be advantageous.

Implementing the 2017 Classification of Periodontal and Peri-Implant Diseases - how are we doing in the South West region of the UK?

Background A new world classification of periodontal diseases and conditions was developed in 2017 and implemented throughout the United Kingdom by the British Society of Periodontology and Implant Dentistry.Method A retrospective audit was undertaken at Bristol Dental Hospital (BDH) (December 2019 to March 2020) to assess uptake of the new classification in referral letters and its implementation by staff. In total, 75 consecutive new patient referrals seen at BDH were manually searched for diagnosis/classification. Additionally, the 75 most recent referrals where both the referring practitioner and BDH staff used the 2017 classification were analysed for agreeability.Results Within South West England, there was a positive uptake of the new classification in general practice, with 85% of referrals using the 2017 periodontal classification. Further, 98% of patients attending BDH for periodontology consultations were diagnosed using the 2017 classification. Results indicate 50.7% and 57.3% agreement for staging and grading, respectively, when comparing consultants to referring clinicians.Discussion The new classification has been widely conveyed to the profession and is being adopted quickly by specialists, general practitioners and dental health professionals. There is an underestimation of both stage and grade by referring practitioners, with 40% of referrals underestimating the stage and 38.7% underestimating the grade.

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health.

AIMS: To determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. MATERIALS AND METHODS: NHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. RESULTS: A total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). CONCLUSIONS: Behaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. CLINICAL SIGNIFICANCE: Plaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.

A randomised controlled trial to compare the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste with a control toothpaste for the prevention of dentine hypersensitivity.

OBJECTIVES: To determine the efficacy of a cosmetic aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for the reduction of dentine hypersensitivity (DH) pain as compared to a control toothpaste containing potassium nitrate. METHODS: The study was a randomised, examiner-blind, two treatment arm, parallel controlled trial in healthy adults with at least 2 sensitive teeth (Schiff >2). At baseline, immediately after treatment and at 7 and 14 days of twice-daily brushing of the test or control toothpaste the sensitivity of 2 test teeth was measured following iced-water (Schiff and VAS) and tactile (Yeaple probe) stimuli, and a whole mouth plaque score was obtained. Participants also completed a whole-mouth VAS and DHEQ15 quality of life questionnaire at baseline, 7 and 14 days. RESULTS: Both toothpastes reduced DH in test teeth, but pain reduction in the test group was significantly better at all timepoints and by all measures (p = 0.005, tooth-level VAS immediately after brushing; p < 0.001 all other comparisons). There was a relative risk reduction of Schiff sensitivity of 55 % immediately after brushing which rose to 81 % after 7 and 88.6 % after 14 days (all p < 0.001). There were no differences in plaque, whole mouth VAS or DHEQ15 scores at any time point. CONCLUSION: This study demonstrated the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste compared to a potassium nitrate control toothpaste for the prevention of dentine hypersensitivity both immediately and over a 2 week period. This agent appears to have potential for pain alleviation from the common oral pain condition of DH and further research is warranted. CLINICAL SIGNIFICANCE: DH pain, whilst transient in nature, is arresting in magnitude, affecting quality of life. Daily application of efficacious toothpastes can relieve DH pain however, as yet, there is no gold standard treatment. The results of this study support further investigation of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for DH management.

Randomised controlled trial of a microneedle patch with a topical anaesthetic for relieving the pain of dental injections.

OBJECTIVES: To determine whether a microneedle patch combined with 5% topical lidocaine reduces dental injection pain more than a patch without microneedles combined with 5% topical lidocaine. METHODS: This proof of principle randomised, two-treatment, double-blind, crossover split-unit design study in 16 healthy participants investigated levels of perceived pain from 3 increasing pain provoking challenges, when topical 5% lidocaine dental gel was applied to the oral mucosa with a microneedle patch and a patch with no microneedles, prior to infiltration with local anaesthesia on 2 visits. Pain was assessed by visual analogue scale (VAS) and 4-point verbal rating scale (VRS). RESULTS: 15 participants completed the study. Mean pain scores, lower at buccal sites, increased in both groups across challenges 1-3: Test palatal 5.1, 11.9, 26.8; buccal 0.7, 2.8, 18.3; Control palatal 12.3, 18.7, 39.5; buccal 4.0, 6.9, 30.6. The microneedle patch plus lidocaine significantly lowered VAS pain scores at both sites for all challenges, the biggest mean difference seen palatally after challenge 3 (12.7, p < 0.001). VRS pain scores were also significantly reduced for test compared to control for all 3 challenges (p = 0.014). Buccal scores favoured the microneedle patch, significantly for pain challenge 3 (p = 0.025). No adverse events occurred. CONCLUSIONS: Prior oral application of a microneedle patch combined with 5% topical lidocaine gel reduced the pain experienced from dental infiltration. Microneedle patch use in the dental setting offers the prospect of improving degree and depth of anaesthesia from topically applied anaesthetic gel, without itself causing any pain. CLINICAL SIGNIFICANCE: Dental injections are associated with fear and anxiety. Application of a microneedle patch, combined with topical anaesthetic, to the oral mucosa prior to delivery of the injection reduces the pain from this dental procedure. This novel technique may allay patients' apprehension of local anaesthesia and improve quality of life outcomes.

Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion.

OBJECTIVES: To compare the effect of bioavailable gluconate-chelated stannous fluoride (SnF2) toothpaste with control toothpastes for treatment of dentine hypersensitivity (DH) and enamel erosion. DATA AND SOURCES: A Procter & Gamble Oral Care archive of clinical studies was reviewed from 2000 to 2020. Eligible studies were Randomised Controlled Trials (RCTs) investigating bioavailable gluconate-chelated SnF2 toothpaste efficacy compared to controls in adult participants measured following tactile (Yeaple force) and/or evaporative stimuli (Schiff score) in-vivo, duration <2 months (DH); or by erosive toothwear (profilometry) from in-situ samples, duration 10-15 days. Two authors independently assessed eligibility and resolved disagreements by discussion. A meta-analysis was undertaken and Risk of Bias (RoB) assessed using the Cochrane collaboration RoB tool for randomized parallel-group and cross-over trials. RESULTS: Fourteen RCTs (1287 participants) assessed DH relief and Six RCTs (184 participants) enamel erosion protection. For DH SnF2 toothpastes provided a 57 % (evaporative air) and 142 % (tactile) benefit versus negative controls (sodium fluoride/monofluorophosphate, 8 studies; p < 0.001). Compared to positive controls (potassium nitrate or arginine, 6 studies), a 22 % advantage (p = 0.036) was seen for evaporative air. In erosion studies, SnF2 toothpastes provided an 83 % benefit versus control toothpastes (arginine or sodium fluoride; p < 0.001) with a change (95 %CI) in average surface profilometry level (µm) of -2.02(-2.85, -1.20). CONCLUSIONS: The use of these bioavailable SnF2 toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of DH pain when present, improving quality of life.

The ability of a potassium oxalate gel strip to occlude human dentine tubules; a Novel in vitro: In situ Study.

OBJECTIVES: To determine if an oxalate strip reduced fluid flow in dentine samples and whether this reduction was maintained following a 14 day intra-oral period. METHODS: Dentine tubule fluid flow was measured by a modified Pashley cell in 40 acid-etched dentine discs 1 mm thick, diameter >10 mm, with an acquired pellicle, pre-equilibrated with Hartmann's solution and conditioned by toothbrushing, pre and post treatment (10 min) with an oxalate (3.14 %) gel strip or no treatment. One control and one test sample were exposed in-situ for 14 days to the oral environment in 20 healthy adult volunteers, and fluid flow re-measured. The appliance containing the two samples was removed for brushing with water after mealtimes when the participant brushed their teeth and for a 2 min daily soak in chlorhexidine. RESULTS: Fluid flow rate was reduced significantly immediately following treatment with the oxalate strip compared to baseline flow rate by 58 %. Following 14 days in-situ oral environment phase, a significant further reduction in fluid flow compared to baseline was identified in both control and oxalate strip treated samples, both (p < 0.0001), but the reduction was greater in the test samples, 94 % vs 87 %, p < 0.01. CONCLUSIONS: This novel investigation is the first to show fluid flow measurement using the Pashley model in dentine samples that have been housed in the mouth for 14 days. Treatment with an oxalate strip designed for dentine hypersensitivity alleviation reduced dentine fluid flow more than control providing evidence that the oxalate treatment withstood the oral environment over a prolonged time. CLINICAL SIGNIFICANCE: This study demonstrated the efficacy and durability of the oxalate precipitate over a 14 day period in achieving and maintaining dentine tubule occlusion when participants had no dietary restrictions. This demonstrates the suitability of the oxalate strip for the treatment of patients suffering from dentine hypersensitivity pain.

A novel cervical tooth wear and recession index, the cervical localisation code, and its application in the prevention and management of dentine hypersensitivity.

