The reliability of using gingival crevicular blood to measure blood glucose and hba1c levels in the dental setting: a systematic review and meta-analysis.

OBJECTIVE: There are 500 million patients living with diabetes mellitus worldwide and 50% of them remain undiagnosed. Routine periodontal probing provides gingival crevicular blood in patients with gingivitis. Gingival blood may be useful for diabetes screening without the need for any expensive, painful or time-consuming method by using convenient glucometers. Therefore, the objective of this systematic review and meta-analysis is to answer the question to "is there a difference in glucose or HbA1c levels (O) in patients with positive gingival bleeding (P) measured on gingival crevicular blood (GCB) (I) compared to finger prick capillary blood (CB) (C). MATERIALS AND METHODS: The authors performed an electronic search of six databases using identical MeSH phrases. Only human clinical studies without limitations on the year of publication were considered. Data extraction was done by using standardized data collection sheets. Risk of bias assessment were conducted using QUADAS-2 and QUADAS-C. Meta-analyses were carried out with the random effects model to aggregate the correlation coefficients and the difference between the means between gingival and capillary blood reading, using 95% confidence intervals. RESULTS: The database and manual search yielded 268 articles, from which the selection procedure provided 36 articles for full-text screening, and the final pool of eligible articles composed of 23 studies with 1680 patients. Meta-analysis results on glycemic levels showed differences between the GCB and CB procedures in patients with and without diabetes with values of -6.80 [-17.35; 3.76] and - 4.36 [-9.89; 1.18], respectively. Statistically significant correlations were found (p = 0.001) between GCB and CB measurements in patients with (0.97 [0.927; 0.987]) and without diabetes (0.927 [0.873; 0.958]). CONCLUSION: Gingival blood could prove to be useful to identify patients with undiagnosed diabetes when the necessary amount of uncontaminated blood is present. However, this technique is limited by the possibility of contamination, prandial status and inaccuracies, so it is unsuited to address the patient's glycemic control accurately.

Translation and validation of the ageism scale for dental students in Iran (ASDS-Persian).

AIMS: A longer life and the growing population of older adults are the achievements of the 20th century. The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. The aim of this study was to translate and validate the ageism scale for dental students in Iran (ASDS-Persian). METHODS: The 27-question ASDS was translated from English into Persian (Farsi) and completed by 275 dental students from two universities in Isfahan, Iran. Principal component analysis (PCA), internal consistency reliability, and discriminant validity were estimated. Furthermore, in this study we conducted an analytical cross sectional study among dental students of Isfahan province (two universities) with the aim of proving data regarding their ageism beliefs and attitudes. RESULTS: PCA revealed an 18-question, four-component scale with acceptable validity and reliability. The four components are 'barriers/concerns on dental treatment in older adults', 'opinions about older adults', 'practitioner's perspective,' and 'older adults' perspective'. CONCLUSION: This preliminary validation of ASDS-Persian produced a new 18-question scale with four components with acceptable validity and reliability. This instrument could be further tested in larger samples in Farsi speaking countries.

Enamel Matrix Derivatives as an Adjunct to Alveolar Ridge Preservation-A Systematic Review.

PURPOSE: To systematically assess the current evidence regarding the adjunctive application of enamel matrix derivatives (EMDs) during alveolar ridge preservation (ARP) following tooth extraction. METHODS: A comprehensive literature search was conducted in MEDLINE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, and Scopus to identify relevant randomized controlled clinical trials (RCTs). The primary outcome parameters of this systematic review were histomorphometric and radiographic data; secondary outcomes were the feasibility of implant placement after ARP as well as patient-related outcomes such as postoperative discomfort. RESULTS: The search identified 436 eligible articles published from 2011 to 2022, but only five were ultimately included for data extraction (146 patients). Given the substantial heterogeneity among the included studies, no meta-analysis could be performed. The authors' qualitative analysis showed marginally improved outcomes regarding an increased percentage of new bone formation after tooth extraction and a reduction in postoperative discomfort. CONCLUSIONS: Given the potential value of EMDs in other fields of regenerative dentistry, more consideration should be given to EMDs as an adjunctive treatment option in ARP. However, more well-controlled randomized clinical trials are necessary to evaluate the exact potential and impacts of EMDs.

