Is Diet a Determining Factor in the Induction of Gingival Inflammation by Dental Plaque? A Secondary Analysis of Clinical Studies.

The aim was to determine the association between plaque and gingival inflammation reported by dietary interventions. Data of four clinical studies dealing with changed nutrition and gingival examination were reanalyzed with regard to gingival inflammation (GI), plaque (PI), and bleeding on probing (BOP). Dietary changes basically involved avoiding sugar, white flour and sweetened drinks and focusing on whole foods for 4 weeks. The control groups were to maintain their usual diet. All participants had to reduce their oral hygiene efforts. Linear regression models taking the clustering of the data due to several studies into account were applied. In total, data of 92 participants (control groups: 39, test-groups 53) were reanalyzed. While both groups showed a slight increase in dental plaque, only the test groups showed a significant decrease in inflammatory parameters: GI (mean value difference End-Baseline (Δ): -0.31 (±SD 0.36)) and BOP (Δ: -15.39% (±16.07)), both p < 0.001. In the control groups, there was a constant relation between PI and GI, while the experimental group showed a decreasing relationship in GI/PI (p = 0.016), and even an inverted relationship BOP/PI under a changed diet (p = 0.031). In conclusion, diet seems to be a determining factor how the gingiva reacts towards dental plaque.

Increased frequency of oral plasma cell mucositis/plasma cell gingivitis after the COVID-19 pandemic: a 23-year retrospective analysis and review of diagnostic challenges relating to this condition.

OBJECTIVE: Oral plasma cell mucositis (PCM) or localized plasma cell gingivitis (PCG) is an idiopathic inflammatory condition often associated with hypersensitivity reactions. This study aimed to evaluate the frequency and features of PCM/PCG in a large biopsy service over a time period of more than 20 years. STUDY DESIGN: The biopsy archives at University of Florida College of Dentistry were searched from 2000 through the first quarter of 2023 for cases of oral PCM or PCG. Case data were aggregated and analyzed. RESULTS: A total of 107 cases were included. Between 2000 and 2019, PCM/PCG was diagnosed in 0.03% of all biopsy cases. Starting in 2020 through 2023, the percentage of biopsies diagnosed as PCM/PCG increased threefold to 0.10% of all biopsy cases, and the mean patient age increased by 3 years. There were no statistically significant differences between cases diagnosed from 2000 to 2019 and those from 2020 to 2023 regarding age, sex, location, or histology. CONCLUSIONS: A significant increase in PCM/PCG was identified in this study at one institution coinciding with the start of the COVID-19 pandemic. Further investigation is recommended to determine if this is a widespread phenomenon and identify possible etiologic mechanisms.

Anti-melanoma Differentiation-associated Gene 5 Antibody-positive Dermatomyositis Presenting as Refractory Gingivitis at the First Clinical Manifestation.

We herein report a case of melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis that developed in a patient with refractory gingivitis. The diagnosis of anti-MDA5 antibody-positive dermatomyositis was made based on a characteristic skin rash, weakness of proximal muscles, interstitial pneumonia, and positivity for anti-MDA5 antibody. The patient was started on triple therapy with high-dose prednisolone, tacrolimus, and intravenous cyclophosphamide. After treatment, the refractory gingivitis disappeared, and the other skin rash and interstitial lung disease also improved. In the diagnosis and treatment of anti-MDA5 antibody-positive dermatomyositis, it is necessary to pay attention to the intraoral findings, including the gingiva.

The relationship between obesity and oral-health status in North African adults: A comparative study.

