Quality of Life and Health in Patients with Chronic Periodontitis: A Qualitative Study.

PURPOSE: Periodontal disease causes tooth loss if not treated early, and advanced periodontitis can cause a decline in various oral functions. These results diminish the health-related quality of life (QOL) for various populations. Thus, early detection and management of the disease, as well as a systematic strategy for the prevention of periodontal disease, are necessary. METHODS: Adults, 19 years of age or older and diagnosed with chronic gingivitis or chronic periodontitis under the ICD-10 codes, were selected to participate in the study. A total of 20 participants were informed of the purpose of the study and gave consent to participate in in-depth interviews. RESULTS: The treatment of periodontal disease improved health-related QOL and enabled the participants to have positive dental care health behaviors. Furthermore, the participants recognized the severity of periodontal disease and the importance of dental examinations. It enabled them to be aware of the societal need for dental care awareness. CONCLUSIONS: This study was an in-depth examination of the health-related QOL of periodontal patients through a qualitative research methodology. We expect that this study will expand research on health-related QOL due to periodontal disease and revitalize the dental health system and practices.

Systematic review of the effect of probiotics on experimental gingivitis in humans.

Probiotic therapy is a viable alternative to chlorhexidine, a widely used antiseptic in dentistry that produces significant adverse effects. This systematic review aimed to analyze the effects of probiotics on experimental gingivitis in humans. Two independent reviewers conducted a comprehensive literature search until March 2019. Randomized clinical trials and controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of five articles were included in the qualitative synthesis. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The use of probiotics showed a slight improvement in clinical parameters. Changes in gingival crevicular fluid volume were lower in the presence of the probiotic than in the placebo group. All the studies showed that the immediate, positive effects of probiotics during the period of discontinued mechanical oral hygiene were due to the modulation of the host response, not the anti-plaque effect. Investigators should conduct randomized clinical trials to elucidate the mechanisms of probiotic action and develop improved delivery systems.

Systematic review of the effect of probiotics on experimental gingivitis in humans

Abstract: Probiotic therapy is a viable alternative to chlorhexidine, a widely used antiseptic in dentistry that produces significant adverse effects. This systematic review aimed to analyze the effects of probiotics on experimental gingivitis in humans. Two independent reviewers conducted a comprehensive literature search until March 2019. Randomized clinical trials and controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of five articles were included in the qualitative synthesis. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The use of probiotics showed a slight improvement in clinical parameters. Changes in gingival crevicular fluid volume were lower in the presence of the probiotic than in the placebo group. All the studies showed that the immediate, positive effects of probiotics during the period of discontinued mechanical oral hygiene were due to the modulation of the host response, not the anti-plaque effect. Investigators should conduct randomized clinical trials to elucidate the mechanisms of probiotic action and develop improved delivery systems.

Salivary and serum biomarkers of inflammation in a man with metastatic medullary thyroid carcinoma and hyperreactive gingiva: a fourteen year odyssey.

A peripheral (gingival) fibroma, a gingival cyst and hyperplastic gingivitis occurred simultaneously in a man with metastatic medullary thyroid carcinoma (MCT). The gingival growths and hyperplasia appeared to be related to poor oral hygiene rather than to the MTC. Despite the patient's improved oral hygiene, the hyperplastic gingivitis and peripheral fibroma recurred, and a new peripheral fibroma and gingival cyst developed, which prompted reconsideration of a link with the MTC. MTC cells secrete calcitonin (CT), procalcitonin (ProCT) and growth factors; the patient's serum CT and ProCT were several fold higher than normal. The patient's salivary CT and ProCT also were elevated, but α-amylase and epidermal growth factor (EGF) were not, compared to three healthy controls. A possible link between the MTC and gingival hyper-reactivity due to CT and/or ProCT promoting inflammatory cytokines, and the utility of salivary ProCT as an indicator of periodontitis in this patient were explored further. Unstimulated whole saliva and serum were collected from the patient followed by a standard periodontal examination before periodontal treatment, and 3 weeks and 3 months after treatment. This cycle was repeated 7 months after the previous periodontal treatment. The saliva was assayed for ProCT and the serum was assayed for ProCT, high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6) and proadrenomedullin (ProADM). The results were analyzed for correlations among the severity of periodontitis and the biomarkers/cytokines. Only the salivary ProCT was correlated with the severity of periodontitis, i.e. it was higher just before and lower at 3 weeks and 3 months after each periodontal treatment. The patient's salivary ProCT content also was much higher than reported elsewhere. The other biomarkers/cytokines were within normal ranges. Our findings indicate that salivary ProCT is independent of serum ProCT and therefore may be a useful marker for moderate to severe periodontitis in patients with MTC. The greatly elevated salivary and serum CT and ProCT, and a trend toward correlation between the serum CRP and ProCT suggest a pro-inflammatory link between the MTC and the hyperreactive gingiva in this patient. Further studies are warranted to determine whether hyperplastic gingivitis and gingival growths, such as cysts and fibromas, occur with unusual frequency in patients with MTC.

