Risk factors and approaches for detection of Trichomonas tenax, the silent culprit in periodontal disease: A narrative review.

Introduction: Periodontal disease is the inflammation of the periodontium tissues surrounding the teeth, potentially leading to loss of tooth attachment. In individuals with periodontal disease, the presence of Trichomonas tenax, a parasitic protozoan of the oral cavity has been observed and its frequency tends to rise as the disease progresses. Methods: A literature search was conducted in the online databases of PubMed, Google Scholar, Web of Science, and Scopus using the combination of keywords: "Trichomonas tenax" AND "periodontal disease" OR "gum disease", OR "oral disease" OR "periodontitis". A total of 9 articles satisfied the inclusion criteria and were included in this study. Results: This review highlights the incidence of T. tenax with periodontal diseases, the risk factors that contribute to the infection of T. tenax and available detection methods for the identification of the protozoan. Conclusion: The inhabitation of the oral cavity by T. tenax prospers with the severity of periodontal diseases. Extensive research should be conducted to fully understand the potential pathogenic role and damaging effect of T. tenax in the oral cavity.

Vitamin D and Periodontal Health: A Systematic Review.

The role of vitamin D in maintaining gum well-being is crucial. However, scientific research reported that the connotations of cholecalciferol and periodontal health have been divested in the present literature. However, there is enormous heterogeneity in the data available. The current review aims to systematically review and appraise the available literature investigating the role of vitamin D in maintaining periodontal health. Studies included randomized controlled trials and clinical trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and cohort studies reporting associations between vitamin D and oral health in systemically healthy patients. Databases such as PubMed, Google Scholar, Scopus, Embase, and other sources, including hand search, were searched until May 2023 using together-equipped search sequences. Altogether, scientific articles that conform to the inclusion principles underwent a thorough eminence evaluation. All papers meeting inclusion criteria were subject to quality assessment, and the method used to assess the risk of bias was the Cochrane risk of bias tool. The search identified 1883 papers, among which 1435 were excluded after title evaluation. After abstract and title screening, 455 were excluded, and six full texts were assessed. After full-text evaluation, two articles were excluded, and only four were included. The data shows vitamin D's association with oral health maintenance. Along with its action on bone metabolism, it has extended function, which provides for its action as an anti-inflammatory agent and production of anti-microbial peptides, which help maintain oral health. Although the literature available is immense, there is enormous heterogenicity in the papers conducted to appraise the association between vitamin D and oral health. This systematic review has filtered all the data to review a few essential aspects of the role of vitamin D in maintaining oral physiology. Vitamin D has a linear relationship with periodontal health; however, the evidence is insufficient, and further studies must be done.

A pro-inflammatory diet is associated with an increased odds of periodontitis: finding from a case-control study.

OBJECTIVE: This study aimed to evaluate the inflammatory effect of diet using the dietary Inflammatory Index (DII) on the odds of periodontitis. We hypothesized that a diet with high DII scores (a pro-inflammatory diet) is associated with high chronic and systematic inflammation resulting in periodontitis. Periodontitis is one of the most common inflammatory diseases that affect the tissues around the tooth and results from the interaction of bacterial infection and the host immune response. The DII shows the association between different food components and the level of specific inflammatory biomarkers. METHOD: The food intake of 87 cases with diagnosed periodontitis and 87 control was assessed using a 163-item valid food frequency questionnaire (FFQ). The DII was calculated based on the FFQ data. Logistic and linear regression models adjusting for multivariable confounders were used to investigate the odds ratio (OR) and 95% confidence intervals (CI) of developing periodontitis. RESULTS: There was a significant difference between the mean intake of micronutrients and food groups, including saturated fatty acids (SFAs), iron, magnesium, manganese, vitamin C, crude fiber, selenium, chromium, whole fiber, caffeine, dairy, and meat, between patients with periodontitis and the control group (p-value˂0.05). DII scores in this study ranged from -3.13 to + 0.99. However, the periodontitis OR in the raw and multivariable-adjusted models was not statistically significant (multivariable-adjusted OR tertiles 1 vs. tertiles 3 = 2.00, 95%CI: 0.4-90.42, p-value = 0.08). A similar result was also observed in the continuous model of DII (multivariable-adjusted OR DII continuous = 1.93, 95%CI: 0.30-98.79, p-value = 0.05). CONCLUSION: Although the OR was not statistically significant in crude models, a significant trend was found in multivariable-adjusted models. The results were promising since this is the first study to examine the association between diet-induced inflammation and dental disease. It is advisable to conduct additional studies with high sample sizes and other designs, such as prospective studies.