INTRODUCTION: The strength of the association between obesity and oral health is still indecisive. OBJECTIVE: The objectives of the study were to compare some oral-health data between two groups involving obese (OG) and normal weight (NWG) participants and determine the influencing factors of the periodontal probing depth (PPD). METHODS: This was a cross-sectional study including 67 Tunisian adults [OG (n = 33, body mass index (BMI) > 30 kg/m2 ), NWG (n = 34, BMI: 18.5-25.0 kg/m2 )]. The plaque level was recorded using the plaque index (PI). Gingival index (GI) was used to evaluate gingival inflammation. The depths of the sulci/pockets were probed using a periodontal probe. Stimulated saliva was collected for 5 min, and salivary flow rate (SFR) was determined. Salivary baseline pH (SBpH) was measured. A multivariable regression analysis was performed between PPD and some independent variables [i.e. obesity status, age, sex, socioeconomic status, systemic diseases and PI data]. RESULTS: The OG and NWG were age- and sex-matched and included comparable percentages of participants with systemic diseases (27.3 vs. 29.4%, respectively). The OG included a higher percentage of participants having a low socioeconomic status (87.9 vs. 64.7%, respectively). Compared with the NWG, the OG: (i) had comparable values of daily toothbrushing frequency, PI, GI and tooth mobility, (ii) included comparable percentages of irregular brushers, of participants with periodontitis, PI classes [0-1]and [1-2]; and GI classes [0-1], [1-2] and [2, 3]; (iii) had a higher PPD (2.02 ± 0.41 vs. 2.35 ± 0.22 mm, respectively), (iv) had lower SBpH (7.59 ± 0.21 vs. 7.45 ± 0.22, respectively) and SFR (1.98 ± 0.28 vs. 1.60 ± 0.32 mL/mn, respectively) and (v) included a higher percentage of participants having a PI class [2, 3] (67.6 vs. 87.9%, respectively). The multivariable regression analysis revealed that only obesity status, age and PI classes influenced the PPD, altogether explained 29.62% of the PPD variance. CONCLUSION: Obesity poses a risk for oral health, and obese adults had altered PPD and lower BSpH and SFR. Dentists should make obese patients aware of the health risks of obesity in an attempt to reduce the potential oral complications associated with this epidemic.

The investigation of antibacterial activity of hyperlight fluid fusion subcellular essential complex.

INTRODUCTION: This study aimed to investigate the possibility of applying the hyperlight fluid fusion essential complex in dental plaque control, and to evaluate the effectiveness of new and modern agents used for the prevention and early treatment of gingivitis. METHODOLOGY: The study included 60 subjects randomly divided into two groups. The control group was assigned to 0.12% chlorhexidine (CHX) mouth rinse, whereas the test group used a solution based on hyper-harmonized hydroxylated fullerene water complex (3HFWC), twice daily for 2 weeks. The plaque, gingivitis and bleeding scores were evaluated and recorded. Collected plaque samples were seeded on blood agar and incubated aerobically at a temperature of 37 °C for 24-48 hours. In order to isolate anaerobic bacteria, samples were seeded on Schaedler Agar and incubated anaerobically at 37 °C for seven days. Serial dilutions in saline from 101 - 106 were made, and grown colonies were counted and identified using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) system. RESULTS: The reduction in the number of bacteria was significant in both control and test groups. The reduction was greater in the control group compared to the experimental group, but without statistically significant difference. CONCLUSIONS: 3HFWC treatment causes significant reduction in the number of dental plaque microorganisms. Since 3HFWC solution exhibited a bacteriostatic effect similar to chlorhexidine it could be an adequate addition to solution of a growing problem in prevention and early treatment of gingivitis and periodontitis.

Evaluation of an advanced oral hygiene regimen on maternity outcomes in a randomized multicenter clinical trial (Oral Hygiene and Maternity Outcomes Multicenter Study).