A relação entre ciclo menstrual e gengivite / The relationship between the menstrual cycle and gingivitis

A gengivite é uma doença inflamatória que interfere nos tecidos de suporte dos dentes. Inicia-se pelo acúmulo da placa bacteriana sobre as faces dentárias e a margem gengival, promovendo a liberação de produtos tóxicos que são efeitos da combinação da bactéria e do hospedeiro. Há indícios de que os hormônios sexuais, principalmente os esteroidais, que estão presentes no ciclo menstrual, apresentem efeitos sobre a saúde periodontal, causando impactos diretos na inflamação gengival e em possíveis alterações de substâncias no fluido gengival. Para tanto, realizou-se uma pesquisa de campo com o intuito de validar a relação entre o ciclo menstrual e a gengivite e seus possíveis diagnósticos frente aos hormônios sexuais que se apresentam de forma tão relevante. OBJETIVO: O objetivo do presente trabalho é verificar através de uma pesquisa de campo, se durante o ciclo menstrual, as alterações hormonais causadas neste período têm capacidade de gerar alterações nos tecidos gengivais. METODOLOGIA: Trata-se de uma pesquisa de campo, realizada por meio de artigos indexados na base científica SciELO e avaliação clínica e sondagem da gengiva de 20 voluntárias durante o período pré-mentrual, menstrual e período pós-mentrual de cada uma.(AU)

Gingivitis is an inflammatory disease that affects the supporting tissues of the teeth. It begins by the accumulation of bacterial plaque on the dental faces and the gingival margin, promoting the release of toxic products that are effects of the combination of bacteria and the host. There are indications that the sex hormones, especially the steroidal ones, that are present in the menstrual cycle, have effects on the periodontal health, causing direct impacts on gingival inflammation and possible alterations of substances in the gingival fluid. Therefore, a field research was carried out with the purpose of validating the relationship between the menstrual cycle and gingivitis and its possible diagnoses against the sex hormones that present themselves in such a relevant way. OBJECTIVE: The objective of the present study is to verify through a field survey whether, during the menstrual cycle, the hormonal changes caused in this period have the capacity to generate alterations in the gingival tissues. METHODOLOGY: This is a field study, carried out by means of articles indexed in SciELO scientific basis and clinical evaluation and gingival probing of 20 volunteers during the pre-mentual period, menstrual period and post-mentual period of each.(AU)

Chronic Gingivostomatitis with Esophagitis in Cats.

BACKGROUND: Chronic gingivostomatitis in cats (FCG) is a debilitating disease with potentially deleterious effects on overall health. HYPOTHESIS/OBJECTIVES: Little is known about the pathophysiology and overall impact of FCG. The aims of our study were to investigate whether gingivostomatitis occurs concurrently with esophagitis, if FCG treatment contributes to esophagitis and if esophagitis exacerbates signs of FCG. ANIMALS: Fifty-eight cats with clinical signs of FCG and 12 healthy control cats exhibiting no signs of oral disease, all client-owned. METHODS: Prospective study. Physical, oral and endoscopic examinations were performed on all cats. Measurements of salivary and esophageal lumen pH were obtained from both groups. Biopsies were acquired from sites of esophageal inflammation in cats with FCG and from normal-appearing esophageal mucosa in control cats. RESULTS: The majority of cats with clinical signs of FCG exhibited some degree of esophagitis especially in the proximal (44/58) and distal (53/58) parts (P < 0.001) with or without columnar metaplasia, compared to controls. All cats lacked signs related to gastrointestinal disease. Salivary and esophageal lumen pH were not statistically different compared to controls. CONCLUSIONS AND CLINICAL IMPORTANCE: Feline chronic gingivostomatitis seems to occur concurrently with esophagitis. Esophagitis also should be managed in cats with chronic gingivostomatitis because it may aggravate the existing condition.

