Exploring the Relation Between Interstitial Lung Diseases and Chronic Periodontitis: A Systematic Review.

The objective of this systematic review is to determine the association between interstitial lung diseases and chronic periodontitis from various aspects such as microbial, biomarker, genetic, and environmental levels. A systematic review was carried out from 2000 to 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations including studies searched in PubMed-Medline, Google Scholar, and Cochrane databases. A total of more than 100 articles were obtained in the initial screening process. Out of these 42 studies fulfilled the inclusion criteria and were included in the study. According to the extracted data, there is mounting evidence suggesting the association between these two diseases. Our systematic review raises the prospect of a connection between chronic periodontitis and interstitial lung diseases, within the limitations of the studies we included.

Periodontal health status in patients with lung cancer: Case-control study.

Objective: The objective of this study was to assess the periodontal health status of individuals with lung cancer in the North Indian population. In addition, the study aimed to determine the levels of human beta-defensin2 (Hbd-2) in the gingival crevicular fluid (GCF) and serum samples collected from the participants. Methods: The study consisted of a total of 90 participants, who were categorized into three groups: Group 1 included 30 healthy individuals, Group 2 comprised 30 patients with chronic periodontitis, and Group 3 involved 30 patients diagnosed with both lung cancer and chronic periodontitis. Various periodontal parameters, including plaque index, gingival index, probing pocket depth, and clinical attachment level (CAL), were assessed in addition to the analysis of human beta defensin2 levels in both the GCF and serum samples of all participants. Results: The study results revealed that all clinical parameters assessed were higher in Group 3 compared to both Group 2 and Group 1. Specifically, the levels of hBD-2 in the GCF were measured as 52.29 ± 46.41 pg/mL in Group 1, 27.15 ± 28.76 pg/mL in Group 2, and 86.01 ± 68.82 pg/mL in Group 3. When comparing the hBD-2 levels in serum, the values were found to be 813.72 ± 269.43 pg/mL in Group 1, 591.50 ± 263.91 pg/mL in Group 2, and 1093.04 ± 674.55 pg/mL in Group 3. These intergroup comparisons indicate variations in hBD-2 levels among the different groups. Conclusions: The study findings demonstrated significantly higher clinical and biochemical markers in patients with both lung cancer and chronic periodontitis, in comparison to individuals with chronic periodontitis alone and healthy participants. These results suggest that Hbd-2 could potentially serve as a valuable diagnostic biomarker for identifying and distinguishing individuals with both lung cancer and chronic periodontitis.

First-order transition to oscillation death in coupled oscillators with higher-order interactions.

We investigate the dynamical evolution of Stuart-Landau oscillators globally coupled through conjugate or dissimilar variables on simplicial complexes. We report a first-order explosive phase transition from an oscillatory state to oscillation death, with higher-order (2-simplex triadic) interactions, as opposed to the second-order transition with only pairwise (1-simplex) interactions. Moreover, the system displays four distinct homogeneous steady states in the presence of triadic interactions, in contrast to the two homogeneous steady states observed with dyadic interactions. We calculate the backward transition point analytically, confirming the numerical results and providing the origin of the dynamical states in the transition region. The results are robust against the application of noise. The study will be useful in understanding complex systems, such as ecological and epidemiological, having higher-order interactions and coupling through conjugate variables.

COVID-19 outbreak journey of dental care workers: A systematic review.

The conditions of health-care professionals including dental fraternity have been extremely affected during the COVID-19 pandemic. Dental care workers have suspended all routine dental activities with the fear of transmission of the virus from aerosol-generating dental procedures. They have also stood with medical care professionals as frontline warriors because of the exponentially overburdened of the COVID-19-positive patients worldwide. With the available literature, the aim of this article is to address the trajectories of the life of oral health workers during the outbreak of COVID-19 as well as to analyze what measures shall be taken to improve their overall physical, mental, social, and economic health and precautions while working in dental environment.

Correlation Between Chronic Periodontitis and Lung Cancer: A Systematic Review With Meta-Analysis.