BACKGROUND: During pregnancy, dental plaque-induced gingivitis prevalence and subsequent risk of periodontal disease increases substantially, as a consequence of both inadequate oral hygiene and changes in sex steroid hormone levels. Although maternal periodontal disease has been associated with adverse pregnancy outcomes, including spontaneous preterm birth, previous clinical trials involving mechanical debridement (eg, scaling and root planing) to remove plaque biofilm have not yielded decreased rates of preterm birth. OBJECTIVE: We hypothesized that an advanced oral hygiene program, including an antibacterial regimen coupled with a power toothbrush and hygiene instruction, may improve the periodontal milieu and reduce the rate of spontaneous preterm birth. Therefore, we conducted a clinical trial of obstetrical patients with moderate-to-severe gingivitis who were randomized to an advanced oral hygiene program vs usual oral hygiene care, and the primary obstetrical outcome compared between the treatment groups was gestational age at delivery. STUDY DESIGN: Obstetrical patients with singleton pregnancies between 8 and 24 weeks' gestation were screened by trained dentists at 2 clinical sites for moderate-to-severe gingivitis (>30 intraoral sites with gingival bleeding on probing). Eligible participants were randomized to an advanced oral hygiene regimen, including antibacterial mouth wash, dental floss, antibacterial toothpaste, a power toothbrush, and intensive oral hygiene education vs standard oral home care instructions and regimen. The primary obstetrical outcome assessed was gestational age at delivery. The overall primary (dental) outcomes were gingival index, bleeding sites, and pocket depth (reported elsewhere). Secondary obstetrical outcomes included birthweight and incidence of preterm birth at <37 weeks' gestation. Regression models were utilized and included factors such as treatment group, gestational age at enrollment, preterm birth history, and potential markers of health disparities (ie, education, employment status). RESULTS: A total of 817 obstetrical patients underwent dental screening at the 2 sites, 789 were identified with moderate-to-severe gingivitis, 746 were randomized, and birth outcomes were available for 613 of the study participants. The gestational age at delivery was 2 days earlier in the control group (P=.040), but the clinical significance of this finding was limited (39.13 vs 38.85 weeks). Overall rates of spontaneous preterm birth <37 weeks and <34 weeks were not statistically different between the 2 treatment groups (7.0% advanced oral hygiene regimen vs 10.3% controls, OR=1.63 (0.90-3.00), P=.11; and 2.3% vs 3.9%, OR=1.88 (0.71-4.98), P=.20, respectively). However, we observed lower rates of spontaneous preterm birth among unemployed participants with less favorable socioeconomic status (4.7% advanced oral hygiene regimen vs 16.0% controls, OR=4.04 (1.34-15.12), P=.01). CONCLUSION: An advanced oral hygiene program may reduce the risk of spontaneous preterm birth among pregnant patients with moderate-to-severe gingivitis and health disparities. This is the same group that may be at highest risk of poor dental hygiene and preterm birth.

Delayed Severe Gingivitis After Placement of Orthodontic Braces in an Atopic Teenager: A Case Report and Literature Review.

We report a case of a 15-year-old atopic patient presenting with delayed, severe ulcerative hypertrophic gingivitis after placement of orthodontic braces, which required removal of braces and restorative laser surgical procedures. Patch testing to multiple metals and chemicals showed weak positive reactions to steel bands and formaldehyde. The patient experienced urticarial, gingivitis, and other intraoral symptoms after patch testing and re-exposure to nickel-containing products. In contrast, nickel, cobalt, and cobalt-chromium (Co-Cr) bracket patch testing sites were negative. Nickel-caused contact dermatitis is Type IV delayed hypersensitivity reaction occurring at least 24 h after exposure. This reaction can result in intraoral blisters, ulcerations, eczematous and urticarial reactions of the face and more distant skin areas. This case illustrates the intraoral delayed response, symptom resolution after removing the braces, and brackets and local reactions upon subsequent nickel exposure, despite negative patch testing and lymphocyte stimulation test to nickel. This case further illustrates the difficulty associated with diagnosing nickel allergy.

Gingivitis in cattle and supplemental protein diet: Insights from proteomic analysis.