Can adjunctive corticosteroid therapy improve patient-centered outcomesfollowing third molar surgery? A systematic review

Background: Third molar surgery is frequently associated with postoperative discomfort such as pain, edema andtrismus. We aimed to evaluate the current evidence on the efficacy of adjunctive corticosteroid therapy in improving patient-centered outcomes following third molar surgery.Material and Methods: This systematic review assessed and searched PubMed, Google scholar, Scopus, web ofscience, clinicaltrials.gov and Cochrane central for controlled trials, up to May 2021. The primary outcome measures were patient-centered outcomes such as quality of life following the use of adjunctive corticosteroid therapyin third molar removal. Only randomized controlled trials published in English language were included.Results: A total of 355 studies were initially identified, and 12 studies were finally included. The results showedthat both methylprednisolone and dexamethasone decreased postoperative side effects such as pain, trismus, andedema and consequently were improving patient reported outcomes. In this regard, none of the included papersreported any significant statistical difference between these two drugs (p > 0.05). The analysis regarding theroute of administration for the corticosteroids showed that local and intravenous injection of dexamethasone hadequivalent effects, and both methods showed better results as compared to simple oral administration.Conclusions: Adjunctive use of corticosteroid drugs may improve patient-centered outcomes following third molar surgery. However, there is no significant difference between drugs and routs of administration. Comparingvarious administration routs, local submucosal injection of dexamethasone seems to be a straightforward, painlessand cost-effective adjunctive therapy. (AU)

The Clinical Use of Curcumin for the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review of Clinical Trials.

Recurrent aphthous stomatitis (RAS) lesions are inflammatory painful oral ulcers with uncertain etiology. Curcumin acts as an effective anti-inflammatory and antibacterial agent in the treatment of various oral diseases. This systematic review aimed to assess the effects of curcumin on RAS. A systematic search of the medical databases, PubMed, Scopus, ISI, Science Direct, and Google Scholar was performed up to March 30, 2020, to identify clinical trials assessing the effect of curcumin on aphthous ulcers. Nine studies comprising of 469 participants met all criteria and were analyzed. Treatment with curcumin significantly reduced aphthous ulcer size (seven studies), pain intensity (eight studies), number of aphthous ulcers (three studies), erythematous halo (one study), and erythema and exudate of the aphthous (one study). In four studies, the effect of curcumin on aphthous ulcer was assessed in comparison to the effects of the standard medication, triamcinolone. In all of these studies, curcumin had similar beneficial effects on the aphthous ulcer as measured by ulcer size, number, and pain. Only three studies were categorized as high quality using the Jadad scale. Within the limitations of this review, it can be concluded that curcumin may have a beneficial role in the treatment of recurrent aphthous ulcers. However, more randomized clinical trials are needed to validate these findings.

Antibacterial Activity of Curcumin Against Periodontal Pathogens: A Systematic Review.

Periodontitis is a chronic inflammatory disease characterized by destruction of the supporting structures of teeth caused by development of dental plaques and accumulation of microorganism around the gingival tissue. Curcumin has been shown to improve clinical parameters in periodontal diseases. However, the efficacy of curcumin in the elimination of periodontal pathogens is not clearly defined. The purpose of this study was to carry out a systematic review of the antibacterial activity of curcumin against periodontal pathogens. An electronic literature search in Medline, Scopus, Science Direct, Web of Science, Cochrane library, and Google scholar was performed up to February 29, 2020, to identify studies assessing the antibacterial activity of curcumin against periodontal pathogens. From 1238 publications, three clinical trials and five in vitro studies met the eligibility criteria. All three clinical studies reported improvement in restoring gingival health in clinical and microbiological parameters, following adjunctive use of curcumin for treatment of periodontitis. All five in vitro studies showed that curcumin could inhibit the growth of bacterial strains. Three of the five in vitro studies evaluated the effect of curcumin on mixed biofilm of periopathogens, which showed a significant inhibitory effect of curcumin on periodontal biofilms. This systematic review found that curcumin has antibacterial activity against periopathogens. The anti-biofilm activity of curcumin is reported as one of the mechanisms for this phenomenon. Curcumin could improve the clinical parameters of periodontal tissue not only by inhibition of the pathogens but also by modulating the host response.