OBJECTIVES: To design and validate a new index to assess tooth wear (TW) in the cervical region and its association with gingival recession (GR), for use both in research studies and as resource in General Dental Practice, with focused prevention and management strategiesparticularly related to aetiology of dentine hypersensitivity provided for each Code score. METHODS: Codes to reflect clinical presentations of the cervical region in health and disease recording both TW and GR were defined. Validation of the Code was undertaken by 3 trained examiners who scored buccal and lingual surfaces of eligible teeth in 42 adult healthy volunteers. Each volunteer underwent 4 identical clinical examinations, being assessed twice by the examiner who performed the first and last exam. RESULTS: Cervical Localisation Code definitions were A: no GR, no coronal TW, B: no GR, distinct coronal TW, C: GR but no coronal TW, D: GR with distinct coronal and root TW. For validation 2073 eligible tooth surfaces were scored. There were only 57 within and 201 between examiner disagreements, the most common being between scores C and D. CONCLUSIONS: The Cervical Localisation Code was used reproducibly by three independent examiners. It will provide focussed data on the cervical region in research studies allowing the association of patient reported dietary and lifestyle factors with specific lesion types, and a tool to aid the management of clinical scenarios, specifically those that lead to dentine hypersensitivity in general dental practice. CLINICAL SIGNIFICANCE: Exposure of dentine at the cervical margin by TW and/or GR often results in dentine hypersensitivity, however current TW indices do not record TW location or GR presence. The Cervical Localisation Code captures both parameters and suggests likely aetiology for dentine hypersensitivity and guide clinical management of the cervical region.

A randomised controlled trial investigating efficacy of a novel toothpaste containing calcium silicate and sodium phosphate in dentine hypersensitivity pain reduction compared to a fluoride control toothpaste.

OBJECTIVES: To compare a calcium silicate and sodium phosphate toothpaste (CSSP) with a fluoride negative control toothpaste for dentine hypersensitivity (DH) pain reduction after 14, 28 and 29 days. METHODS: This was a double blind, parallel study in 247 healthy adults with DH (Schiff score >2, tactile 10-20 g) in 2 teeth in different quadrants of the mouth. After acclimatisation, participants were randomised to CSSP or control toothpaste. After measuring baseline sensitivity products were applied twice-daily by toothbrushing, and once daily massaging into the sensitive teeth. Sensitivity was assessed following airblast (Schiff and VAS) and tactile (Yeaple probe) stimuli at baseline, 14 and 28 days, and at 29 days, 12 h after last product application. Participants completed a quality of life questionnaire at each study visit up to day 28. RESULTS: After 14, 28 and 29 days the CSSP group had significantly lower Schiff, lower VAS and higher Yeaple probe scores compared to control (VAS at 14 days, p < 0.04; all other comparisons, p < 0.001). Quality of life scores improved in both groups, but no significant differences between groups were observed. CONCLUSIONS: The CSSP toothpaste was more effective than the fluoride control toothpaste at reducing DH pain with benefit persisting 12 h following application. CLINICAL SIGNIFICANCE: This novel calcium silicate and sodium phosphate toothpaste (CSSP) toothpaste is an effective twice-daily treatment when brushed on the teeth for dentine hypersensitivity sufferers compared to brushing with a conventional fluoride paste. Twice-daily brushing provides a sustained effect for long-lasting pain relief from dentine hypersensitivity.

A randomised controlled trial to determine patient experience of a magnetostrictive stack scaler as compared to a piezoelectric scaler, in supportive periodontal therapy.

OBJECTIVES: To compare the pain/discomfort experienced by patients in supportive periodontal therapy, following treatment with a piezoelectric ultrasonic scaler, designed for use with warmed water irrigation, and a magnetostrictive ultrasonic scaler. METHODS: This was a single-centre, randomised, split mouth study with regard to side, and crossover with regard to treatment order. Patients attending general dental practice for supportive periodontal therapy were randomised to receive treatment from one scaler on the left and the other scaler on the right-hand side of the mouth, the left side of the mouth always being treated first. The piezo scaler (Tigon+®) was used with room temperature irrigation for half of the participants (approx 20 °C) and warmed water irrigation (approx 36 °C) for the other half. The magnetostrictive scaler (Cavitron Select SPS 30K®) was used with room temperature irrigation (approx 20 °C) only. Participants rated their pain/discomfort, noise and vibration by VAS scale. RESULTS: 140 participants completed the study. Mean VAS scores for all measures were significantly better for the piezo scaler used with warm irrigation as compared to the magnetostrictive scaler p < 0.001. When both scalers were used with room temperature irrigant, there were no significant differences in the VAS scores between scalers (pain/discomfort, p = 0.68; noise p = 0.2; vibration p = 0.85). CONCLUSIONS: Participants indicated to statistical significance, less pain/discomfort, noise and vibration when the piezo scaler (Tigon+®) device was used with warmed irrigant, compared to the magnetostrictive scaler (Cavitron Select SPS 30K®). There were no significant differences between the instruments when room temperature irrigant was used. CLINICAL SIGNIFICANCE: Regular scaling in supportive periodontal therapy, is essential for maintenance of susceptible patients, however it can be painful due to dentine hypersensitivity deterring patients from attending. Using a piezo scaler with warm water improves patient quality of life and subsequent oral health. This may have positive effects on patient attendance. ISRCTN REGISTERED: ISRCTN15573995.