Periodontal disease is associated with many systemic diseases, such as cardiovascular diseases, atherosclerosis, diabetes mellitus, stroke, and pulmonary diseases. Interestingly, recent literature suggests that periodontal disease might be a risk factor for various cancers such as lung, colon, oesophageal, head, and neck cancers. However, the precise mechanistic link is lacking. Hence, in this meta-analysis, we aimed to investigate the correlation between periodontal disease and lung cancer in periodontally diseased patients. Data were searched for relevant studies from 2010 to 2022. We correlated periodontal disease and lung cancer based on adjusted ORs/HRs and associated CIs. I2 statistic was used to assess statistical heterogeneity. Publication bias was analyzed by visually inspecting the symmetry of the funnel plot and Egger's test. The study is registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration no: CRD42023390819). A total of 194,850 participants from observational studies (two case-control studies and five cohort studies) were incorporated for the current analysis. The meta-analysis of included studies showed an overall effect size (risk ratio) of the periodontal disease group with respect to the non-periodontal disease group for lung neoplasm to be 1.41 (95% CI: 1.32-1.52). The value was more than 1, indicating that the periodontal disease group had a relatively higher lung cancer prevalence than the non-periodontal disease group. Further, the overall risk ratio was found to be statistically significant (p<0.00001). Moreover, the funnel plot suggested some degree of publication bias. Evidence in our study implicated that there is an increased risk of occurrence of lung cancer in chronic periodontitis patients.

Solitary death in coupled limit cycle oscillators with higher-order interactions.

Coupled limit cycle oscillators with pairwise interactions are known to depict phase transitions from an oscillatory state to amplitude or oscillation death. This Research Letter introduces a scheme to incorporate higher-order interactions which cannot be decomposed into pairwise interactions and investigates the dynamical evolution of Stuart-Landau oscillators under the impression of such a coupling. We discover an oscillator death state through a first-order (explosive) phase transition in which a single, coupling-dependent stable death state away from the origin exists in isolation without being accompanied by any other stable state usually existing for pairwise couplings. We call such a state a solitary death state. Contrary to widespread subcritical Hopf bifurcation, here we report homoclinic bifurcation as an origin of the explosive death state. Moreover, this explosive transition to the death state is preceded by a surge in amplitude and followed by a revival of the oscillations. The analytical value of the critical coupling strength for the solitary death state agrees with the simulation results. Finally, we point out the resemblance of the results with different dynamical states associated with epileptic seizures.

Comparative evaluation of vascular and clinical changes in micro and macrosurgical techniques in the management of mucogingival problems.

Background: Mucogingival surgery is performed to resolve the problems arising due to high frenum attachment and shallow vestibular depth (VD). The surgical procedures are mainly indicated to prevent gingival recession and for esthetic reasons. The aim of this study was to compare the degree of vascularization in the treatment of mucogingival problems by both microsurgical and macrosurgical techniques. Materials and Methods: Forty-two participants with aberrant frenum and shallow VD were randomly selected for frenectomy, frenotomy, and vestibular deepening either by a microsurgical (test) or macrosurgical (control) approach. Fluorescein angiography was performed at 1, 7, and 14 days after the surgical procedures. In addition, patient's satisfaction scores were recorded postoperatively. Results: Angiographic evaluation at test site revealed a statistically significant vascularization at 1, 7, and 14 days after the surgical procedure when compared to control sites. Probing pocket depth(PPD) in both the groups in vestibular deepening procedure decreased from 1 month to 6 months, but the reduction was insignificant. There was significant reduction in VD in both the groups over a period of 6 months. Microsurgical approach in all three procedures was superior in terms of patient satisfaction than macrosurgical approach. Mean surgical time spent in vestibular deepening and frenectomy procedures was highly significant in micro group as compared to the macro group. Conclusion: This clinical study indicates that microsurgical approach improved the percentage of vascularization and patient satisfaction compared with macrosurgical approach.

A retrospective correlative profiling of lung functions, microbiological, radiological, periodontal, hematological parameters in noncystic fibrosis bronchiectasis patients of North India.