Soft-Tissue Augmentation in Periodontally Compromised Patients during Immediate Placement and Immediate Loading Dental Implant Surgery - A Retrospective Study.

Introduction: The purpose of this article is to describe a soft-tissue augmentation procedure for multiple tooth extraction sites during immediate placement and immediate loading (IPIL) dental implant surgery in periodontally compromised patients and to present follow-up results of its effectiveness. Methods: A retrospective study was conducted on data from patients who underwent IPIL dental implant surgery between 2018 and 2021 at an oral implant centre in Bulgaria. Based on inclusion and exclusion criteria, 103 patients were included, 53 of whom had pre-operative indications for connective tissue grafts (CTGs) and 50 of whom did not. The post-operative incidence of gum recession was evaluated in the two patient groups. Results: The majority of the 53 patients (56.60%) had six, seven or eight tooth sites grafted. A significant proportion (87%) needed CTGs at the canine teeth (13 and 23), P < 0.001. The post-operative data showed a low incidence of gum recessions in both the patient groups, with a lower rate in the CTG group at tooth no: 13 (2.20% vs. 18%, P = 0.016) and in the total sum of 10 tooth sites with CTGs (P = 0.001). A reduction in gum problems and increased satisfaction with gum health and aesthetics were reported by 100% of the CTG patients. Discussion: Soft-tissue augmentation at multiple tooth extraction sites during IPIL dental implant treatment may benefit periodontally compromised patients through an improved prosthesis-tissue interface in the aesthetic area and a reduction in gum infections, swelling, bleeding and pain.

A Narrative Review on Oral and Periodontal Bacteria Microbiota Photobiomodulation, through Visible and Near-Infrared Light: From the Origins to Modern Therapies.

Photobiomodulation (PBM) consists of a photon energy transfer to the cell, employing non-ionizing light sources belonging to the visible and infrared spectrum. PBM acts on some intrinsic properties of molecules, energizing them through specific light wavelengths. During the evolution of life, semiconducting minerals were energized by sun radiation. The molecules that followed became photoacceptors and were expressed into the first proto-cells and prokaryote membranes. Afterward, the components of the mitochondria electron transport chain influenced the eukaryotic cell physiology. Therefore, although many organisms have not utilized light as an energy source, many of the molecules involved in their physiology have retained their primordial photoacceptive properties. Thus, in this review, we discuss how PBM can affect the oral microbiota through photo-energization and the non-thermal effect of light on photoacceptors (i.e., cytochromes, flavins, and iron-proteins). Sometimes, the interaction of photons with pigments of an endogenous nature is followed by thermal or photodynamic-like effects. However, the preliminary data do not allow determining reliable therapies but stress the need for further knowledge on light-bacteria interactions and microbiota management in the health and illness of patients through PBM.

Introducing a flexible drug delivery system based on poly(glycerol sebacate)-urethane and its nanocomposite: potential application in the prevention and treatment of oral diseases.

In this study, a novel biopolymer based on poly(glycerol sebacic)-urethane (PGS-U) and its nanocomposites containing Cloisite@30B were synthesized by facile approach in which the crosslinking was created by aliphatic hexamethylene diisocyanate (HDI) at room temperature and 80 °C. Moreover, metronidazole and tetracycline drugs were selected as target drugs and loaded into PGSU based nanocomposites. A uniform and continuous microstructure with smooth surface is observed in the case of pristine PGS-U sample. The continuity of microstructure is observed in the case of all bionanocomposites. XRD result confirmed an intercalated morphology for PGSU containing 5 wt% of clay nanoparticles with a d-spacing 3.4 nm. The increment of nanoclay content up to 5%, the ultimate tensile stress and elastic modulus were obtained nearly 0.32 and 0.83 MPa, which the latter was more than eight-fold than that of pristine PGS-U. A sustained release for both dugs was observed by 200 h. The slowest and controlled drug release rate was determined in the case of PGSU containing 5 wt% clay and cured at 80 °C. A non-Fickian diffusion can be concluded in the case of tetracycline release via PGS-U/nanoclay bionanocomposites, while a Fickian process was detected in the case of metronidazole release by PGS-U/nanoclay bionanocomposites. As a result, the designed scaffold showed high flexibility, which makes it an appropriate option for utilization in the treatment of periodontal disease.