Infection and apoptosis associated with inflammation in periodontitis: An immunohistologic study.

OBJECTIVE: Evidence of increased apoptosis is observed in periodontitis and may be associated with destruction of the periodontal tissue caused by the increased cell death, with the release of danger signals and subsequent stimulation of the proinflammatory processes. However, the exact mechanisms associated with these processes remain unclear. This study aimed to investigate the presence of the periodontal pathogen Treponema denticola, apoptosis, high mobility group box 1 as a damage-associated molecular pattern, and several inflammatory markers in periodontitis and gingivitis subjects. MATERIALS AND METHODS: Soft tissue specimens from gingival tissues of periodontitis and gingivitis patients were used for immunohistochemical and immunofluorescence staining of T. denticola chymotrypsin-like proteinase (CTLP), apoptosis markers, high mobility group box 1, Toll-like receptor 4, inflammatory cell markers, and proinflammatory cytokines. RESULTS: Treponema denticola was detected in all periodontitis-affected tissues. This was associated with a significant increase in the number of apoptotic cells, including macrophages, alterations in the expression of high mobility group box 1 and its receptor, and increased levels of proinflammatory cytokines compared with gingivitis. CONCLUSIONS: In summary, the presence of T. denticola (especially its CTLP), apoptosis, high mobility group box 1, and inflammatory markers suggests their potential involvement in the pathogenesis of periodontitis.

Trichomonas tenax and periodontal diseases: a concise review.

Periodontal diseases (gingivitis and periodontitis), result from a disruption of the host-oral microbiome homoeostasis. Whereas the pathological role of some specific bacterial strains during periodontal diseases is well documented, the impact of parasites in periodontium pathophysiology is still under debate. This review aims to collect data about the prevalence and the potential role of Trichomonas tenax during periodontal diseases. Data from 47 studies revealed that T. tenax prevalence in diseased periodontium ranged from 0 to 94·1%. The prevalence of oral protozoan infections was found to be largely greater in patients with periodontal diseases than with healthy periodontium. The parasite detection was mainly performed by direct microscopy. Trichomonas tenax presence was clearly correlated with periodontal disease. The high heterogeneity of its periodontal prevalence may be correlated with the diversity of the population screened (age, sex, systemic diseases), and the methods used for diagnosis. This protozoan seems to have the capacity to be involved in the inflammatory process of gum disease. Animal experimentation, using relevant physiopathological models of periodontitis, needs to be performed to investigate the ability of T. tenax to cause and/or worsen the disease. Further investigations using standardized experimental designs of epidemiologic studies are also needed.

[Modern approaches to periodontal microcirculatory parameters assessment]. / Sovremennye podkhody k otsenke pokazatelei mikrogemodinamiki v tkanyakh parodonta.

The article presents comprehensive functional study of periodontal tissues in 62 patients aged 20-45 with periodontal disease by laser Doppler flowmetry, Doppler ultrasound and computer capillaroscopy. All patients were divided into 5 groups depending on the severity of inflammation in the periodontium (chronic gingivitis, light, moderate and severe chronic periodontal disease). The relationship between microcirculatory indexes was evaluated by Pearson Product Moment Correlation or PPMC. The study shows high correlation between blood flow velocity measurement, diameter of microvessels and oxygen saturation in periodontal tissues that establish a direct relationship between studied parameters.

The paradox of painless periodontal disease.