Medicinal plants and bioactive natural products as inhibitors of NLRP3 inflammasome.

The NLR family, pyrin domain-containing 3 (NLRP3) inflammasome is a multiprotein complex that induces caspase-1 activation and the downstream substrates involved with the processing and secretion of the pro-inflammatory cytokines interleukin-1ß (IL-1ß) and IL-18 and tumor necrosis factor-α (TNF- α). The NLRP3 inflammasome is activated by a wide range of danger signals that derive from metabolic dysregulation. Activation of this complex often involves the adaptor ASC and upstream sensors including NLRP1, NLRP3, NLRC4, AIM2, and pyrin, which are activated by different stimuli including infectious agents and changes in cell homeostasis. It has been shown that nutraceuticals and medicinal plants have antiinflammatory properties and could be used as complementary therapy in the treatment of several chronic diseases that are related to inflammation, for example, cardiovascular diseases and diabetes mellitus. Herb-based medicine has demonstrated protective effects against NLRP3 inflammasome activation. Therefore, this review focuses on the effects of nutraceuticals and bioactive compounds derived from medicinal plants on NLRP3 inflammasome activation and the possible mechanisms of action of these natural products. Thus, herb-based, natural products/compounds can be considered novel, practical, and accessible agents in chronic inflammatory diseases by inhibiting NLRP3 inflammasome activation.

Interleukin-35 pathobiology in periodontal disease: a systematic scoping review.

BACKGROUND: Interleukin (IL)-35 is a novel anti-inflammatory cytokine that is produced by regulatory T cells. IL-35 mediates immunological functions and plays a protective role in several diseases such as asthma and rheumatoid arthritis. However, the role of IL-35 in gingivitis and periodontitis remains unclear. The aim of this study was to systematically review the literature and collecting the available evidence regarding the role of IL-35 in pathogenesis of periodontal disease. METHODS: A systematic search of electronic databases including MEDLINE, Google Scholar, Cochrane Library, Web of Science, and Scopus was conducted in November 2020 to identify studies addressing the Interleukin-35 pathobiology in periodontal disease. The identified studies were subjected to pre-identified inclusion criteria. The retrived papers were assessed by the authours independently and consensus was reached in cases where disagreement occurred. Articles written in languages other than English, case reports, letters to editors, conference abstracts, theses, and dissertations were excluded from the review. RESULTS: A total of 176 possibly relevant articles were identified through the search strategy. Finally, 15 papers which met the criteria of eligibility were included in this review by consensus. The included articles were classified based on their design and level of evidence.Three subclinical study, ten cross sectional investigation and two randomized clinical trials constituted the final set of studies in this review. At preclinical level, Il-35 showed inhibitory characteristics regarding alveolar bone resorption of animal periodontitis models. The results of observatory human studies confirmed the presence of high levels of IL-35 in saliva, GCF, serum, and gingival biopsies of patients suffering from inflammatory periodontal disease. Moreover, two included clinical trials showed that non-surgical periodontal therapy could downregulate IL-35 production in chronic periodontitis patients. CONCLUSION: Interleukin-35 has an undeniable role in pathobiology of inflammatory periodontal disease. Further well-controlled studies are needed to better elucidate the functional pattern of IL-35 in pathogeneisis of gingival and periodontal disease.

The Effect of Herbal Medicine and Natural Bioactive Compounds on Plasma Adiponectin: A Clinical Review.