Identification and Characterization of Citrus Concave Gum-Associated Virus Infecting Citrus and Apple Trees by Serological, Molecular and High-Throughput Sequencing Approaches.

Citrus concave gum-associated virus (CCGaV) is a negative-stranded RNA virus, first reported a few years ago in citrus trees from Italy. It has been reported in apple trees in the USA and in Brazil, suggesting a wider host range and geographic distribution. Here, an anti-CCGaV polyclonal antiserum to specifically detect the virus has been developed and used in a standard double antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) that has been validated as a sensitive and reliable method to detect this virus both in citrus and apple trees. In contrast, when the same antiserum was used in direct tissue-blot immunoassay, CCGaV was efficiently detected in citrus but not in apple. Using this antiserum, the first apple trees infected by CCGaV were identified in Italy and the presence of CCGaV in several apple cultivars in southern Italy was confirmed by field surveys. High-throughput sequencing (HTS) allowed for the assembling of the complete genome of one CCGaV Italian apple isolate (CE-c3). Phylogenetic analysis of Italian CCGaV isolates from apple and citrus and those available in the database showed close relationships between the isolates from the same genus (Citrus or Malus), regardless their geographical origin. This finding was further confirmed by the identification of amino acid signatures specific of isolates infecting citrus or apple hosts. Analysis of HTS reads also revealed that the CE-c3 Italian apple tree, besides CCGaV, was simultaneously infected by several viruses and one viroid, including apple rubbery wood virus 2 which is reported for the first time in Italy. The complete or almost complete genomic sequences of the coinfecting agents were determined.

The silent epidemic of common oral diseases among the Arab population: An emerging health problem.

Oral diseases are often ignored in public health policy within the Arab world, despite being a prevalent public health problem exerting a significant continuous increasing socioeconomic cost. This review paper explored the current status of the common oral diseases (dental caries, periodontal disease, oral cancer, and oro-facial trauma) in the Arab world through a literature search of the PubMed, Scopus, Google Scholar, and Google databases between 1998 and 2021. The literature available revealed sufficient evidence to support that oral diseases are highly prevalent in Arab nations. Collective, multi-sectorial action to reduce and eliminate oral diseases among the Arab population has become an urgent need.

Oral health problems in high-performance athletes at 2019 Pan American Games in Lima: a descriptive study.

INTRODUCTION: Dental care is provided for high-performance athletes at national and international sports events. Elite athletes may seek care for sports-related injuries and pre-existing oral diseases. Previous studies indicate an association between oral health problems and negative performance impacts in elite athletes. OBJECTIVES: To determine the prevalence of the most common oral pathologies in high-performance athletes during the emergency dental care performed at the Lima 2019 Pan American Games (JPL-19). METHODOLOGY: All reports of athletes (≥18 years old, of both sexes, from 41 countries) who received emergency dental care at Pan American Villas during the JPL-19 were included. Injuries and types of oral diseases were classified according to the Injury and Disease Surveillance System proposed by the International Olympic Committee. RESULTS: Of the 6680 participating athletes, 76 (1.14%) presented as dental emergencies, 90.8% (69/76) of the athletes seen presented pre-existing oral pathological conditions, the most frequent were periodontal diseases (34%, 26/76) and dental caries (29%, 22/76). Among the sports with the most cases, there were 22 (29%) in athletics, 6 (8%) in soccer, and 6 (8%) in taekwondo. The most frequent dental emergencies came from Peru, Puerto Rico, Bahamas, Grenada, and Venezuela. CONCLUSIONS: Pre-existing oral diseases were more frequent than sports-related accidents. The most prevalent diseases were periodontal disease and dental caries disease. It is necessary to implement new care strategies for athletes, based on prevention, before and during sports competitions.

Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study.

OBJECTIVES: Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain whether periodontal disease affects the risk of mortality and morbidity in patients with advanced CKD. MATERIALS AND METHODS: Taiwan's National Health Insurance Research Database was used to conduct a nationwide population-based cohort study. Propensity score matching procedures were performed to select people with stage 5 CKD and to compare the long-term risk of mortality, end-stage renal disease, and major adverse cardiovascular events (MACE) between people with and without periodontal disease. Multivariable Cox regression analyses were conducted to calculate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the outcome of interest. RESULTS: A total of 8119 subjects with stage 5 CKD were initially included. After matching to demographic and clinical covariates, 1254 subjects with 7099 person-years of follow-up were selected for analyses. Periodontal disease was not associated with long-term risks of all-cause mortality (aHR: 0.77, 95% CI: 0.49-1.22), progression to end-stage renal disease (aHR: 0.91, 95% CI: 0.75-1.10), or MACE (aHR: 1.18, 95% CI: 0.91-1.53). These findings were generally consistent across subgroups of age, sex, comorbid diabetes, uses of systemic antibiotic, and different dental procedures. CONCLUSIONS: Periodontal disease is not a predictor for long-term mortality or morbidity in patients with advanced CKD. CLINICAL RELEVANCE: These results provide important evidence to elucidate the relationship between periodontitis and critical clinical outcomes of advanced CKD.

Proanthocyanidins and Flavan-3-ols in the Prevention and Treatment of Periodontitis-Immunomodulatory Effects, Animal and Clinical Studies.

This paper continues the systematic review on proanthocyanidins and flavan-3-ols in the prevention and treatment of periodontal disease and covers the immunomodulatory effects, and animal- and clinical studies, while the other part discussed the direct antibacterial properties. Inflammation as a major response of the periodontal tissues attacked by pathogenic microbes can significantly exacerbate the condition. However, the bidirectional activity of phytochemicals that simultaneously inhibit bacterial proliferation and proinflammatory signaling can provide a substantial alleviation of both cause and symptoms. The modulatory effects on various aspects of inflammatory and overall immune response are covered, including confirmed and postulated mechanisms of action, structure activity relationships and molecular targets. Further, the clinical relevance of flavan-3-ols and available outcomes from clinical studies is analyzed and discussed. Among the numerous natural sources of flavan-3-ols and proanthocyanidins the most promising are, similarly to antibacterial properties, constituents of various foods, such as fruits of Vaccinium species, tea leaves, grape seeds, and tannin-rich medicinal herbs. Despite a vast amount of in vitro and cell-based evidence of immunomodulatory there are still only a few animal and clinical studies. Most of the reports, regardless of the used model, indicated the efficiency of these phytochemicals from cranberries and other Vaccinium species and tea extracts (green or black). Other sources such as grape seeds and traditional medicinal plants, were seldom. In conclusion, the potential of flavan-3-ols and their derivatives in prevention and alleviation of periodontal disease is remarkable but clinical evidence is urgently needed for issuing credible dietary recommendation and complementary treatments.

Proanthocyanidins and Flavan-3-Ols in the Prevention and Treatment of Periodontitis-Antibacterial Effects.

Flavan-3-ols and their oligomeric forms called proanthocyanidins are polyphenolic compounds occurring in several foodstuffs and in many medicinal herbs. Their consumption is associated with numerous health benefits. They exhibit antioxidant, anti-inflammatory, cytoprotective, as well as antimicrobial activity. The latter property is important in the prevention and treatment of periodontal diseases. Periodontitis is a multifactorial polymicrobial infection characterized by a destructive inflammatory process affecting the periodontium. Using non-toxic and efficient natural products such as flavanol derivatives can significantly contribute to alleviating periodontitis symptoms and preventing the disease's progress. Therefore, a comprehensive systematic review of proanthocyanidins and flavan-3-ols in the prevention and treatment of periodontitis was performed. The present paper reviews the direct antibacterial effects of these compounds against periodontic pathogens. The immunomodulatory effects, including animal and clinical studies, are included in a separate, parallel article. There is significant evidence supporting the importance of the antibacterial action exerted by proanthocyanidins from edible fruits, tea, and medicinal herbs in the inhibition of periodontitis-causing pathogens.

