Subgingival Microbiota and Periodontal Clinical Status in Patients with Plaque Psoriasis: A Cross-Sectional Study.

Plaque Psoriasis (PP) and periodontitis are inflammatory disorders with a bidirectional association. They both have a qualitatively similar immune-modulatory cascade, cytokine profile, and a recently described dysbiosis. Different oral bacterial species compositions in the periodontal pocket might play a role in the development of PP. To describe the subgingival microbiota of the Mexican population with PP and the periodontal conditions. Subjects were divided into two groups: periodontal health (PH) (PH-non-PP, PH-PP) and periodontitis (PD) (P-non-PP, PD-PP). Following clinical examination, the patients were classified into three groups according to the degree of psoriasis as measured by the Psoriasis Area Severity Index (PASI) and the periodontal status according to the parameters of the American Academy of Periodontology (AAP). Subgingival microbiota samples of each patient were used to determine 40 species of periodontal bacteria by checkerboard DNA-DNA hybridization. IL-2 and IL-6 were measured by ELISA. Of the forty-eight patients with PP, 21 patients had PH and 27 patients had PD. PD-PP group has a significant increase in the percentage of plaque, gingival redness, pocket probing depth, and clinical attachment loss (P<0.001) compared to PH-PP group. Microbiologically PD-PP exhibited significantly higher mean counts for A. georgiae, A. israelii, A. naeslundii from blue complex (P<0.001) than PD-non-PP. Moreover, the counts of these Actinomyces in PD-PP increased according to the severity of index PASI. The concentration of IL-2 and IL-6 were increased in saliva from PH-PP and PD-PP patients compared to PH non-PP. PP individuals harbored a particular sub-gingival microbiota profile different from non-PP. The severity of psoriasis was related to dysbiosis of microbiota -PASI > 5 related to periodontitis with the predominance of Actinomyces periodontal, irrespective of their periodontal condition. Finally, the severity of psoriasis could be unbalanced in subgingival microbiota and increase the risk to develop periodontitis.

Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis.

The objective of this article was to conduct a systematic review of the literature to contrast the existing evidence regarding the relationship between periodontal disease (PD) and diabetes mellitus (DM) with the possibly increased risk of SARS-CoV-2 infection, as well as to establish a hypothesis that explains the ways in which this interaction could take place. A literature search up from 1 January 2020 to 21 March 2021 was conducted in three electronic databases, namely, PubMed, Web of Science, and Scopus, in order to identify studies on periodontal disease alone or in conjunction with diabetes mellitus, reporting any relation with SARS-CoV-2 infection as a primary outcome. Only articles published in the English language were included. Due to the lack of studies, we decided to collect all the theoretical and clinical evidence suggesting a possible biological pathway evidencing the relationship among PD, DM, and SARS-CoV-2 infection. From a total of 29 articles, 12 were included for final review studies (five reviews, two hypotheses, one Special Issue, one perspective, one commentary, one case-control study, and one case report). In addition, this systematic review article hypothesizes the correlation between PD and type 2 diabetes mellitus (T2DM) by expression of angiotensin-converting enzyme 2 (ACE2) in periodontal tissue and the risk of SARS-CoV-2 infection. T2DM is a metabolic disorder characterized by high blood glucose levels resulting from altered insulin secretion or action. Likewise, periodontitis and T2DM are inflammatory disorders with a bidirectional association, and both diseases have a similar immunomodulatory cascade and cytokine profile. ACE2 is a crucial component of the renin-angiotensin system (RAS) and the key factor of entry in the cells by the new SARS-CoV-2. ACE2 is widely distributed in the lung and kidneys, and interestingly has a great distribution in the oral cavity, principally in the tongue and periodontal tissue. ACE2 in periodontal tissue plays a crucial role between health and disease. Moreover, the ACE2/Ang-(1-7)/MasR axis is downregulated in the dysbiotic and inflammatory periodontal environment. Nevertheless, the balance of ACE2 activity is modified in the context of concurrent diabetes, increasing the expression of ACE2 by the uncontrolled glycemia chronic in T2DM. Therefore, the uncontrolled hyperglycemia possibly increases the risk of developing periodontitis and triggering overexpression of ACE2 in periodontal tissue of T2DM patients, with these events potentially being essential to SARS-CoV-2 infection and the development of mild-to-severe form of COVID-19. In this sense, we would like to point out that the need for randomized controlled trials is imperative to support this association.