Noncommunicable diseases (NCDs) are one of the major public health concerns globally. Most of the NCDs including insulin resistance, metabolic syndrome, type 2 diabetes mellitus, fatty liver disease, and coronary heart disease are related to obesity and are called obesity-related NCDs (OR-NCDs). However, adipocytes can reduce OR-NCDs by secreting adiponectin. Adiponectin has an inverse relationship with body fat. Obese people have impairment in differentiating pre-adipocytes to adipocytes, the process facilitated by adiponectin. Adiponectin directly increases insulin sensitivity and reduces obesity-related insulin resistance by down-regulating hepatic glucose production and increasing fatty acid (FA) oxidation in skeletal muscle. Considering the various beneficial effects of adiponectin on health, increasing adiponectin might be a promising approach to prevent and treat OR-NCDs. Recent studies have shown that nutraceuticals and medicinal compounds isolated from plants could prevent and treat various diseases, particularly cardiovascular diseases (CVDs), diabetes mellitus, obesity, and non-alcoholic fatty liver disease. However, to our knowledge, the effect of these natural products, including herbal supplements and functional foods on adiponectin, has not yet been fully reviewed. The main aim of this review is to summarize the effects of nutraceuticals and herbal bioactive compounds on plasma adiponectin concentrations based on clinical studies. It can be concluded that medicinal plants, and herbal bioactive compounds, particularly curcumin, anthocyanins, resveratrol, soy, walnut, and dihydromyricetin can be used as adjunct or complementary therapeutic agents to increase plasma adiponectin, which could potentially prevent and treat NCDs.

The Effects of Nutraceuticals and Bioactive Natural Compounds on Chronic Periodontitis: A Clinical Review.

The paper aims to review the current clinical evidence of various herbal agents as an adjunct treatment in the management of chronic periodontitis patients. Gingivitis and periodontitis are two common infectious inflammatory diseases of the supporting tissues of the teeth and have a multifactorial etiology. An important concern about chronic periodontitis is its association with certain systemic disease. New treatment strategies for controlling the adverse effects of chronic periodontitis have been extensively assessed and practiced in sub-clinical and clinical studies. It has been shown that the phytochemical agents have various therapeutic properties such as anti-inflammatory and antibacterial effects which can be beneficial for the treatment of periodontitis. The findings of this review support the adjunctive use of herbal agents in the management of chronic periodontitis. Heterogeneity and limited data may reduce the impact of these conclusions. Future long-term randomized controlled trials evaluating the clinical efficacy of adjunctive herbal therapy to scaling and root planing are needed.

The impact of pregnancy on women's oral health-related quality of life: a qualitative investigation.

BACKGROUND: Complex psychological and physiological changes occur in women's body during pregnancy. These changes affect both oral health status and oral health-related quality of life (OHRQoL). In almost all of the previous cross-sectional design studies on pregnant women, generic OHRQoL instruments have been used to measure OHRQoL. While such instruments may be reliable, they may not be appropriate to evaluate the OHRQoL in special populations like pregnant women. The purpose of this study was to investigate the self-perceived factors affecting the OHRQoL among pregnant women. METHODS: In this qualitative descriptive study, twenty- seven pregnant women were recruited from four healthcare centers located in Isfahan city, Iran. The interpretative phenomenological analysis was used to collect and analyze the data. Four criteria of credibility, dependability, transferability, and confirmability were implemented through established procedures to confirm the study rigor. RESULTS: Three major themes and six sub-themes capturing the impacts of pregnancy on women's OHRQoL were identified. They covered all areas of life, including daily life, psychological well-being, social life, physical impact, and also barriers to utilization of dental care services. Some new domains such as "dentists' refusal to treat pregnant women", "negative feelings about pregnancy" and "concerns about fetal health" were found as important factors which could influence the OHRQoL during pregnancy. CONCLUSION: The findings help to better understand the oral health issues impacting women during pregnancy and to achieve person-centered care and improved oral health outcomes in pregnant women. The conceptual framework created based on the results of this study may help health care workers and policy makers for improving the health of pregnant women.

Medicinal plants and bioactive natural compounds as inhibitors of HMG-CoA reductase: A literature review.