A quality improvement project to assess the use of visual aids to improve understanding and motivation in periodontal patients.

AIMS: A quality improvement project was carried out in a General Dental Practice in London. The aim was to improve understanding and motivation in periodontal patients. METHODS: Research into interventions in the medical field to improve understanding and motivation amongst patients, lead to the idea of using visual aids to help motivate periodontal patients and to improve their understanding of the disease. The results from the first Plan-Do-Study-Act cycle using visual aids are presented. RESULTS: After the use of visual aids, patients felt more motivated in maintaining good oral hygiene, felt the visual aids improved their understanding of gum disease and how to take care of their gums and teeth. One hundred percent of patients preferred their diagnosis to be explained to them with visual aids. DISCUSSION: The project supported the increase in motivation and understanding in periodontal patients. However further data is required to learn more about how visual aids influence patient behaviour, how effective they are in improving patients' understanding and motivation, and other factors which play a role in this. CONCLUSIONS: The results of this quality improvement project are promising; it has highlighted that visual aids can have a place in the management of periodontitis in general practice.

Rapamycin rejuvenates oral health in aging mice.

Periodontal disease is an age-associated disorder clinically defined by periodontal bone loss, inflammation of the specialized tissues that surround and support the tooth, and microbiome dysbiosis. Currently, there is no therapy for reversing periodontal disease, and treatment is generally restricted to preventive measures or tooth extraction. The FDA-approved drug rapamycin slows aging and extends lifespan in multiple organisms, including mice. Here, we demonstrate that short-term treatment with rapamycin rejuvenates the aged oral cavity of elderly mice, including regeneration of periodontal bone, attenuation of gingival and periodontal bone inflammation, and revertive shift of the oral microbiome toward a more youthful composition. This provides a geroscience strategy to potentially rejuvenate oral health and reverse periodontal disease in the elderly.

Age is the single greatest risk factor for many human diseases, including cancer, heart disease, and dementia. This is because, as the body ages, it becomes less able to repair itself. One way to prevent age-related disease and extend lifespan, at least in laboratory animals, is to use a drug called rapamycin. Mice treated with rapamycin live longer, have stronger hearts, and respond better to vaccination. But, despite these promising observations, the use of rapamycin as an anti-aging treatment is still under investigation. One open question is what age-related diseases rapamycin can help to prevent or treat. In the United States, more than 60% of adults over the age of 65 have gum disease. These people are also more likely to have other age-related diseases, like heart disease or Alzheimer's. This association between gum problems and other age-related diseases prompted An et al. to ask whether it might be possible to treat gum disease by targeting aging. To find out whether rapamycin could improve gum health, An et al. performed three-dimensional CT scans on mice as they aged to measure the bone around the teeth. Some of mice were treated with rapamycin, while the rest received a placebo. The mice that received the placebo started to show signs of gum disease as they aged, including inflammation and loss of bone around the teeth. The types of bacteria in their mouths also changed as they aged. Treating mice with rapamycin not only delayed the onset of these symptoms, but actually reversed them. After eight-weeks of the drug, the older mice had lost less bone and showed fewer signs of inflammation. There was also a shift in their mouth bacteria, restoring the balance of species back to those found in younger mice. Rapamycin is already approved for use in people, so a clinical trial could reveal whether it has the same effects on gum health in humans as it does in mice. But there are still unanswered questions about how rapamycin affects the mouth as it ages. These include how the drug works at a molecular level, and how long the changes to gum health persist after treatment stops.

CO2 Laser De-epithelization Technique for Subepithelial Connective Tissue Graft: A Study of 21 Recessions.

BACKGROUND/AIM: To report cases in which we achieved sufficient width of the keratinized gingiva using a coronally advanced flap in combination with a subepithelial connective tissue graft (SCTG) obtained by the 'CO2 laser de-epithelization technique' (CODE). PATIENTS AND METHODS: Eleven patients with 21 Miller Class I, II, and III gingival recessions had surgery. To prepare SCTG, free gingival grafts were harvested and de-epithelialized extra-orally. De-epithelialization was conducted by irradiation of CO2 laser. Postoperative examinations were performed at 12 months. RESULTS: At 12 months, statistically highly significant root coverage was achieved in all recessions. Complete root coverage was obtained in 7 of the 21 recessions. The treatment yielded mean root coverage of 41.0%, and was associated with a mean gain of keratinized gingiva of 2.9±0.3 mm. CONCLUSION: The use of CODE allows harvesting grafts of excellent quality and quantity and increases the keratinization of the overlying mucosal epithelium.

