Systematic Review of Prognosis Models in Predicting Tooth Loss in Periodontitis.

This study reviews and appraises the methodological and reporting quality of prediction models for tooth loss in periodontitis patients, including the use of regression and machine learning models. Studies involving prediction modeling for tooth loss in periodontitis patients were screened. A search was performed in MEDLINE via PubMed, Embase, and CENTRAL up to 12 February 2022, with citation chasing. Studies exploring model development or external validation studies for models assessing tooth loss in periodontitis patients for clinical use at any time point, with all prediction horizons in English, were considered. Studies were excluded if models were not developed for use in periodontitis patients, were not developed or validated on any data set, predicted outcomes other than tooth loss, or were prognostic factor studies. The CHARMS checklist was used for data extraction, TRIPOD to assess reporting quality, and PROBAST to assess the risk of bias. In total, 4,661 records were screened, and 45 studies were included. Only 26 studies reported any kind of performance measure. The median C-statistic reported was 0.671 (range, 0.57-0.97). All studies were at a high risk of bias due to inappropriate handling of missing data (96%), inappropriate evaluation of model performance (92%), and lack of accounting for model overfitting in evaluating model performance (68%). Many models predicting tooth loss in periodontitis are available, but studies evaluating these models are at a high risk of bias. Model performance measures are likely to be overly optimistic and might not be replicated in clinical use. While this review is unable to recommend any model for clinical practice, it has collated the existing models and their model performance at external validation and their associated sample sizes, which would be helpful to identify promising models for future external validation studies.

The Alcohol Harm Paradox in Periodontitis.

Individuals of lower socioeconomic position (SEP) experience a greater rate of alcohol-related harms, yet they consume equal or lower amounts of alcohol than higher-SEP individuals. This phenomenon, called the "alcohol harm paradox" (AHP), gained attention recently, and different mechanisms have been proposed to explain it. Since both SEP and alcohol have been suggested to be associated with periodontitis risk, we conducted a secondary analysis using data from the National Health and Nutrition Examination Survey 2011 to 2012 and 2013 to 2014 cycles, aiming to examine 1) whether the association between alcohol consumption and periodontitis is modified by SEP and 2) the extent to which the effect of SEP inequalities on periodontitis is mediated by and/or interacts with alcohol consumption. We set educational attainment as the main SEP proxy and tested the poverty income ratio in subsequent sensitivity analyses. Effect measure modification analysis was employed, considering heavy drinking as exposure, and causal mediation analysis based on the potential outcome's framework decomposed the effect of SEP on periodontitis in proportions attributable to mediation and interaction. Models were fitted using binary logistic regression and adjusted for sex, ethnicity, age, body mass index, smoking status, diabetes, binge drinking, and regular preventive dental visits. The analytical sample comprised 4,057 participants. After adjusting for covariates, less educated heavy drinkers presented 175% (odds ratio, 2.75; 95% confidence interval [CI], 2.04-3.72) higher odds of periodontitis than their counterparts, and super-additive associations were found (relative excess risk due to interaction: 1.35; 95% CI, 0.49-2.20). Additionally, -69.5% (95% CI, -122.1% to -16.8%) of the effects of education on periodontitis were attributable to interaction with heavy drinking, consistent with the AHP. No contribution was found for the mechanism of mediation. Heavy drinking disproportionately impacts the occurrence of periodontitis in lower-SEP individuals. Lower-SEP individuals seem to experience differential effects of heavy drinking on periodontitis.

Co-occurrence of Periodontitis and Diabetes-Related Complications.