Periodontal diseases, primarily gingivitis and periodontitis, are characterised by progressive inflammation and tissue destruction. However, they are unusual in that they are not also accompanied by the pain commonly seen in other inflammatory conditions. This suggests that interactions between periodontal bacteria and host cells create a unique environment in which the pro-algesic effects of inflammatory mediators and factors released during tissue damage are directly or indirectly inhibited. In this review, we summarise the evidence that periodontal disease is characterised by an accumulation of classically pro-algesic factors from bacteria and host cells. We then discuss several mechanisms by which inflammatory sensitisation of nociceptive fibres could be prevented through inactivation or inhibition of these factors. Further studies are necessary to fully understand the molecular processes underlying the endogenous localised hypoalgesia in human periodontal disease. This knowledge might provide a rational basis to develop future therapeutic interventions, such as host modulation therapies, against a wide variety of other human pain conditions.

Microcirculation alterations in experimentally induced gingivitis in dogs.

The present study aimed to morphologically examine the gingival microvascular network using a microvascular resin cast (MRC) technique, and to investigate how inflammatory disease functionally affects gingival microcirculation using laser Doppler flowmetry (LDF). We used four beagle dogs with healthy periodontal tissue as experimental animals. To cause periodontal inflammation, dental floss was placed around the cervical neck portions of the right premolars. The unmanipulated left premolars served as controls, and received plaque control every 7 days. After 90 days, gingivitis was induced in the experimental side, while the control side maintained healthy gingiva. To perform morphological examinations, we used an MRC method involving the injection of low-viscosity synthetic resin into the blood vessels, leading to peripheral soft-tissue dissolution and permitting observation of the bone, teeth, and vascular cast. Gingival blood flow was estimated using an LDF meter. The control gingival vasculature showed hairpin-loop-like networks along the tooth surface. The blood vessels had diameters of 20-40 µm and were regularly arranged around the cervical portion. On the other hand, the vasculature in the experimental group was twisted and gathered into spiral forms, with blood vessels that had uneven surfaces and smaller diameters of 8-10 µm. LDF revealed reduced gingival blood flow in the group with experimentally induced gingivitis compared to controls. The actual measurements of gingival blood flow by LDF were in agreement with the alterations that would be expected based on the gingivitis-induced morphological alterations observed with the MRC technique.

Prevalence and Mechanisms of Peri-implant Diseases.

The aim of the present critical review is to summarize recent evidence on the prevalence of peri-implant diseases and their similarities and differences with periodontal diseases with a focus on their pathogenetic mechanisms. Reports on the extent and severity of peri-implant diseases are influenced by different case definitions. The prevalence of peri-implant diseases is reported at the subject or implant level and affected by the type of population samples analyzed (e.g., randomly selected population samples or convenience samples). The outcomes of studies on animals and humans indicate that experimental biofilm accumulation leads to a higher frequency of bleeding sites around implants as compared with teeth. Despite the proof of principle that experimentally induced mucositis may be reversible, early diagnosis and management of naturally occurring peri-implant mucositis are clinically relevant. Tissue destruction at experimental peri-implantitis sites is faster and more extensive when compared with that at experimental periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a histopathologic point of view. To avoid implant loss, patients diagnosed with peri-implantitis should be treated without delay.

CHANGES IN TOOTH HARD TISSUE MINERALI-ZATION AND BLOOD RHEOLOGY IN HEALTHY ADOLESCENTS AND THOSE WITH THYROID DYSFUNCTION.

Thyroid dysfunction causes spreading and development of caries in the teeth and changes in periodontal tissues. In addition, it causes changes in peripheral blood flow and mineralization, local transcapillary metabolism causes changes in blood rheology. There are only few works in this direction and, therefore, the purpose of our research was to find out how the mineralization and the rheological properties of blood are changed in lesion of periodontal tissue on a background of thyroid dysfunction. Accordingly, the stomatological study was conducted in 75 adolescents aged 12-18 years by the standard method, recommended by the World Health Organization. According to the study, 45 patients out of them suffered from thyroid dysfunction, in particular from hypothyroidism. The comparator group consisted of 30 children of the same age without endocrine abnormalities. By the gained results it is noted that in spite of different type lesions due to dental caries, the caries incidence and intensiveness is higher in children with hypothyroidism as compared to healthy children. Decrease in saliva excretion rate and increase in oral fluid viscosity was found in children with thyroid and endocrine diseases as compared to healthy children. In children with endocrine disorders concurrent increase in calcium content (1,43±0,08 mmol/l) and decrease in inorganic phosphate concentrations (4,54±0,15 mmol/l) is reliably established. In children with thyroid disfunction and while periodontal tissue pathology, rheological features are disordered more dramatically than in healthy children. Therefore, it can be said that the changes in the adolescents' thyroid function is one of the reasons for formation of periodontal tissue diseases.Therefore, at detecting even the first signs of the periodontal tissue diseases, it is desirable in adolescents to assess the thyroid functional condition, since it will be the precondition for effective treatment and management of dental disease, in particular, dental caries and lesions of periodontal tissue.