Introduction: Noncystic fibrosis bronchiectasis (NCFB) is a neglected debilitating condition with scarce epidemiological literature explaining its geographical heterogeneity, especially in lower and middle-income countries. This study aimed to assess and correlate the functional profile of NCFB patients and evaluate the correlation of body mass index (BMI) with several disease variables. Methods: This mixed-method retrospective research study was conducted on 124 radiologically confirmed NCFB patients in terms of various qualitative and quantitative variables. Results: Restrictive ventilatory defect was the most common type with the preponderance of male former smokers. Mean platelet lymphocyte ratio (PLR; 104.08 ± 73.59) revealed certain degree of systemic inflammatory burden with a slightly higher mean peripheral leukocyte count (10665.19 ± 4268.81 cell/mm3) and eosinophilia of >2%. Almost all patients had periodontal disease with a higher prevalence of chronic periodontitis (54.83%). Moderately severe and predominantly cystic radiological type was encountered with 61.2% patients positive for Pseudomonas aeruginosa. Bronchiectasis aetiology comorbidity index (BACI) i.e., 2.34 ± 2.37 represented an intermediate mortality risk in our patients. On basis of BMI, majority were young underweights with poor pulmonary functions while PLR skewed toward overweight patients (nonsignificant P > 0.05). Forced expiratory volume/forced vital capacity displayed a negative weak moderately significant correlation with BACI (r = -0.24; P = 0.008). Peripheral lymphocyte count demonstrated a weak negative but significant correlation with modified Reiff score (r = -0.20; P = 0.023) while serum neutrophil count had a weak negative moderately significant correlation with hemoglobin (r = -0.20; P = 0.023). Conclusions: NCFB bears great heterogeneity with distinct geographical phenotypes and should be correlated thoroughly in terms of peripheral leukocytes count, pulmonary functions, radiology, BMI, and coexisting comorbidities for adequate management.

The Relationship Between Clinical Phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stages/Groups in Patients With Chronic Obstructive Pulmonary Disease.

Background Chronic obstructive pulmonary disease (COPD) cannot be properly characterised by a single metric, forced expiratory volume in the first second (FEV1), due to its complexity and heterogeneity. The GOLD 2017 report contained the ABCD evaluation method to measure airflow limitation, symptoms, and/or exacerbation risk. Objective The purpose of this study was to explore the relationship between clinical characteristics and GOLD groups or stages in patients with COPD. Methods This cross-sectional observational study was conducted at the department of respiratory medicine, King George's Medical University, Lucknow, Uttar Pradesh, India, between 2019 and 2022. Here, stable COPD patients' demographics, clinical characteristics, and the number of exacerbations were compared between the groups following the GOLD 2022 report. An unpaired t-test with Welch's correction, chi-square test, Fisher's exact test, one-way ANOVA, and Kruskal-Wallis test were used for statistical significance. Results In this study, 349 stable COPD patients (256 males and 93 females) were selected. The GOLD 2017 categorization placed 78 (22.4%) patients in group A, 158 (45.3%) in B, 44 (12.6%) in C, and 69 (19.8%) in D. Further, we used GOLD 2017 to classify COPD patients into 16 subgroups (1A-4D). FEV1 (% predicted) decreased across groups A to D (p<0.0001). Groups C and D had a longer duration of illness, higher COPD assessment test (CAT) score, higher Modified Medical Research Council (mMRC) dyspnea scale, longer exacerbation history, and more COPD hospitalizations in the previous year than groups A and B. More symptomatic patients (B and D) exhibited lower FEV1 (% predicted) and more severe airflow limitation than less symptomatic patients (A and C) (p=0.0002). Symptomatic individuals exhibited higher CAT and mMRC dyspnea scores (p<0.0001). Groups C and D comprised older patients and those with longer disease duration, higher mMRC dyspnea scale and CAT, lower FEV1, and more severe airflow limitation (A and B). Conclusion The present study demonstrates the distribution of COPD patients' clinical phenotypes in an Indian population. We conclude that the combined COPD assessment according to the GOLD 2022 guideline provides a better understanding of COPD.

Periodontal status of patients with nontubercular respiratory diseases hospitalized in a tertiary care hospital.