Periodontitis is a common finding among people with diabetes mellitus (DM) and has been cited as a DM complication. Whether and how periodontitis relates to other diabetes-related complications has yet to be explored. This study aims to examine the clustering of periodontitis with other diabetes-related complications and explore pathways linking diabetes-related complications with common risk factors. Using data from participants with DM across 3 cycles of the National Health and Nutrition Examination Survey (NHANES) (n = 2,429), we modeled direct and indirect pathways from risk factors to diabetes-related complications, a latent construct comprising periodontitis, cardiovascular diseases, proteinuria, and hypertension. Covariates included age, sex, socioeconomic status (SES), smoking, physical activity, healthy diet, alcohol consumption, hemoglobin A1c (HbA1c), dyslipidemia, and body mass index (BMI). Sensitivity analyses were performed considering participants with overweight/obesity and restricting the sample to individuals without DM. Periodontitis clustered with other diabetes complications, forming a latent construct dubbed diabetes-related complications. In NHANES III, higher HbA1c levels and BMI, older age, healthy diet, and regular physical activity were directly associated with the latent variable diabetes-related complications. In addition, a healthy diet and BMI had a total effect on diabetes-related complications. Although sex, smoking, dyslipidemia, and SES demonstrated no direct effect on diabetes-related complications in NHANES III, a direct effect was observed using NHANES 2011-2014 cycles. Sensitivity analysis considering participants with overweight/obesity and without DM showed consistent results. Periodontal tissue breakdown seems to co-occur with multiple diabetes-related complications and may therefore serve as a valuable screening tool for other well-known diabetes-related complications.

Effect of Smoking Exposure on Nonsurgical Periodontal Therapy: 1-Year Follow-up.

This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters (n = 46), moderate smokers (n = 17), and heavy smokers (n = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.

Scoping Review of Oral Health-Related Birth Cohort Studies: Toward a Global Consortium.

The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Regulation of PGLYRP1 and TREM-1 during Progression and Resolution of Gingival Inflammation.

INTRODUCTION: The triggering receptor expressed on myeloid cells 1 (TREM-1) signaling pathway is stimulated by bacteria and, together with its putative ligand peptidoglycan recognition protein 1 (PGLYRP1), propagates proinflammatory responses. OBJECTIVES: We aimed to evaluate the TREM-1/PGLYRP1/interleukin (IL)-1ß regulation in response to biofilm accumulation and removal in an experimental human gingivitis model. METHODS: The study (n = 42 participants, mean age: 23.8 ± 3.7 y) comprised a recruitment step (day -14) followed by experimentally induced biofilm formation (induction [I] phase, day 0 to +21) and a 2-wk resolution (R) phase (day +21 to +35). Plaque was recorded by the Modified Quigley and Hein Plaque Index (TQHPI), while records of gingival inflammation were based on the Modified Gingival Index (MGI). Unstimulated whole saliva supernatants (n = 210, 5 time points) were tested for TREM-1, PGLYRP1, and IL-1ß by enzyme-linked immunosorbent assay. RESULTS: During the I-phase, concentrations of all analytes showed a tendency for downregulation at day +7 compared to day 0. TREM-1 (P = 0.019) and PGLYRP1 (P = 0.007) increased significantly between day +7 and day +21. Although all analyte levels decreased during the R-phase, the difference was not significant except TREM-1 being at borderline significance (P = 0.058). Moreover, TREM-1, PGLYRP1, and IL-1ß showed significant positive correlations (P < 0.0001) with each other. The study participants were grouped into "fast" and "slow" responders based on clinical gingival inflammation scores. At each time point, fast responders showed significantly higher concentrations of TREM-1 (P < 0.025), PGLYRP1 (P < 0.007), and IL-1ß (P < 0.025) compared to slow responders. Mixed-effects multilevel regression analyses revealed that PGLYRP1 (P = 0.047) and IL-1ß (P = 0.005) showed a significant positive association with the MGI scores. CONCLUSION: The study demonstrated that TREM-1 and PGLYRP1 are regulated in response to biofilm accumulation and removal, and fast responders demonstrated higher levels of these analytes compared to slow responders. KNOWLEDGE TRANSFER STATEMENT: The results of this study demonstrated the suitability of salivary TREM-1 and PGLYRP1 to reflect biofilm accumulation and removal and PGLYRP1 to monitor the progression and resolution of inflammation in gingivitis-susceptible individuals (fast responders). Combined with conventional risk factors, the molecular toolbox proposed here should be further validated in future studies to confirm whether it can be used for population-based monitoring and prevention of gingivitis.

Mini-implants and narrow diameter implants as mandibular overdenture retainers: A systematic review and meta-analysis of clinical and radiographic outcomes.