Evaluation of oral microbiota in undernourished and eutrophic children using checkerboard DNA-DNA hybridization.

The aim of this study was to evaluate the relationship among nutritional status, gingival health and the composition of oral microbiota in children of a public school from a very poor area of San Miguel de Tucuman. Forty-five children ranging in age from 6 to 14 years old, 13 males and 32 females were studied. Twenty of these children were undernourished (Lejarraga-Morasso Table) and twenty-five were eutrophic. A clinical study that included DMF and dmf indexes, Löe Silness Plaque Index and bleeding on probing was performed. For microbiological study, saliva samples without stimulation were taken; aliquots of them were immediately placed in TAE buffer pH 7.6, adding NaOH (N and keeping at -70 °C until processed by checkerboard DNA-DNA hybridization method to check the presence of 40 oral microorganism species. Positive bleeding on probing was present in more than 80% of children, without significant differences between eutrophic and undernourished groups. Same result were obtain for the other clinical indexes (p > 0.05, Two Way ANOVA). Significant differences were found for some oral microorganism species, with a higher percentage of undernourished children harboring them. That was the case of S. gordonii (p < 0.05), Capnocitophaga gingivalis and C. ochraceae (p < 0.01 and p < 0.10, respectively), F. nucleatum ss nucleatum (p < 0.05), P. nigrescens (p < 0.10), Campylobacter gracilis (p < 0,05), and T. denticola (p < 0.10, multiple logistic regression). Significant differences were also found between children groups for E. saborreum (p < 0.001), P. acnes (p < 0.10), G. morbillorum (p < 0.05) and L. buccalis (p < 0.10). Gingivitis and bleeding on probing would not be related to nutritional status in the groups of children studied. There were significant differences for the presence of some of the main periodontal pathogen species between eutrophic and undernourished children. It would be important to study the meaning of significant differences found for the other microorganisms more deeply.

Oral pathology in inflammatory bowel disease.

The incidence of inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Gingival health and oral hygiene practices of schoolchildren in the North West Region of Cameroon.

BACKGROUND: Optimal oral hygiene practices are instrumental to achieving good dental and gingival health. The purpose of this study was to determine the gingival health and oral hygiene practices of schoolchildren in the North West region of Cameroon. METHODS: This cross-sectional survey among 12-13 years old rural and urban schoolchildren in the North West region of Cameroon was conducted between March and November, 2010. RESULTS: A total of 2295 schoolchildren were interviewed but only 2287 of them had oral examination giving a 99.7% participation rate. Out of 2287 school children examined, 1676 (73.3%) had normal gingiva while 26.7% had gingivitis of varying severity. The gingivitis was found significantly more in rural dwellers (P = 0.001). In terms of the severity of the recorded gingivitis, mild gingivitis constituted 549 (89.9 %), moderate gingivitis 49 (8.0%) and severe gingivitis 13 (2.1%). The majority-1929 (85.4%) of the participants had received instruction on how to care for their teeth and the predominant source of this instruction was from their parents. Irregular teeth cleaning were marked 1137 (49.7%) among the children. The dominant teeth cleaning materials were toothbrush and toothpaste. The other oral hygiene aid utilized by the participants include dental floss-25 (1.1%), stick-759 (33.6%), dental floss-25 (1.1%) and other unorthodox agents. The reasons for teeth cleaning among the participants in descending order were to make the teeth clean, to prevent halitosis, to make teeth stronger, to prevent pain and dental diseases. CONCLUSION: The prevalence of gingivitis among Cameroonian schoolchildren in the Northwest region was 26.7% with majority being of mild gingivitis category. Parents, dental professionals and teachers were the main sources of instruction on oral care.