Salivary proteins are essencial in the maintenance of oral homeostasis and can reflect systemic and localized processes, like gingivitis. However, little is known about the relationship between diet and the occurrence of gingivitis in cattle. The present study aimed to characterize the salivary proteomic profile of cattle (n = 12) fed hay (112.19 g/kg of crude protein) cultivated in reformed pastures, and, one group received protein supplement (PS, n = 6); the effect of the protein supplement on the gingival health of the cattle was determined by weekly intraoral examination and periodontal evaluation of the eight (deciduous) incisors. The whole saliva proteome of the two groups was evaluated after 20 and 60 days of confinement. In the periodontal clinical evaluation both groups had episodes of gingivitis; however, the average number of affected sites in the PS group was higher on day 60. The cattle fed exclusively hay, presented a lower average of affected gingival sites on day 60. After 60 days of experimentation, nine biological and 11 immunological processes were altered in bovine saliva. Proteins with multiple functions were detected in the saliva of the cattle; however, differences were observed in their regulation between the two groups. SIGNIFICANCE: In bovine populations, the relationship between diet and increased incidence of gingivitis is theorized. The results of the present pilot study, both diets caused episodes of gingivitis in the primary dentition of cattle and, apparently, diets with protein supplementation stimulate the expression of salivary proteins with a protective role in cattle that can act against infectious-inflammatory processes, such as gingivitis. However, it is plausible that over time, cattle will adapt to these diets and become more vulnerable to gingivitis.

Plasma Cell Gingivitis and Its Mimics.

Plasma cell gingivitis (PCG) is an inflammatory condition that affects the gingival mucosa of the oral cavity. It is characterized by polyclonal dense plasma cell infiltrate in the connective tissue. Lesions do not respond to prophylactic treatment. Etiology is most likely hypersensitivity to certain antigens (eg, toothpastes, oral rinses, chewing gums, spices). Differential diagnosis of PCG includes reactive, granulomatous, and neoplastic lesions. The diagnostic workup is based on patient's history and the clinicopathologic correlation to rule out mimics of PCG. Dermatologic patch test may be indicated in chronic conditions to identify the allergen.

Use of an antiseptic rinse (NanArgol) for the oral hygiene maintenance of subjects with fixed appliances: A randomized clinical trial.

BACKGROUND: The risk of periodontal diseases development increased in patients with malocclusion undergoing orthodontic treatment. Thus, the aim of this study was to examine the efficacy of the use of adjunctive rinses with nano-Argentum to standard oral hygiene regimen in subjects wearing fixed orthodontic appliances. MATERIALS AND METHODS: Eighty patients were observed for 1 year. They were divided in two groups: in test group patients were instructed to rinse with non-ionic colloidal silver solution according to protocol for 6 months as an adjunct to standard; in control group the patients followed the standard oral hygiene regimen. Index of efficiency of oral hygiene (PHPm), community periodontal index (CPI) and papillary-marginal-alveolar index (PMA) were evaluated before treatment and after 1 and 6 months. For statistics analysis, Mann-Whitney, Kruskal-Wallis tests and Pearson criterion were used. RESULTS: Baseline hygiene levels in two groups had no differences. Oral hygiene indices were significantly lower in the test group in comparison with control after 1 month (PHPm = 0.38 ± 0.18 and 1.19 ± 0.45, respectively, p < 0.01; PMA = 11.78 ± 8.5 and 47.25 ± 20.9, respectively, p < 0.05; CPI = 0.65 ± 0.53 and 1.53 ± 0.77, respectively, p < 0.01) and 6 months (PHPm = 0.5 ± 0.2 and 1.2 ± 0.4, respectively, p < 0.01; PMA = 11.62 ± 19.6 and 66.33 ± 27.9, respectively, p < 0.01; CPI = 0.63 ± 0.73 and 1.68 ± 0.78, respectively, p < 0.01). CONCLUSIONS: The use of the test solution as an adjunct to standard oral hygiene provided a significant beneficial effect in terms of oral hygiene in patients undergoing orthodontic treatment.

Association between asthma and oral conditions in children and adolescents: a systematic review with meta-analysis.