Periodontal treatment and peripheral arterial disease severity - a retrospective analysis of health insurance claims data.

Background: Although epidemiological data suggest an association between periodontitis (PD) and peripheral arterial disease (PAD), it is currently unclear whether treatment of PD influences the severity of PAD. Patients and methods: Whether periodontal treatment is associated with PAD disease severity was examined by analysing health insurance claims data of patients insured by the German health insurance fund, BARMER, between January 1, 2012 and December 31, 2016. The presence of PAD was determined in individuals using International Classification of Diseases (ICD) 10th revision codes for intermittent claudication (IC) or chronic limb threatening ischaemia (CLTI). Treatment of PD was assessed by adequate ambulatory coding for non-surgical and surgical treatment of PD. Multivariate logistic regression analysis was performed to evaluate the association between PAD stages and periodontal treatment, adjusted for diabetes, age and sex. Results: The study cohort included 70,944 hospitalized patients with a diagnosis of symptomatic PAD (54.99 % women, 49.05 % IC). Among these patients, 3,567 (5.03 %) had received prior treatment for PD by supra- or sub-gingival debridement. PAD patients who had received periodontal treatment showed a lower proportion of CLTI (28.76 % among treated vs. 52.12 % among non-treated). Using multivariable regression methods, exhibiting a CLTI (vs. IC) was associated with not being treated for PD (Odds Ratio 1.97, 95 %-CI 1.83-2.13) after adjustment for age, gender, and diabetes. Conclusions: In this large-scale retrospective analysis of health insurance claims data comprising hospitalized symptomatic PAD patients, treatment of PD was associated with PAD disease severity independent of age, gender and diabetes. A potential benefit of periodontal treatment in relation to PAD will have to be determined in further prospective studies.

SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk.

PURPOSE: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. METHODS: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. RESULTS: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07-1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05-1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. CONCLUSIONS: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

Long-term Association of Periodontitis With Decreased Kidney Function.

RATIONALE & OBJECTIVE: Previous studies have yielded inconclusive findings regarding the relationship between periodontitis and kidney function. We sought to investigate whether periodontitis is associated with subsequent decreases in kidney function (reductions in estimated glomerular filtration rate [eGFR] and increased urinary albumin-creatinine ratio [UACR]) in the general population. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: We used baseline and 11-year follow-up data from 2,297 and 1,512 adult participants, respectively, in the Study of Health in Pomerania (SHIP). Age range was limited to 20 to 59 years to avoid the potential influence of tooth loss. EXPOSURES: Periodontal status defined by periodontal pocket probing depth (PPD) and clinical attachment level. Mean levels and the percentage of sites ≥ 3mm was determined for either all sites (PPD) or interproximal sites (clinical attachment level). All PPDs≥4mm were summed to calculate the total PPD. OUTCOMES: GFR estimated from serum creatinine and serum cystatin C (eGFRcr-cys). Moderately increased albuminuria defined as UACR>30mg/g. ANALYTICAL APPROACH: Adjusted linear and logistic mixed regression models. RESULTS: At baseline and follow-up, average eGFRcr-cys was 118.3 and 105.0mL/min/1.73m2, respectively. Using mixed models, no consistently significant associations between periodontitis variables and eGFRcr-cys were detected. Long-term changes in UACR were inconsistently associated with periodontitis measures. After imputation of missing data, associations were either attenuated or no longer detectable. LIMITATIONS: Because periodontal assessments were performed using a partial recording protocol, periodontal disease severity estimates might have been underestimated, resulting in attenuated effect estimates. CONCLUSIONS: We found no consistent evidence for an association between periodontitis and decreased kidney function. In contrast to previous studies, these results do not support the hypothesis that periodontitis is an important risk factor for chronic kidney disease.