Cardiovascular diseases (CVDs) are one of the most important causes for mortality worldwide. Elevated levels of total cholesterol, and particularly LDL-cholesterol (LDL-C) are the main risk factor for acute myocardial infarction (AMI) and ischemic heart disease. The risk of CVDs could be reduced by decreasing the elevated cholesterol levels. ß-hydroxy ß-methylglutaryl-CoA reductase (HMGCoAR) is the primary and rate-limiting enzyme in the cholesterol biosynthesis pathway. Recently, the crucial role of nutraceuticals in maintaining normal physiological function was established. Nutraceuticals play an important role in preventing several non-communicable diseases such as obesity, CVDs, cancer, diabetes, and reducing hyperlipidemia. Although the effect of nutraceuticals and herbal medicine on CVDs and dyslipidemia was previously investigated thoroughly, the effect of these natural products on HMGCoAR as one of the important enzymes involved in CVDs etiopathogenesis has not yet been investigated. Therefore, the major aim of this paper was to review the effects of nutraceuticals and medicinal plants on HMGCoAR. Results indicate that different types of natural foods, isolated nutrients, herbal products, and dietary supplements as nutraceuticals decrease the expression and activity of HMGCoAR. This review shows that medicinal plants and nutraceuticals could be used to decrease HMGCoAR activity as accessible and convenient and economical natural compounds to prevent dyslipidemia and CVDs.

Association between periodontal disease and non-apnea sleep disorder: a systematic review.

OBJECTIVES: Inflammation is an integral part of the pathogenesis of periodontitis and sleep disorders. The aim of the present study was to review systematically the current evidence relating to the association between periodontal diseases and non-apnea sleep disorder. MATERIALS AND METHODS: Systematic searches were performed in MEDLINE, PsycINFO, Cochrane library, Web of Science, and Scopus without any limitation. Following preliminary screening, the quality of the remaining selected papers was appraised using the Newcastle-Ottawa Scale. Due to substantial heterogeneity among the selected articles, main outcomes were reported in a qualitative manner. RESULTS: Following screening and evaluation, a final set of 13 studies was selected for inclusion. These studies examined the association between periodontal disease and short sleep duration, long sleep duration, poor sleep quality, or non-specific sleep disorders. The majority (N = 12/13) reported an association or trend between one type of sleep abnormality and periodontal or gingival parameters. CONCLUSION: Despite the respective limitations of the articles included in this systematic review, an association between periodontal diseases and sleep disturbances was apparent. CLINICAL RELEVANCE: Adequate management of periodontal disease requires that a patient's lifestyle factors be taken into consideration in treatment planning. One such factor is sleep initiation and maintenance. An obvious association between sleep disturbances and periodontitis exists. Sleep disorders may induce systemic inflammation, which, in turn, could influence the development of periodontitis.

Saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients: a scoping review.

BACKGROUND: From the begging months of 2020 a severe acute respiratory syndrome coronavirus (SARS-CoV-2, also called 2019-nCoV) caused a devastating global outbreak. At present, the diagnosis of coronavirus disease 2019 (COVID-19) is made through a nasopharyngeal swab based on reverse transcription polymerase chain reaction (RT-PCR) technique. However, some recent studies suggested the possible role of oral fluids and saliva in the detection of SARS-CoV-2. The purpose of this scoping review is evaluating the available evidence regarding the efficacy of saliva as a diagnostic specimen in COVID-19 patients. METHODS: A systematic literature review of six databases (PubMed, Scopus, The Cochrane Central Register of Controlled Trials [CENTRAL], Science Direct, Web of Science and Google scholar) was carried out without any restrictions on date of publication to identify the reliability of saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients. RESULTS: Nine eligible articles were included in this review based on our described method. All the included studies are based on clinical surveys among patients with confirmed SARS-CoV-2 infection. Most of studies included in this review, reported that there is no statistically significant difference between nasopharyngeal or sputum specimens and saliva samples regarding viral load. CONCLUSIONS: Despite limitations of this study, the findings of this review suggest that the use of self-collected saliva as a non-invasive specimen has proper accuracy and reliability regarding detection of SARS-CoV-2 based on RT-PCR technique.