Depression, anxiety, and stress during the sanitary emergency of COVID-19 in southeastern México

Abstract: Aim: Evaluate the level of depression, anxiety, and stress; and identify the factors associated with these psychological responses during the third phase of the COVID-19 health emergency in a sample of Mexican population. Methods: An online cross-sectional survey was conducted. We performed bivariate and multivariate analyses to identify factors associated with depression, anxiety, and stress. Results: We included 997 individuals with a mean age of 35.3 ± 12.9 years; 18.9% of the participants presented symptoms of depression, 21.7% symptoms of anxiety and 14.1% symptoms of stress. Respondents were more likely to present depression if they were <40 years old (OR 1.73), not having a religion (OR 1.71), if they were currently unemployed (OR 1.54). Factors associated with anxiety were age<40 years old (OR 1.73) and having recent contact with suspected or diagnosed patients with COVID-19 (OR 1.54). Self-perception of insufficient knowledge about COVID-19 disease was associated with stress (OR 1.55). Declaring not feeling safe of COVID-19 infection was associated with depression (OR 2.03), anxiety (OR 1.90), and stress (OR 1.75). Conclusions: The damage to mental health caused by the COVID-19 pandemic is evident; health personnel must pay attention to their psychological state and well-being to take appropriate measures.

Resumen: Objetivo: Evaluar el nivel de depresión, ansiedad y estrés; e identificar los factores asociados a estas respuestas psicologicas durante la tercera fase de la emergencia sanitaria COVID-19 en una muestra de población mexicana. Métodos: Se realizó un estudio transversal en línea. Mediante análisis bivariado y multivariado identificamos factores asociados con depresión, ansiedad y estrés. Resultados: Participaron 997 individuos con una edad media de 35,3 ± 12,9 años; el 18,9% de los participantes presentó síntomas de depresión; 21,7%, ansiedad; y 14,1%, estrés. Los encuestados tenían más probabilidades de presentar depresión si tenían <40 años (OR 1,73), si no tenían religión (OR 1,71) y no tenían empleo (OR 1,54). Los factores asociados con la ansiedad fueron edad <40 años (OR 1,73) y contacto reciente con pacientes sospechosos o diagnosticados de COVID-19 (OR 1,54). La autopercepción de conocimiento insuficiente sobre la enfermedad se asoció a estrés (OR 1,55). Declarar no sentirse seguro ante el contagio se asoció con depresión (OR 2,03); ansiedad (OR 1,90); y estrés (OR 1,75). Conclusiones: El daño a la salud mental causado por la pandemia COVID-19 es evidente; el personal de salud debe prestar atención a su estado psicológico y bienestar para tomar las medidas adecuadas.

Resumo: Objetivo: Avaliar o nível de depressão, ansiedade e estresse; e identificar os fatores associados a essas respostas psicológicas durante a terceira fase da emergência sanitária da COVID-19 em uma amostra da população mexicana. Métodos: Foi realizado um estudo transversal on-line. Através da análise bivariada e multivariada identificamos fatores associados à depressão, ansiedade e estresse. Resultados: 997 indivíduos com idade média de 35,3 ± 12,9 anos participaram; 18,9% dos participantes apresentaram sintomas de depressão; 21,7%, ansiedade; e 14,1%, estresse. Os respondentes tinham maior probabilidade de depressão se tivessem <40 anos (OR 1,73), não tivessem religião (OR 1,71) e estivessem desempregados (OR 1,54). Os fatores associados à ansiedade foram idade <40 anos (OR 1,73) e contato recente com pacientes suspeitos ou diagnosticados com COVID-19 (OR 1,54). O conhecimento insuficiente autopercebido sobre a doença estava associado ao estresse (OR 1,55). O relato de não se sentir seguro contra infecção estava associado à depressão (OR 2,03); ansiedade (OR 1,90); e estresse (OR 1,75). Conclusões: Os danos à saúde mental causados pela pandemia da COVID-19 são evidentes; os profissionais da saúde devem prestar atenção ao seu estado psicológico e bem-estar a fim de tomar as medidas apropriadas.