This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for clinical studies that evaluated implants with diameter ≤3.5 mm. Data on the MI and NDI for survival and success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective longitudinal (PL) clinical studies and 7 randomised clinical trials (RCT) with follow-up periods ranging from 1 day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used both loading types, and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6 PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used conventional loading, 1 study used immediate loading, and 1 study did not report. The average survival rates of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and 96%, respectively. The average peri-implant bone loss after 12, 24 and 36 months was 0.89, 1.18 and 1.02 mm for MI and 0.18, 0.12 and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behaviour as overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies adopting conventional loading.

The split crest technique and dental implants: a systematic review and meta-analysis.

This systematic review aimed to determine: (1) the expected bone volume gain with the split crest technique, and (2) how the use of surgical instruments affects the performance of this technique. An electronic search was performed in the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Embase, PubMed/MEDLINE, Scopus, and Web of Science databases. Twenty-seven articles met the selection criteria and were subjected to meta-analysis of bone gain and survival rate; 17 reported the use of conventional surgical instruments and nine the use of surgical ultrasound. A total of 4115 implants were installed in 1732 patients (average patient age 52 years). The overall implant survival rate was 97%. The average bone gain in studies that used conventional surgical instruments was 3.61mm, while this was 3.69mm in those that used ultrasound. Only two studies presented a low risk of bias. The greatest problems identified during the qualitative analysis were related to random selection of the population and the absence of statistical analysis. The split crest technique appears to be a promising and effective technique to gain bone width, regardless of the surgical instruments used. Considering the diversity of the studies and implant types, no definitive recommendations can be made, especially with regard to the best instruments and implant design to be used.

Mini-implants for Orthodontic Anchorage: Surface Analysis after Redrilling and Sterilization - An in vitro Study.

OBJECTIVE: This study aimed to investigate, in vitro, possible alterations on mini-implants surface after retrieval and if the cleaning process and sterilization can predispose damages. MATERIALS AND METHODS: Two commercial mini-implants were tested for deformations after drilling and removing in artificial bone four times. Samples were analyzed by scanning electron microscopy, and surface alterations verified through thread and pitches deformation. To alterations caused by insertion/removal and the cleaning process and sterilization were verified in different procedures: Insertions and sterilization, only insertions, and only sterilization. Photomicrographs were analyzed in order to compare the surface characteristics. Head deformation was verified qualitatively. For a quantitative analysis, distances between threads were measured across the active part of the mini-implants. RESULTS: No deformation was observed in both groups. The cleaning and sterilization processes did not provoke alteration in both groups. Nevertheless, the presence of synthetic bone was noted in some samples. The mean distances between implant threads were similar after all steps in all regions in both groups. CONCLUSION: The results suggest that the tested mini-implants can be retrieved without damage of its surface after four cycles of insertion, removal, and sterilization. KEYWORDS: Orthodontic mini-implant, Redrilling, Sterilization. CLINICAL SIGNIFICANCE: Mini-implants can be retrieved without damage to its surface after four cycles of insertion, removal, and sterilization in the same patient without representing a biological concern.

Is there a relationship between obesity and tooth loss and edentulism? A systematic review and meta-analysis.

This study conducted a systematic review to assess the bi-directional association between tooth loss/edentulism and obesity. Electronic searches were performed in four different databases. Observational studies that tested associations between tooth loss/edentulism and obesity as either exposures or outcomes were included. Additionally, meta-analyses, funnel plots and sensitivity analyses were conducted to synthesize the evidence. A total of 549 articles were identified in the electronic database search. Out of which, 16 studies were included within the meta-analyses: 75% considered tooth loss/edentulism as exposure and obesity as outcome, whereas 25% alternatively considered obesity as exposure and tooth loss/edentulism as outcome. Pooled estimates showed that obese individuals had 1.49 (95%CI 1.20-1.86) and 1.25 (95%CI 1.10-1.42) times higher odds of having any tooth loss and edentulism, respectively. Alternatively, when tooth loss or edentulism were considered as exposures, individuals with any tooth loss had 1.41 (95%CI 1.11-1.79) times higher odds for obesity, while edentates had even higher odds (OR 1.60; 95%CI 1.29-2.00). The results indicate a bi-directional association between tooth loss and obesity. Considering that all selected studies were of cross-sectional study design limiting inferences on temporality, longitudinal prospective studies are required to test the causal relationship between tooth loss/edentulism and obesity or vice a versa. © 2016 World Obesity.