Background: There is strong evidence that periodontal disease (PD) is related to various systemic diseases including respiratory diseases. Dental plaque is the primal cause of PD, and it can also be used as a reservoir of lung pathogens. After inhalation, it can cause a variety of respiratory infections. In addition, low nutritional status and immuneosuppression due to treatment or disease progression may affect the oral health of the hospitalized patients with nontubercular respiratory diseases. Here, we aimed to assess the periodontal status in hospitalized patients with nontubercular respiratory problems. Materials and Methods: We have enrolled 100 hospitalized nontubercular respiratory ill patients and 100 periodontal patients in this study. Periodontal clinical parameters, namely plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were evaluated in both the groups. Modified Kuppuswamy's socioeconomic scale was utilized to assess the education, occupation, and monthly family income. Results: Sociodemographic profile was comparable in both the studied groups. Hospitalized patients with nontubercular respiratory diseases had more severe PD (PPD and CAL) and poorer oral hygiene (higher PI), although the GI was lower compared to patients in the periodontal group. In addition, compared with patients in the high-income group, low-income patients are at greater risk of periodontal infections. Conclusions: Our data show that the prevalence of periodontal infections in hospitalized patients with non-tubercular respiratory diseases is higher, indicating that there is an association between PD and respiratory diseases.

Emergent Dynamics and Spatio Temporal Patterns on Multiplex Neuronal Networks.

We present a study on the emergence of a variety of spatio temporal patterns among neurons that are connected in a multiplex framework, with neurons on two layers with different functional couplings. With the Hindmarsh-Rose model for the dynamics of single neurons, we analyze the possible patterns of dynamics in each layer separately and report emergent patterns of activity like in-phase synchronized oscillations and amplitude death (AD) for excitatory coupling and anti-phase mixed-mode oscillations (MMO) in multi-clusters with phase regularities when the connections are inhibitory. When they are multiplexed, with neurons of one layer coupled with excitatory synaptic coupling and neurons of the other layer coupled with inhibitory synaptic coupling, we observe the transfer or selection of interesting patterns of collective behavior between the layers. While the revival of oscillations occurs in the layer with excitatory coupling, the transition from anti-phase to in-phase and vice versa is observed in the other layer with inhibitory synaptic coupling. We also discuss how the selection of these spatio temporal patterns can be controlled by tuning the intralayer or interlayer coupling strengths or increasing the range of non-local coupling. With one layer having electrical coupling while the other synaptic coupling of excitatory(inhibitory)type, we find in-phase(anti-phase) synchronized patterns of activity among neurons in both layers.

Impact of Non-surgical Periodontal Therapy on Pulmonary functions, Periodontal Health and Salivary Matrix Metalloproteinase-8 of COPD Patients with Chronic Periodontitis: A Clinico-biochemical Study.

OBJECTIVE: The aim of the study was to assess the impact of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, spirometric indices, and salivary MMP-8 levels in patients with chronic obstructive pulmonary disease (COPD) with concurrence of chronic periodontitis (CP) compared with systemically healthy CP. MATERIAL AND METHODS: In this prospective clinico-biochemical study, a total of 75 patients belonging to various socioeconomic strata were randomly divided into cases, that is, COPD patients as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria with concurrence of CP [at least ≥ 20 teeth with ≥ 2 tooth sites having pocket probing depth (PPD) or clinical attachment loss (CAL) ≥ 4mm and bleeding on probing (BOP)] and controls (systemically healthy CP). Both groups underwent NSPT and were evaluated for plaque index (PI), gingival index (GI), PPD, CAL, and BOP and spirometry (FEV1/forced vital capacity (FVC)) values at baseline, 3, 6, and 12 months and for salivary MMP-8 levels at baseline and 3 months. RESULTS: Statistical results showed that cases (COPD with CP; n = 37) were significantly older (mean age 56.16 ± 9.01 years), ex-smokers (48.6%) with male preponderance (78.4%), and belonged to the upper middle class (40.5%) as compared to controls (systemically healthy CP; n = 38). After NSPT, significant improvement in mean PI, GI, PPD, CAL, and BOP was observed in both groups at 3, 6, and 12 months with better results in controls. FEV1/FVC was significantly improved (P < .001) in cases with insignificant change in controls at 12 months. After 3 months, MMP-8 levels were significantly reduced in cases (P = .002) and controls (P < .001). CONCLUSION: The present study provided substantial evidence that COPD patients have poorer periodontal health as compared to systemically healthy counterparts. Further, these patients showed improvement in FEV1/FVC, however, with higher salivary MMP-8 levels despite NSPT at the end of the study, indicating a possible role of systemic inflammatory overburden of pulmonary disease.