MMP-2 salivary activity in type 2 diabetes mellitus patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and periodontitis are chronic inflammatory diseases with a bidirectional relationship. The uncontrolled levels of glucose in T2DM patients change the pathophysiology and balance of inflammatory mediators. Matrix Metalloproteinase-2 (MMP-2) is a zinc-dependent endopeptidase that is responsible for tissue remodeling and degradation of the extracellular matrix in periodontal tissue. Therefore, the uncontrolled levels of glucose in T2DM could lead to an imbalance in MMP-2 activity in saliva, favoring the development of periodontitis. METHODS: Ninety-seven T2DM patients from Hospital Dr. Donato Alarcon were included in the study. Following clinical examination, the patients were classified into four groups according to the presence and degree of periodontal disease and glycemic control. Blood and whole saliva samples (WSS) were collected from each patient. Blood samples were used for Hba1c and polymorphonuclear cells count determination, while WSS were used to determine MMP-2 activity, TIMP-1 and nitrite. MMP-2 activity was determined by zymography. TIMP-1 were determined by Western blotting, and nitric oxide (NO) levels were determined by the Griess method. RESULTS: Of the 97 patients with T2DM, 66 had periodontitis of different severities: 18 patients had mild periodontitis, 15 had moderate and 33 had severe. Salivary MMP-2 activity, HbA1c and TIMP-1 were positively correlated with the severity of periodontitis. On the other hand, the increase in HbA1c was negatively correlated with MMP-2 activity and quantity of TIMP-1 but was positively correlated with nitrite levels. CONCLUSIONS: T2DM with glycemic uncontrol conditions, distinct clinical alterations in periodontal tissue were identified, including a decrease in the gingival redness, increased the clinical attachment loss and imbalance of MMP-2/TIMP-1, as the possible causes of disorders promoting the progression of periodontitis. Accelerated periodontitis development with poor glycemic uncontrol likely results from the altered response of host defenses and decreased activity of polymorphonuclear cells. Taken together, these findings identify MMP-2 as a promising molecular market for periodontitis.

Caries dental y microorganismos asociados a la caries en la saliva de los alumnos del primer año de la Facultad de Odontología, UNAM / Dental caries and caries-associated mechanisms found in the saliva of first year students at the School of Dentistry, UNAM (National Autonomous University of Mexico)

Se estudiaron 380 alumnos del primer año en la Facultad de Odontología (n = 380) (periodo 2012-2013) a fin de determinar el índice CPOD y relacionar si la caries está asociada con los microorganismos Streptococcus y Lactobacillus. El índice CPOD (cariado, perdido y obturado) se registró usando los parámetros de la Organización Mundial de la Salud. Se tomaron muestras de saliva de cada alumno y se determinaron las unidades formadoras de colonias de Streptococcus y Lactobacillus. La media de los índices CPOD fue de 7.25 ± 4.59. Las mujeres (n = 278) y hombres (n = 102) presentaron una media de índices CPOD de 7.11 ± 4.66 y 7.29 ± 4.57, respectivamente. Encontramos que los alumnos de 19 años presentaron menos caries que los estudiantes de otras edades. Tanto Streptococcus y Lactobacillus se correlacionaron significativamente entre sí, así como en la incidencia de caries. Un incremento en el número de estos microorganismos, especialmente de Streptococcus mutans, se asociaron con el incremento en CPOD.