Comparison of Blood Bacterial Communities in Periodontal Health and Periodontal Disease.

The use of Next Generation Sequencing (NGS) techniques has generated a wide variety of blood microbiome data. Due to the large variation in bacterial DNA profiles between studies and the likely high concentrations of cell-free bacterial DNA in the blood, it is still not clear how such microbiome data relates to viable microbiota. For these reasons much remains to be understood about the true nature of any possible healthy blood microbiota and of bacteraemic events associated with disease. The gut, reproductive tracts, skin, and oral cavity are all likely sources of blood-borne bacteria. Oral bacteria, especially those associated with periodontal diseases, are also commonly associated with cardiovascular diseases such as infective endocarditis, and also have been linked to rheumatoid arthritis and Alzheimer's disease. Periodontal treatment, dental probing, and toothbrushing have been shown to cause transient bacteraemia and oral bacteria from the phyla Firmicutes (e.g. Streptococci) and Bacteroidetes (e.g. Porphyromonas) are found in cardiovascular lesions (CVD). Many studies of blood bacterial DNA content however, find Proteobacteria DNA to be the dominant microbiome component, suggesting a gut origin. Most studies of this type use total DNA extracted from either whole blood or blood fractions, such as buffy coat. Here, using a method that purifies DNA from intact bacterial cells only, we examined blood donated by those with active, severe periodontitis and periodontally healthy controls and show that 43-52% of bacterial species in blood are classified as oral. Firmicutes, consisting largely of members of the Streptococcus mitis group and Staphylococcus epidermidis, were predominant at 63.5% of all bacterial sequences detected in periodontal health and, little changed at 66.7% in periodontitis. Compared to studies using total DNA Proteobacteria were found here at relatively low levels in blood at 13.3% in periodontitis and 17.6% in health. This study reveals significant phylogenetic differences in blood bacterial population profiles when comparing periodontal health to periodontal disease cohorts.

Examining the causal association between 25-hydroxyvitamin D and caries in children and adults: a two-sample Mendelian randomization approach.

Background: Prior observational studies have reported that higher levels of vitamin D are associated with decreased caries risk in children. However, these studies are prone to bias and confounding so do not provide causal inference. Genetic variants associated with a risk factor of interest can be used as proxies, in a Mendelian randomization (MR) analysis, to test for causal association with an outcome. The objective was to estimate the causal association between serum 25-hydroxyvitamin D (25(OH)D) (the commonly measured vitamin D metabolite in blood) and dental caries using a MR approach which estimates the causal effect of an exposure on an outcome. Methods: A total of 79 genetic variants reliably associated with 25(OH)D were identified from genome-wide association studies and used as a proxy measure of 25(OH)D. The association of this proxy measure with three outcome measures was tested; specifically: caries in primary teeth (n=17,035, aged 3-12 years), caries in permanent teeth in childhood and adolescence (n=13,386, aged 6-18 years), and caries severity in adulthood proxied by decayed, missing and filled tooth surfaces (DMFS) counts (n=26,792, aged 18-93 years). Results: The estimated causal effect of a one standard deviation increase in natural log-transformed 25(OH)D could be summarized as an odds ratio of 1.06 (95%CI: 0.81, 1.31; P=0.66) for caries in primary teeth and 1.00 (95%CI: 0.76, 1.23; P=0.97) for caries in permanent teeth in childhood and adolescence. In adults, the estimated casual effect of a one standard deviation increase in natural log-transformed 25(OH)D was 0.31 fewer affected tooth surfaces (95%CI: from 1.81 fewer DMFS to 1.19 more DMFS; P=0.68) Conclusions: The MR-derived effect estimates for these three measures are small in magnitude with wide confidence intervals and do not provide evidence against the null hypothesis of no effect.

Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR.

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.

Dementia friendly dentistry for the periodontal patient. Part 1: recognising and assessing patients with dementia.

This is the first of two articles that provide a guide for the clinical management for people with dementia who present with periodontal disease in dental practice. Conditions that cause dementia and their increasing prevalence are described. Advice is given to aid the dental team in recognising patients with dementia. The impact that dementia and the medications used in its medical management have on the oral environment are also covered. The complexities of completing an accurate periodontal assessment for those with dementia are discussed and indications for best practice provided. Although both articles (Part 1 and Part 2) centre on periodontal care, much of the content is equally applicable to wider general dental care for the dementia patient.