OBJECTIVE: To investigate the association between asthma and oral conditions in children and adolescents. MATERIAL AND METHODS: Observational studies that evaluated the association between asthma and oral conditions in children and/or adolescents were retrieved from five databases, grey literature and reference lists up to April 7th, 2022. Meta-analyses were performed, and I2 statistics were calculated. The mean difference was used as a measure of effect for continuous variables. Event frequencies were evaluated to determine odds ratios for dichotomous variables. Publication bias was investigated using Egger's test. The methodological quality (JBI) and certainty of the evidence (GRADE) were assessed. RESULTS: Forty-two studies were eligible, and sixteen were included in the meta-analysis. Mean dmft (MD: 1.11, 95%CI: 0.48-1.73), DMFT (MD: 1.01, 95% CI: 0.45-1.56), dmfs (MD: 3.62, 95%CI: 2.60-4.63) and DMFS (MD: 4.47, 95%CI: 0.98-7.96) indices were significantly higher in asthmatic children and adolescents compared to those without asthma. In the analysis of biofilm, asthmatic children and adolescents had a higher Plaque Index compared to those without asthma (MD: 0.18, 95%CI: 0.03-0.33). CONCLUSION: Asthmatic children and adolescents may be more likely to develop tooth decay and build up biofilm compared to those without asthma. It is suggested that there are no differences between asthmatic and non-asthmatic children and adolescents regarding gingivitis, developmental defects of enamel or erosive tooth wear. The certainty of the evidence was classified as 'very low'. CLINICAL RELEVANCE: Knowledge of the risks that asthma and asthma medications for oral health can assist in counselling families of children and adolescents with this condition in terms of control and prevention measures for oral problems.

ASSESSMENT OF THE SEVERITY OF GINGIVITIS IN CHILDREN WITH DISORDERS OF TEETH FORMATION SUFFERED AFTER THE CHORNOBYL NPP ACCIDENT. / OTsINKA STUPENIa TIaZhKOSTI GINGIVITU U DITEI Z PORUShENNIaMY FORMUVANNIa ZUBIV, POSTRAZhDALYKh VNASLIDOK AVARIÏ NA ChORNOBYL'S'KII AES.

OBJECTIVE: to determine the severity of gingivitis in children with teeth formation disorders - residents of the ter-ritories contaminated with radionuclides as a result of Chornobyl Nuclear Power Plant (ChNPP) accident. MATERIALS AND METHODS: The object of the study is 1470 children aged 6-14 years with dental malformations, 528 amomg them are residents of areas contaminated with radionuclides as a result of the ChNPP with the identified types of disorders of teeth formation (DTF) (systemic enamel hypoplasia (SEH) and molar-incisor hypomineralization (MIH)), and different stages of the severity of gingivitis. RESULTS: Determining of the degree of severity of gingivitis in children with DTF indicates the presence of its lesion of a moderate degree of the severity with a prevalence in persons with SEH or MIH and chronic diseases of internal organs suffered after the ChNPP accident. CONCLUSIONS: In irradiated children with DTF, an average degree of severity of gingivitis was established (РМА = (43.03 ± 19.64) %, p > 0.001), which may be due to the effect of a complex of negative factors, in particular the influence of low doses of ionizing radiation, the peculiarities of the social status of the examined persons (imbalanced nutrition), unsatisfactory oral hygiene. In children suffered after the ChNPP accident with SEH, the indicators of the PMA index were reliable (p > 0.05) higher compared to individuals with MIH, which indicates a more pronounced degree of periodont damage. Revealed damage to periodont, in particular gingivitis, in children with DTF residents of the contaminated territories, probably caused by the action of a complex of negative environmental factors, in particular the influence of low doses of ionizing radiation, and the peculiarities of the social status of children, which requires a comprehensive approach to the prevention of complications of defects of hard tissues of the teeth.

Dental Caries, Traumatic Dental Injuries and Gingivitis among Street-Children in Kano, Nigeria.