Three hundred and eighty first year students of the National School of Dentistry (UNAM) (n = 380) (academic year 2012-2013), were assessed targeting determination of DMFT (decayed, missing, lost teeth) index as well as to establish a relationship of whether caries is associated to Lactobacillus and Streptococcus microorganisms. DMFT index was recorded using World Health Organization (WHO) parameters. Samples of all students were taken and colony-forming units of Streptococcus and Lactobacillus were determined. DMFT indexes mean was established at 7.25 ± 4.59. Females (n = 278) and males (n = 102) exhibited mean DMFT indexes of 7.11 ± 4.66 and 7.29 ± 4.57 respectively. Results revealed that 19 year old students exhibited lesser amounts of caries than students of other ages. Both Streptococcus and Lactobacillus were significantly correlated to each other as well as to caries incidence. Increase in the number of the aforementioned micro-organisms, especially Streptococcus mutans, were associated to DMFT increase.

Hydrogen peroxide-induced apoptosis in human gingival fibroblasts.

In the process of bleaching vital, discolored teeth, low concentrations of hydrogen peroxide (H2O2) are effective alternatives to heat-activated 30% H2O2. However, interest has been expressed in the assessment of pathological effects of long-term exposure to bleaching agents such as irritation and ulceration of the gingival or other soft tissues. The aim of the present study was to determine the effect of hydrogen peroxide on apoptosis in human gingival fibroblasts (HGF). Cytochrome c, Bcl-2, Bax, Bid and caspase-3 protein expression were detected by Western blotting. HGF cell apoptosis induced by H2O2 was both dose and time dependent. The addition of H2O2 resulted in the release of cytochrome c to the cytosol, and an increase of Caspase-3 cleavage. Data suggest that oxidative stress-induced apoptosis in HGF is intrinsic pathway involved the release of apoptotic signal from mitochondria.

Flavonoids inhibit iNOS production via mitogen activated proteins in lipoteichoic acid stimulated cardiomyoblasts.

Infective endocarditis is caused by oral commensal bacteria which are important etiologic agents in this disease and can induce release of nitric oxide (NO), promoting an inflammatory response in the endocardium. In this study, we investigated the properties of kaempherol, epigallocatechin, apigenin, and naringin in embryonic mouse heart cells (H9c2) treated with lipoteichoic acid (LTA) obtained from Streptococcus sanguinis. NO production was measured with the Griess method. Expression of inducible nitric oxide synthase (iNOS) was detected by reverse transcriptase polymerase chain reaction (RT-PCR). In addition, western blot assays and immunofluorescence staining were used to assess translocation of nuclear factor kappa beta (NF-κB), degradation of IκB, and activity of the mitogen activated protein (MAP) kinases extracellular signal-regulated kinase (ERK 1/2), p38, and c-Jun N-terminal kinase (JNK). And the effects of these flavonoids on cell viability were also assessed. Our results showed that flavonoids blocked activation of ERK, JNK, and p38 in cardiomyocytes treated with LTA. Moreover, the flavonoids showed no cytotoxic effects and blocked NF-κB translocation and IκB degradation and inhibited LTA-induced NF-κB promoter activity, iNOS expression and NO production. In conclusion these effects are consistent with some of the observed anti-inflammatory properties of other flavonoids.

Myricetin blocks lipoteichoic acid-induced COX-2 expression in human gingival fibroblasts.

Periodontitis is an infectious disease caused by microorganisms present in dental bacterial plaque. Lipoteichoic acid (LTA) is a component of the external membrane of Gram-positive bacteria. It causes septic shock. Ingested flavonoids have been reported to directly affect the regulation of cyclooxygenase-2 (COX-2) expression induced by bacterial toxins. In this study, we examined the effects of four flavonoids (luteolin, fisetin, morin and myricetin) on the activation of ERK1/2, p38 and AKT, and on the synthesis of COX-2 in human gingival fibroblasts treated with LTA from Streptococcus sanguinis. We found that luteolin and myricetin blocked AKT and p38 activation and that myricetin blocked LTA-induced COX-2 expression. The results of our study are important for elucidating the mechanism of action of flavonoid regulation of inflammatory responses.