Psychological distress and salivary secretory immunity.

Stress-induced impairments of mucosal immunity may increase susceptibility to infectious diseases. The present study investigated the association of perceived stress, depressive symptoms, and loneliness with salivary levels of secretory immunoglobulin A (S-IgA), the subclasses S-IgA1, S-IgA2, and their transporter molecule Secretory Component (SC). S-IgA/SC, IgA1/SC and IgA2/SC ratios were calculated to assess the differential effects of stress on immunoglobulin transport versus availability. This study involved 113 university students, in part selected on high scores on the UCLA Loneliness Scale and/or the Beck Depression Inventory. Stress levels were assessed using the Perceived Stress Scale. Unstimulated saliva was collected and analysed for total S-IgA and its subclasses, as well as SC and total salivary protein. Multiple linear regression analyses, adjusted for gender, age, health behaviours, and concentration effects (total protein) revealed that higher perceived stress was associated with lower levels of IgA1 but not IgA2. Perceived stress, loneliness and depressive symptoms were all associated with lower IgA1/SC ratios. Surprisingly, higher SC levels were associated with loneliness and depressive symptoms, indicative of enhanced transport activity, which explained a lower IgA1/SC ratio (loneliness and depression) and IgA2/SC ratio (depression). This is the first study to investigate the effects of protracted psychological stress across S-IgA subclasses and its transporter SC. Psychological stress was negatively associated with secretory immunity, specifically IgA1. The lower immunoglobulin/transporter ratio that was associated with higher loneliness and depression suggested a relative immunoglobulin depletion, whereby availability was not keeping up with enhanced transport demand.

Diet influenced tooth erosion prevalence in children and adolescents: Results of a meta-analysis and meta-regression.

OBJECTIVE: The aim of the present study was to assess the influence of diet in tooth erosion presence in children and adolescents by meta-analysis and meta-regression. DATA: Two reviewers independently performed the selection process and the quality of studies was assessed. SOURCES: Studies published until May 2014 were identified in electronic databases: Pubmed, EBSHost, Scopus, Science direct, Web of Science and Scielo, using keywords. STUDY SELECTION: Criteria used included: observational studies, tooth erosion and diet, subject age range 8-19 years old, permanent dentition and index. Meta-analysis was performed and in case of heterogeneity a random-effects model was used. Thirteen studies that fulfilled the inclusion criteria were selected. Higher consumption of carbonated drinks (p=0.001) or acid snacks/sweets (p=0.01 and for acid fruit juices (p=0.03)) increased the odds for tooth erosion, while higher intake of milk (p=0.028) and yogurt (p=0.002) reduced the erosion occurrence. Heterogeneity was observed in soft drinks, confectionary and snacks and acidic fruit juices models. Methodological issues regarding the questionnaires administration and the inclusion of other variables, such as food groups and tooth brushing, explained partially the heterogeneity observed. CONCLUSIONS: Some dietary components (carbonated drinks, acid snacks/sweets and natural acidic fruits juice) increased erosion occurrence while milk and yogurt had a protective effect. Methods to assess diet could influence the homogeneity of the studies and should be considered during the study design. CLINICAL SIGNIFICANCE: The method to assess diet should be carefully considered and well conducted as part of the clinical assessment of tooth erosion, since diet could influence the occurrence of tooth erosion.

Association between developmental defects of enamel and dental caries: A systematic review and meta-analysis.