BACKGROUND: Street-children (Almajirai) constitute a significant proportion of the adolescent population in northern Nigeria. They face health challenges, especially oral health, from being inadequately protected, supervised or directed by responsible adults. OBJECTIVES: The objective of the study was to determine the prevalence of dental caries, dental trauma, gingivitis and oral hygiene scores in street-children. METHODOLOGY: Three hundred and sixty-six school-aged children were selected through a multi-stage sampling of 10 to 12-year-old children from four modern and traditional qur'anic schools, and examined for oral conditions using the WHO protocol. The DMFT index, the modified Ellis criteria, the Gingival Bleeding Index and the Oral Hygiene Index-Simplified (OHI-S) were used to assess dental caries, traumatic dental injuries, gingivitis and oral hygiene scores respectively. Chi-squared tests and Odds Ratio were used to compare the difference and test the association between Almajirai groups. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS version 20). Statistical significance was considered when p < 0.05. RESULTS: One hundred and sixty eight (45.9%) traditional Almajirai and 198 (59.4%) modern-type Almajirai, participated in the study. Their mean age was 10.8(±0.8) years. The prevalence of dental caries was 25.4% with mean DMFT and SiC scores of 0.6 (±1.3) and 1.7 respectively. DMFT scores ranged from 0 to 12. The prevalence of traumatic dental injuries and gingivitis were 8.7% and 82.2% respectively, while the OHI-S score was 3.0. The odds for traumatic dental injuries were 41% less in the modern-type Almajirai (p=0.02); the modern-type Almajirai were twice as likely to develop gingivitis (aOR 95%CI =2.0, p=0.01). OHI-S scores showed poorer oral hygiene levels in the modern Almajirai (p=0.02). CONCLUSION: Dental caries, traumatic dental injuries, gingivitis and poor oral hygiene were prevalent among street-children in Kano. There is a high level of untreated dental disease in the study population.

CONTEXTE: Les enfants des rues constituent une proportion importante de la population adolescente du nord du Nigeria. Ils sont confrontés à des problèmes de santé, notamment de santé bucco-dentaire, du fait qu'ils ne sont pas suffisamment protégés, supervisés ou dirigés par des adultes responsables. OBJECTIFS: L'objectif de cette étude était de déterminer la prévalence des caries dentaires, des traumatismes dentaires, de la gingivite et des scores d'hygiène buccale chez les enfants des rues. MÉTHODOLOGIE: Trois cent soixante-six enfants d'âge scolaire ont été sélectionnés par un échantillonnage à plusieurs degrés d'enfants de 10 à 12 ans dans quatre écoles qur'aniques modernes et traditionnelles, et ont été examinés pour les conditions bucco-dentaires en utilisant le protocole de l'OMS. L'indice CAOD, les critères d'Ellis modifiés, l'indice de saignement gingival et l'indice d'hygiène buccale simplifié (IOB-S) ont été utilisés pour évaluer les caries dentaires, les lésions dentaires traumatiques, la gingivite et les scores d'hygiène buccale, respectivement. Les tests du chi carré et l'Odds Ratio ont été utilisés pour comparer les différences et tester l'association entre les groupes Almajirai. L'analyse des données a été réalisée à l'aide du progiciel statistique pour les sciences sociales (SPSS version 20). La signification statistique a été considérée lorsque p < 0,05. RÉSULTATS: Cent soixante-huit (45,9%) Almajirai traditionnels et 198 (59,4%) Almajirai de type moderne ont participé à l'étude. Leur âge moyen était de 10,8 (±0,8) ans. La prévalence de la carie dentaire était de 25,4 % avec des scores moyens de CAOD et de SiC de 0,6 (±1,3) et 1,7 respectivement. Les scores CAOD variaient de 0 à 12. La prévalence des lésions dentaires traumatiques et de la gingivite était de 8,7 % et 82,2 % respectivement, tandis que le score OHI-S était de 3,0. Les risques de lésions dentaires traumatiques étaient 41 % moins élevés chez les Almajirai de type moderne (p=0,02) ; les Almajirai de type moderne étaient deux fois plus susceptibles de développer une gingivite (aOR 95%CI =2,0, p=0,01). Les scores OHI-S ont montré des niveaux d'hygiène buccale plus faibles chez les Almajirai de type moderne (p=0,02). CONCLUSION: Les caries dentaires, les lésions dentaires traumatiques, les gingivites et une mauvaise hygiène bucco-dentaire étaient prévalentes chez les enfants des rues de Kano. Il existe un niveau élevé de maladies dentaires non traitées dans la population étudiée. Mots clés: Caries, enfants des rues, Almajirai, Adolescents, Hygiène buccale, Gingivite.