Assessment of the Healing of Dental Implant Surgical Site Following Low-Level Laser Therapy Using Bioclinical Parameters: An Exploratory Study.

The purpose of this study was to evaluate whether low-level laser therapy improves healing of the implant surgical site with clinical and biochemical parameters. Thirty patients with an edentulous space spanning a single tooth were selected. The patients were randomly allocated to 1 of 2 groups: control group and test group. The test group received laser energy at a power of 2 J/cm2 with a total of 4-6 J energy over each implant. Clinical parameters (implant stability quotient, probing index, modified sulcus bleeding index) and osteoprotegerin were assessed at baseline and follow-up intervals (2 weeks, 6 weeks, and 3 months). The test group showed significantly higher implant stability quotient than the control group at 2 weeks (57.93 ± 3.95 vs 35.67 ± 3.08; P < . 01) and 3 months (58.86 ± 3.75 vs 67.06 ± 3.78; P < . 01). A significant rise in osteoprotegerin levels of the test group (686.30 ± 125.36 pg/mL at baseline and 784.25 ± 108.30 pg/mL at 3 months; P < . 01) was seen contrary to significant decline in the control group (839.50 ± 249.08 pg/mL at baseline vs 415.30 ± 78.39 pg/mL at 3 months; P < . 01). Within the limitations of the study, the findings suggest that the healing of peri-implant hard and soft tissues may be enhanced with the use of low-level laser therapy as an explicit modality during the postoperative period.

Differential expression of inflammatory responsive genes between chronic periodontitis and periodontally affected bronchiectasis patients.

The study aimed to investigate differential expression of targeted inflammatory-immune responsive genes [LTA, LTB, TNFSF4, TNFSF11/RANKL, TNFSF13, TNFSF13B, TNFRSF11B/ Osteoprotegerin; OPG and GFPT1/GFA ] in gingival tissues of bronchiectasis patients having chronic periodontitis in North central Indian population. Gingival tissues were collected from 30 systemically healthy chronic periodontitis patients (CP), 30 bronchiectasis patients with chronic periodontitis (B+CP), 3 systemically healthy with healthy gingiva (healthy control; HC) and 3 bronchiectasis with healthy gingiva (bronchiectasis control; BC). Statistical analysis revealed 7 genes to be significantly upregulated on comparing CP with B+CP i.e LTA (P<0.0001) in B+CP while LTB (P<0.0001), TNFSF4 (P=0.0003), TNFSF11 (P<0.0001), TNFSF13 (P=0.0003), TNFSF13B (P<0.0001) and TNFRSF11B (P=0.0004) in CP group. LTA (Lymphotoxin A) gene could be a potential genetic marker in bronchiectasis patients with chronic periodontitis.

Advent of extreme events in predator populations.

We study the dynamics of a ring of patches with vegetation-prey-predator populations, coupled through interactions of the Lotka-Volterra type. We find that the system yields aperiodic, recurrent and rare explosive bursts of predator density in a few isolated spatial patches from time to time. Further, the global predator biomass also exhibits sudden uncorrelated occurrences of large deviations from the mean as the coupled system evolves. The maximum value of the predator population in a patch, as well as the maximum value of the predator biomass, increases with coupling strength. These trends are further corroborated by fits to Generalized Extreme Value distributions, where the location and scale factor of the distribution increases markedly with coupling strength, indicating the crucial role of coupling interactions in the generation of extreme events. These results indicate how occurrences of extremely large predator populations can emerge in coupled population dynamics, and in a more general context they suggest a generic class of deterministic nonlinear systems that can naturally exhibit extreme events.