Bradykinin promotes Toll like receptor-4 expression in human gingival fibroblasts.

Bacterial infections are a potent mechanism for enzymatic generation of kinins such as bradykinin (BK), a universal mediator for inducing inflammatory reaction by associating with the B2 receptor and stimulating liberation of arachidonic acid and synthesis of prostaglandin E2 (PGE2). In this study we evaluate the role of bradykinin in regulating the expression of TLR4 receptor in human gingival fibroblasts. We examine the ability of bradykinin to modulate inflammatory response of human gingival fibroblasts to Gram-negative components and evaluated the role of Toll-like receptors (TLR)-4 in the co-operation between bradykinin and bacterial pathogens. We show that treatment with bradykinin promotes TLR4 receptor expression in human gingival fibroblasts (HGF) and amplifies inflammatory responses to the bacterial components of Gram-negative bacteria. The TLR4 expression induced by bradykinin was blocked with Hoe 140, a B2R antagonist. When HGF cells were incubated with BK resulted of an increased in cyclooxygenase-2 (COX-2) expression and prostaglandin E2 synthesis. Bradykinin and lipopolysaccharide, a specific TLR4 ligand stimulated COX-2 expression. In other series of experiments we found that ERK, phosphatidylinositol-3 kinase, protein kinase C and NFkB are involved in BK promoted-increased in TLR4 expression. The results demonstrate that bradykinin up-regulates the expression of TLR4 and promotes an additive increase in inflammatory responses to lipopolysaccharides.

Bradykinin promotes TLR2 expression in human gingival fibroblasts.

Bradykinin (BK) is implicated in the sensation of pain, vasodilation, increases in vascular permeability and pathogenic processes associated with inflammation. Studies have shown that BK promotes the intracellular movement of calcium in human gingival fibroblasts by binding to the B2 receptor. In this study we investigated the effect of BK on regulation of Toll-like receptor 2 (TLR2) expression. Our results show that BK stimulates TLR2 receptor transcription and translation by activation of protein kinase C as well as AKT. Our study contributes important information on the regulation and expression of molecules that promote chronic inflammatory processes, which lead to periodontitis and consequently to loss of the dental organ.

Activation of ERK1/2 by protein kinase C-alpha in response to hydrogen peroxide-induced cell death in human gingival fibroblasts.

Hydrogen peroxide (H(2)O(2)) increases protein tyrosine phosphorylation of numerous proteins in human gingival fibroblasts (HGFs). Two main proteins, with an apparent molecular weight of 44 and 42kDa, were phosphorylated after hydrogen peroxide stimulation of the human gingival fibroblasts. Further analysis identified these two proteins as ERK1/2. Maximum phosphorylation was detected at 10min post-H(2)O(2) treatment. Pretreatment with an MEK inhibitor, PD98059, inhibited H(2)O(2)-stimulated ERK1/2 phosphorylation in a dose-dependent manner. Treatment with H(2)O(2) also induced phosphorylation of protein kinase C-alpha (PKCalpha). Staurosporine, a PKC inhibitor, blocked ERK1/2 phosphorylation induced by H(2)O(2). In addition, H(2)O(2)-induced cell death was prevented by PD98059, SB203580, and calphostin C, which are MEK, p38 and PKC inhibitors, respectively. These results suggest that H(2)O(2) leads to the phosphorylation and activation of ERK1/2 in a PKC-dependent manner. These findings demonstrate that the MAPK signaling pathway plays an active role in mediating the H(2)O(2)-induced decrease in HGF cell viability and ATP depletion.