Oral Health-Related Quality of Life during Pregnancy: A Systematic Review.

OBJECTIVE: High prevalence of Dental and periodontal problems during the gestation period may have a negative effect on oral health-related quality of life (OHRQoL) in pregnant women. This systematic review aimed to perform a quality assessment and provide a critical overview of the current research available on OHRQoL in pregnant women. METHODS: For this systemic review, all original and peer-reviewed human studies, which investigated OHRQoL of women during pregnancy or post- partum period, were searched. Studies were screened in title and abstract for the relevance by two independent investigators. Methodological quality was assessed using modified items recommended by the Newcastle-Ottawa Scale for observational studies. RESULTS: All of the eight included studies had a cross-sectional design. Meta-analysis was not possible due to the heterogeneity of key aspects among the included studies. Thus, the data from the studies were evaluated qualitatively. The overall risk of bias of the included studies was low. CONCLUSION: The main conclusion of this review is that the presence of signs and symptoms of dental and gingival disease negatively affects the self-perception of OHRQoL in pregnant women. The most affected domains of OHRQoL in pregnant women were related to mental and psychological discomfort, followed by physical and functional problems.

Retro MTA and tricalcium phosphate/retro MTA for guided tissue regeneration of periodontal dehiscence defects in a dog model: a pilot study.

OBJECTIVES: Retro MTA is a fast setting Calcium silicate cement used in endodontic regeneration procedures in recent years. Beta-tricalcium phosphate (ß-TCP) is another common biomaterial used for bone augmentation procedures. The present pilot study was undertaken to evaluate and compare the efficacy of Retro MTA and a mixture of Retro MTA / ß-TCP for periodontal tissue regeneration. MATERIALS AND METHODS: In 4 beagle dogs, periodontal dehiscence type defects were created. In each side, one dehiscence defect was left empty as a control site and three treatment modalities were randomly applied for the others: Retro MTA covered with a collagen membrane, Retro MTA + ß-TCP covered with a membrane and covering the defect with a membrane without any bone augmentation. After 8 weeks Animals were sacrificed and Histomorphometric and histologic analysis were conducted. RESULTS: Histologic analysis showed more cementum formation for both Retro MTA+ ß-TCP (3.74 ± 0.34 mm) and Retro MTA group (3.24 ± 0.56 mm) compared to control group 1 (1. 15 ± 0.45 mm) and control group 2 (0.78 ± 0.65 mm). Formation of newly formed bone and cementum in the experimental groups were significantly higher as compared to the control groups (P < 0.0001). CONCLUSIONS: Retro MTA or Retro MTA+ ß-TCP covered with a collagen membrane resulted in regeneration of periodontal tissues. However, Retro MTA+ ß-TCP showed tendency towards better results than the use of Retro MTA alone.

Effect of vitamin D level on periodontal treatment outcomes: a systematic review.

The authors conducted a systematic search to collect and evaluate scientific evidence identifying a correlation between vitamin D administration and healing after periodontal surgery. A comprehensive search of 8 electronic databases--Ovid (MEDLINE), EMBASE, PubMed, Web of Science, Scopus, Science Direct, Cochrane Central, and Wiley--was conducted. The reference lists of all of the selected articles were also reviewed for potentially relevant studies. The initial search of the literature, containing both surgical and nonsurgical treatment approaches, yielded 660 citations, 392 of which were duplicates. All of the identified study abstracts were reviewed. Outcomes of the studies were assessed based on clinical attachment loss and periodontal probing depth. Following the abstract-reviewing process, 4 articles stood out from the rest. Full texts of the 4 articles were reviewed, and 3 articles fulfilled all of the considered criteria. The Cochrane risk-of-bias tool was used for study appraisal and rating of evidence. The reviews differed by study design or population characteristics; therefore, the results of the included studies were assessed in a qualitative manner. The results of this review suggest that vitamin D deficiency at the time of periodontal treatment negatively affects treatment outcomes. However, large-scale, longitudinal clinical trials are required to confirm these initial results.