Non-infectious granulomatous disorders of the upper lip: clinicopathological analysis of 11 patients.

BACKGROUND: Non-infectious granulomatous disorders of the upper lip represent a special chapter of oral and maxillofacial pathology. In this work we report a case-series of this process, to analyse its main clinicopathological features and find differential data that allow us improve its diagnosis and understand its pathogenesis. METHODS: We present 11 cases of non-infectious granulomatous disorders of the upper lip, 8 women and 3 men with an age range of 29-84 years, who have been attended at the Oral Medicine Department of the IUCT (France) and the Oral Medicine Unit of the UPV/EHU (Spain). All clinicopathological data were collected in a specific protocol. RESULTS: We recognized 4 different subtypes of non-infectious granulomatous disorders of the upper lip: (1) associated with Crohn's disease (1 case), (2) associated with foreign body (2 cases), (3) associated with gingivitis lichenoid-like (4 cases), (4) idiopathic (4 cases). CONCLUSIONS: Clinicopathological differences were identified between these subtypes. A good differential diagnosis is necessary in all cases to rule out the presence of local or systemic etiopathogenic factors.

Caries experience and gingival health in children and adolescents with type 1 diabetes mellitus-A cross-sectional study.

AIM: To investigate the oral health of children and adolescents with type 1 diabetes (T1D) and its associations with diabetes-related and lifestyle factors. DESIGN: Cross-sectional study at a large tertiary hospital pediatric diabetes clinic. Oral examination determined dental caries experience and gingival health. Secondary outcome measures included salivary characteristics, oral hygiene and dietary practices, and diabetes-related factors. RESULTS: Eighty children and adolescents with T1D participated; mean (SD) age and HbA1c were 13.4(2.6) years and 7.7(0.9)%, respectively. Forty-seven (59%) participants had one or more decayed, missing or filled teeth; 75 (94%) participants had gingivitis. Half (50%) reported ≥3 hypoglycemic episodes necessitating rapid-acting carbohydrate in the previous week. Sixty-two participants (78%) had normal saliva flow, however, 42 (52%) had reduced salivary buffering capacity. Glycemic control (HbA1c ) was not associated with caries experience, gingival health or salivary characteristics. Increased frequency of tooth brushing (OR, 0.11; 95%CI 0.01-0.97, p = 0.05) and interdental flossing (OR, 0.31; 95%CI 0.12-0.81, p = 0.02) were associated with lower caries experience. Interdental flossing (OR, 0.31; 95% CI 0.12-0.80, p = 0.02) and good oral hygiene (OR, 0.06; 95% CI 0.01-0.22, p < 0.001) were associated with less gingivitis. CONCLUSION: Poor oral health is common in children with T1D, regardless of HbA1c. Given potential implications for short- and long-term systemic health, this study demonstrates the need for targeted strategies to improve oral health in children with T1D.

Oral health and cardiometabolic disease: understanding the relationship.

Examination of the oral cavity can identify clinical signs indicative of underlying systemic disease. Key features to examine include the general appearance and number of the teeth, signs of inflammation of the mucosa or gingival tissues including bleeding of the gums and redness, swelling or hyperplasia. Additionally, the tongue should be assessed for any ulceration or discolouration and the presence of excessive build-up (coating). Cardiovascular disease and diabetes, together known as cardiometabolic disease have an impact on oral health. Similarly, oral health conditions, such as gum disease (periodontitis) and dryness of the mouth (xerostomia), are associated with an increased risk for both cardiovascular disease and type 2 diabetes mellitus. The aim of this narrative review is to outline both the impact of periodontitis and xerostomia on cardiometabolic disease and the impact of cardiometabolic health on these oral health conditions. Key features of periodontitis and xerostomia will be provided along with a brief discussion of current concepts in early prevention and management of these oral health conditions. The biological mechanisms linking cardiometabolic disease and periodontitis will be outlined and the evidence supporting the association between cardiometabolic disease and oral health conditions will be presented together with an identification of areas where further research is indicated. Last, guidance for general practitioners to assess and support early diagnosis and management of oral health conditions by raising awareness of the relationship between oral health and cardiometabolic disease, providing simple oral health advice and referring to a dental practitioner will be presented.