BACKGROUND: Dental caries is the main problem oral health and it is not well established in the literature if the enamel defects are a risk factor for its development. OBJECTIVE: Studies have reported a potential association between developmental defects enamel (DDE) and dental caries occurrence. We investigated the association between DDE and caries in permanent dentition of children and teenagers. DATA SOURCES: A systematic review was carried out using four databases (Pubmed, Web of Science, Embase, and Science Direct), which were searched from their earliest records until December 31, 2014. STUDY SELECTION: Population-based studies assessing differences in dental caries experience according to the presence of enamel defects (and their types) were included. PRISMA guidelines for reporting systematic reviews were followed. Meta-analysis was performed to assess the pooled effect, and meta-regression was carried out to identify heterogeneity sources. From the 2558 initially identified papers, nine studies fulfilled all inclusion criteria after checking the titles, abstracts, references, and complete reading. Seven of them were included in the meta-analysis with random model. RESULTS: A positive association between enamel defects and dental caries was identified; meta-analysis showed that individuals with DDE had higher pooled odds of having dental caries experience [OR 2.21 (95% CI 1.3; 3.54)]. Meta-regression analysis demonstrated that adjustment for sociodemographic factors, countries' socioeconomic status, and bias (quality of studies) explained the high heterogeneity observed. CONCLUSION: A higher chance of dental caries should be expected among individuals with enamel defects.

Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis.

OBJECTIVES: The main purpose of this systematic review was to estimate the prevalence of dental erosion in permanent teeth of children and adolescents. METHODS: An electronic search was performed up to and including March 2014. Eligibility criteria included population-based studies in permanent teeth of children and adolescents aged 8-19-year-old reporting the prevalence or data that allowed the calculation of prevalence rates of tooth erosion. Data collection assessed information regarding geographic location, type of index used for clinical examination, sample size, year of publication, age, examined teeth and tissue exposure. The estimated prevalence of erosive wear was determined, followed by a meta-regression analysis. RESULTS: Twenty-two papers were included in the systematic review. The overall estimated prevalence of tooth erosion was 30.4% (95%IC 23.8-37.0). In the multivariate meta-regression model use of the Tooth Wear Index for clinical examination, studies with sample smaller than 1000 subjects and those conducted in the Middle East and Africa remained associated with higher dental erosion prevalence rates. CONCLUSIONS: Our results demonstrated that the estimated prevalence of erosive wear in permanent teeth of children and adolescents is 30.4% with high heterogeneity between studies. Additionally, the correct choice of a clinical index for dental erosion detection and the geographic location play an important role for the large variability of erosive tooth wear in permanent teeth of children and adolescents. CLINICAL SIGNIFICANCE: The prevalence of tooth erosion observed in permanent teeth of children and adolescents was considerable high. Our results demonstrated that prevalence rate of erosive wear was influenced by methodological and diagnosis factors. When tooth erosion is assessed, the clinical index should be considered.

Avaliação da atividade antimicrobiana de extratos vegetais / Evaluation of the antimicrobial activity of vegetal extracts

Especialmente nas últimas décadas, inúmeros esforços têm sido dirigidos para conferir às plantas seu real papel e valor na terapia. Neste estudo foi avaliada a atividade antimicrobiana de extratos secos de Artemisia absinthium L. (losna), Mentha pulegium L. (poejo), Punica granatum L. (romã), Xanthosema violaceum Schott (taioba) e Syzygium cuminii L. (jambolão). Para avaliar a atividade antimicrobiana foi realizado o teste de difusão em ágar, com 15 diferentes microrganismos, utilizando discos impregnados com as dispersões aquosas dos extratos vegetais. A Concentração Inibitória Mínima (CIM) foi determinada para os extratos que apresentaram atividade inibitória. Os resultados mostraram que os extratos de X. violaceum e S. cuminii inibiram, respectivamente, 8 e 6 bactérias. Conclui-se que os extratos de X. violaceum e S. cuminii são capazes de inibir expressivamente o crescimento microbiano.

In the last decades, innumerable efforts have been directed to confer to the plants its real value in the therapy. The aim of this study was to evaluate the antimicrobial activity of dry extracts of Artemisia absinthium L. (wormwood), Mentha pulegium L. (poejo), Punica granatum L. (pomegranate), Xanthosema violaceum Schott(taro) and Syzygium cuminii L. (jambolan). To evaluate the antimicrobial activity the diffusion test in agar was carried through, with 15 different microorganisms, using discs impregnated with aqueous dispersions of the vegetal extracts. For those extracts that had presented inhibitory activity, the calculation of Minimum Inhibitory Concentration was carried out (CIM). The results had shown that the extracts of X. violaceum and S. cuminii had inhibited 8 and 6 bacteria, respectively. What leads to the conclusion that the extracts of X. violaceum and S. cuminii are capable to inhibit the microbial growth.