Assessment of pain among a group of Nigerian dental patients.

BACKGROUND: Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. METHODS: A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. RESULTS: Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. CONCLUSION: It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Morphological and quantitative study of collagen fibers in healthy and diseased human gingival tissues.

OBJECTIVES: This study aimed to evaluate types I, III and IV collagen in healthy gingival tissue and to compare them to gingival tissues suffering from chronic gingivitis and chronic periodontitis. MATERIALS AND METHODS: Thirty-two man patients were selected. The patients belonged to three diagnostic categories: healthy gingiva (HG), chronic gingivitis (CG) and chronic periodontitis (CP), based on clinical and radiographical criteria. Gingival tissue samples were obtained from patients who underwent periodontal surgery procedures. Hematoxylin and Eosin (HE), Picrosirius red, indirect immunofluorescence by confocal microscopy and quantitative analyses were performed to identify the presence and location of types I, III and IV collagen. Statistical significance was verified using the Kruskal-Wallis test. RESULTS: Samples from HG group showed thick collagen fibers arranged in a parallel pattern. Samples from CG group showed dilated blood vessels; collagen fibers and inflammatory cells were found dispersed throughout the tissue. Samples from CP group showed the extracellular matrix severely damaged, disorganized collagen fibers and large amount of inflammatory cells. The HG group showed an apparent higher expression of type I collagen, when compared to tissues with CG and CP, however no statistical differences were detected (p=0.064). The types III and IV collagen fibers showed no difference in expression in tissues with gingivitis and periodontitis. CONCLUSIONS: Following the periodontal disease there was a morphological destruction of the extracellular matrix with lower expression of collagen, which led to a change in tissue architecture that might compromise its functional capacity. There were differences in type I collagen expression among healthy, chronic gingivitis and chronic periodontitis tissue samples.

Impact of periodontal status on oral health-related quality of life in patients with and without type 2 diabetes.

OBJECTIVES: To investigate the impact of periodontal status on oral health-related quality of life (OHRQoL) in patients with and without type 2 diabetes mellitus (T2DM). METHODS: 61 patients with T2DM and 74 non-diabetic patients matched for age, gender and periodontal status (health, gingivitis, chronic periodontitis) were recruited. The oral health impact profile (OHIP)-49 was self-completed by all participants at baseline and by the patients with periodontitis at 3 months and 6 months after non-surgical periodontal therapy. RESULTS: There were no significant differences in the overall OHIP-49 summary scores between patients with T2DM (median; interquartile range; 37.0; 19.5-61.0) and without T2DM (30.4; 16.8-51.0) (p>0.05). Among non-diabetic patients, there were significantly higher OHIP-49 scores (indicating poorer OHRQoL) in patients with gingivitis (41.0; 19.7-75.7) and periodontitis (33.0; 19.9-52.5) compared to patients who were periodontally healthy (11.1; 7.1-34.5) (p<0.05), though such an effect was not observed in the patients with diabetes. In the non-diabetic patients with periodontitis, statistically significant reductions in OHIP-49 scores were noted in the psychological discomfort and psychological disability domains following periodontal treatment, indicating an improvement in OHRQoL. In contrast, there were no statistically significant changes in OHIP-49 scores following periodontal treatment in the patients with diabetes. CONCLUSION: T2DM does not impact on overall OHRQoL as measured by OHIP-49. Chronic periodontitis and gingivitis were associated with poorer OHRQoL in non-diabetic patients, with evidence of improvements following periodontal treatment, but no such effects were observed in patients with diabetes. CLINICAL SIGNIFICANCE: Gingivitis and periodontitis are associated with reduced OHRQoL compared to periodontal health in non-diabetic patients, with improvements following treatment of periodontitis. No impact of type 2 diabetes on OHRQoL was noted; this may be related to the burden of chronic disease (diabetes) minimising the impact of oral health issues on OHRQoL.