Prevalence of Gingivitis in Second Trimester of Pregnancy.

Background Gingivitis simply means the inflammation of gingiva. It is a reversible state but can lead to periodontitis. The final result could be the exfoliation of the tooth causing decreased masticatory function leading to a compromised quality of life. Gingivitis in the pregnant woman should be carefully assessed and treated and given special attention. There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. Objective To evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing. Method An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites. Result The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing. Conclusion The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targeting the pregnant women of least developed countries to uplift their periodontal health.

Case report of spongiotic gingivitis in an adult male treated with novel 9,300-nanometer carbon dioxide laser low-energy ablation.

BACKGROUND AND OVERVIEW: To date, only about 125 cases of juvenile or adult spongiotic gingivitis have been described in the literature, primarily from retrospective biopsy searches. Spongiotic gingivitis is a relatively new, often misdiagnosed, periodontal pathology that was originally attributed only to juveniles. This is the first case report to our knowledge on spongiotic gingivitis diagnosed in a middle-aged adult man and treated with a novel carbon dioxide (CO2) laser low-energy ablation therapy. CASE DESCRIPTION: A 56-year-old man sought treatment for a localized erythematous lesion on the facial gingiva of the maxillary left central incisor (tooth no. 9). Initial treatment was conventional excisional surgery and biopsy. Diagnosed as spongiotic gingivitis, it reoccurred in the same location within 4 months. It was then treated in 3 sessions using a novel 9,300-nm CO2 laser low-energy ablation set at 0.4 W and 1.25-mm cut width for an irradiance of 33.3 W/cm2 and energy density of 0.21 J/cm2. The lesion was significantly reduced and has shown no hyperplastic reoccurrence to date. CONCLUSIONS AND PRACTICAL IMPLICATIONS: This case report brings to dental professionals' attention that acute spongiotic gingivitis may occur in older adults, not just juveniles. As such, spongiotic gingivitis may be underreported in adults with localized gingivitis, possibly attributed to toothpastes containing sodium laurel sulfate. 9,300-nm CO2 laser therapy may successfully treat lesions such as acute spongiotic gingivitis without the need for anesthesia or additional medications. This report may also encourage further research on treatment modalities, biopsy of lesions resembling this entity, and improved reporting of adult spongiotic gingivitis to better understand this unique gingival pathology.

The impact of a needs-oriented dental prophylaxis program on bacteremia after toothbrushing and systemic inflammation in children, adolescents, and young adults with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing. METHODS: To examine whether intensive dental prophylaxis can restore oral health, reduce the prevalence of bacteremia and degree of systemic inflammation indicated by CRP levels, we conducted this pilot study examining 30 CKD patients aged 6-26 years, 15 receiving intensive prophylaxis (IP), 15 receiving treatment as usual (TAU) serving as control group. There were three appointments for examination, each 10 ± 1 weeks apart (at baseline, after intervention periods one and two, when TAU also received IP, and the IP group stopped prophylaxis). RESULTS: The gingival index (GI) in the IP group decreased by 90% (GI 0.09; p=0.001), resulting in almost healthy gingiva. There was no significant change in CRP or prevalence of bacteremia. General prevalence of bacteremia after toothbrushing was 9.5% affecting 7 (26%) of the participants. In three participants, bacteremia dissolved after IP, in one after TAU. Two patients developed bacteremia ≥ 10 weeks after ending IP. We identified eight different bacterial species. CONCLUSIONS: We were able to show that IP can effectively treat gingivitis. It might be a promising approach to reduce systemic inflammation and subsequently lower premature cardiovascular disease, despite the lack of statistical significance. Future research requires a larger patient cohort to enable matched treatment groups with long-term follow-up and molecular detection methods for bacteremia. A higher resolution version of the Graphical abstract is available as Supplementary information.