Amplitude chimera and chimera death induced by external agents in two-layer networks.

We report the emergence of stable amplitude chimeras and chimera death in a two-layer network where one layer has an ensemble of identical nonlinear oscillators interacting directly through local coupling and indirectly through dynamic agents that form the second layer. The nonlocality in the interaction among the dynamic agents in the second layer induces different types of chimera-related dynamical states in the first layer. The amplitude chimeras developed in them are found to be extremely stable, while chimera death states are prevalent for increased coupling strengths. The results presented are for a system of coupled Stuart-Landau oscillators and can, in general, represent systems with short-range interactions coupled to another set of systems with long-range interactions. In this case, by tuning the range of interactions among the oscillators or the coupling strength between two types of systems, we can control the nature of chimera states and the system can also be restored to homogeneous steady states. The dynamic agents interacting nonlocally with long-range interactions can be considered as a dynamic environment or a medium interacting with the system. We indicate how the second layer can act as a reinforcement mechanism on the first layer under various possible interactions for desirable effects.

Explosive death in nonlinear oscillators coupled by quorum sensing.

Many biological and chemical systems exhibit collective behavior in response to the change in their population density. These elements or cells communicate with each other via dynamical agents or signaling molecules. In this work, we explore the dynamics of nonlinear oscillators, specifically Stuart-Landau oscillators and Rayleigh oscillators, interacting globally through dynamical agents in the surrounding environment modeled as a quorum sensing interaction. The system exhibits the typical continuous second-order transition from oscillatory state to death state, when the oscillation amplitude is small. However, interestingly, when the amplitude of oscillations is large we find that the system shows an abrupt transition from oscillatory to death state, a transition termed "explosive death." So the quorum-sensing form of interaction can induce the usual second-order transition, as well as sudden first-order transitions. Further, in the case of the explosive death transitions, the oscillatory state and the death state coexist over a range of coupling strengths near the transition point. This emergent regime of hysteresis widens with increasing strength of the mean-field feedback, and is relevant to hysteresis that is widely observed in biological, chemical, and physical processes.

Explosive death in complex network.

We report the emergence of an explosive death transition in a network of identical oscillators interacting to other oscillators through nonlocal coupling in the presence of a common environment. This transition has an abrupt and irreversible characteristic in parameter space which has been a common signature of first order phase transition. For the similar coupling scheme, both ensemble of chaotic and periodic oscillators showed qualitatively similar kind of transition, hence making it a universal transition. The details of which along with dependence of environmental and nonlocal coupling on this first-order like phase transition is also discussed.

Comparative evaluation of neodymium-doped yttrium aluminum garnet laser with nanocrystalline hydroxyapatite dentifrices and herbal dentifrices in the treatment of dentinal hypersensitivity.

BACKGROUND: The aim of this study was to compare and evaluate the efficacy of neodymium-doped yttrium aluminum garnet laser with and without herbal and nanohydroxyapatite dentifrices in management of dentinal hypersensitivity (DH). MATERIALS AND METHODS: A total of 180 patients who responded to air-blast test and cold-water test using verbal rating scale (VRS) were included in this study. The patients were randomly assigned to six groups (n = 30): control group (CG), scaling and root planning (SRP) + nanocrystalline hydroxyapatite dentifrices, SRP + nanocrystalline hydroxyapatite dentifrices + laser, SRP + herbal dentifrices, SRP + herbal dentifrices + laser, and SRP + laser. Each group was evaluated at baseline, 1 week, 1 month, and 6 months. In every visit of each patient, their clinical examination was done. RESULTS: Among all groups', repeated ANOVA measures and Kruskal-Wallis test was performed in which laser groups showed maximum reduction in DH in all indices while the CG showed minimum reduction in DH. The VRS values showed maximum reduction in SRP + nanocrystalline hydroxyapatite dentifrices + laser group with mean of 0.3 ± 0.5 and minimum reduction in CG with mean of 3.0 ± 0.5 (P < 0.001). CONCLUSION: Among all the groups, SRP + Nanocrystalline hydroxyapatite + Laser can be an effective treatment modality for DH.