Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis.

AIM: To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS: This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS: The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (ß = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (ß = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS: This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.

Periodontal disease and its association to endothelial dysfunction and clinical changes in limited systemic sclerosis: A case-control study.

OBJECTIVES: Periodontal disease occurs frequently in patients with limited cutaneous systemic sclerosis (lcSSc) while data about underlying pathways contributing to periodontal changes are scarce. The aim of this study was to evaluate periodontal disease and to investigate its association with endothelial dysfunction and clinical changes in patients with lcSSc. METHODS: In 38 lcSSc patients and 38 controls, periodontal status was evaluated by disease-specific questionnaire, dental examination including bleeding on probing (BOP), pocket depth, and plaque index, and dental panoramic radiograph. Periodontopathogen bacteria were collected subgingivally using paper points and interleukin-1 (IL-1) gene polymorphisms were evaluated using buccal swabs. Endothelial dysfunction was measured by flow-mediated dilatation, pulse-wave velocity and biochemical analysis, including arginine metabolites and endothelial microparticles. Additionally, lcSSc-specific clinical changes and parameters were recorded. RESULTS: Periodontitis was present in 31 patients with lcSSc (81.6%) and in 27 controls (71.1%) (p = .280). LcSSc patients had a lower teeth number (p = .039) and Eikenella corrodens was to a higher degree detectable in patients with lcSSc (p = .041) while the remaining periodontal parameters revealed no differences between both cohorts. Significant correlations between parameters of arterial stiffness, EUSTAR index, number of teeth and BOP were observed (all p < .05). Detection of Prevotella intermedia was associated with selected IL-1 gene polymorphisms (p = .032) and Porphyromonas gingivalis was associated with severe periodontitis (p = .041). CONCLUSION: Periodontal disease may occur frequently in patients with lcSSc and may be associated with arterial stiffness and with SSc activity.

Effect Of Dental Proximal Restorations On Periodontal Health In Patients.

Background: The oral cavity is colonized by more than 700 species of bacteria and hundreds of those can be present within oral biofilms. Objective was to determine the frequency of periodontal attachment loss in patients with dental proximal restorations. Methods: This cross-sectional study included 100 patients with Class II (mesial /distal or mesio-occluso-distal composite and amalgam restorations. The minimum duration of pre-existing restoration for which periodontal attachment loss was assessed was more than 3 months. Patients wearing orthodontic appliances, pregnant women, patients having systemic health problems with well-established links to periodontal diseases such as diabetes mellitus and patients who had received periodontal treatment within the last 3 months were excluded. Periodontal Pocket depth and bleeding on probing was recorded using WHO periodontal probe. Pocket depth greater than 3 mm was considered pathologic. The data were analyzed using the SPSS, version 20. Descriptive statistics were computed. Chi square test was applied to compare the effects of duration of restoration and type of teeth on periodontal attachment loss. Results: Of total 100 participants 65 (65%) were males and 35 (35%) were females. The mean age was 30.74±9.21 years. In 14% cases having class II or Mesio occluso distal restorations normal pocket depth was recorded while 86% had pathologic pockets. Teeth where proximal restorations were present for more than one year were most commonly associated (29%) with pathologic pockets followed by proximal restorations which were present for three months (25%). As the duration of proximal restoration increased, the frequency of periodontal pathologic pockets increased (p<0.001). The prevalence of periodontal pocket was more in molars than premolars (p<0.001). Conclusion: Proximal restoration can be a significant risk factor for periodontal disease. Strict oral hygiene, proper design of restoration margin and supportive periodontal therapy is the utmost responsibility of the clinician.

Waistline to gumline: a retrospective analysis of body mass index in treated periodontitis patients undergoing periodontal maintenance therapy.

Periodontal disease affects 42% of adults in the United States. Both the periodontal microbiome and the host immune inflammatory response may be influenced by overweight/obesity status. This retrospective analysis sought to determine the associations of periodontal disease parameters with body mass index (BMI) and obesity status in patients undergoing periodontal maintenance therapy. The records of 418 patients who were undergoing periodontal maintenance after periodontitis treatment were examined, and the patients' demographic characteristics (sex, age, and race/ethnicity), self-reported BMI, periodontal disease condition, number of sites with probing depth ≥ 4 mm, missing teeth, and sites with bleeding on probing (BOP) were recorded. Patients were determined to have active moderate to severe periodontitis if they presented with 2 or more sites in 2 different quadrants with clinical attachment loss ≥ 5 mm and probing depth ≥ 5 mm. Individuals were also categorized into 3 groups: underweight/normoweight, BMI < 25; overweight, BMI 25 ≤ 30; or obese, BMI ≥ 30. In the study population, BMI ranged from 16.827 to 51.389. The periodontitis status was not significantly associated with a BMI status of overweight (odds ratio [OR] = 1.388 [95% CI, 0.961- 2.006]) or obese (OR = 1.168 [95% CI, 0.77-1.757]). Female sex (OR = 0.561 [95% CI, 0.343-0.918]) and age (OR = 0.983 [95% CI, 0.967-0.999]) were negatively associated with active periodontitis status. Obese patients demonstrated significantly more sites with BOP than either underweight/normoweight or overweight patients, and a BMI indicating obesity was associated with increasing age (P < 0.001) and higher number of missing teeth (P = 0.0064). In a population of patients undergoing periodontal maintenance therapy, BMI was associated with age and missing teeth, and obese status was associated with a significantly higher number of sites with BOP.

Metabolic syndrome and periodontitis among adults: The 2018 Indonesia National Health Survey.

AIM: This study aimed to examine the association between metabolic syndrome (MetS), its components, and periodontitis among Indonesian adults. MATERIALS AND METHODS: Cross-sectional data from the 2018 Indonesia National Health Survey (Riskesdas) was analysed. The sample included dentate individuals aged 35 years or older for whom complete information was available on components of MetS and periodontitis, including bleeding on probing (BOP) (N = 13,356), pocket depth (PD) (N = 13,273), and clinical attachment loss (CAL) (N = 13,000). Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated with negative binomial regression models. RESULTS: The prevalence of MetS was 41.0%. The prevalence of individuals having at least one tooth with BOP, one tooth with PD ≥4 mm, or one sextant with CAL ≥4 mm was 74.9%, 40.7%, and 40.6%, respectively. No associations were observed between MetS and BOP, PD, or CAL, but hyperglycaemia was constantly positively associated with BOP (RR = 1.06; 95% CI 1.01-1.11), PD (RR = 1.13; 95% CI 1.03-1.23), and CAL (RR = 1.15; 95% CI 1.08-1.23). CONCLUSIONS: Our findings support the potential influence of hyperglycaemia on periodontitis. Incorporating oral disease prevention strategies into the management of systemic diseases could be beneficial for reducing the burden of these diseases in Indonesia.

Periodontal and caries status in unexplained female infertility: A case-control study.

BACKGROUND: The aim of this study was to investigate the possible association between maternal periodontal disease and dental caries that affect oral health and unexplained infertility. METHODS: This cross-sectional case-control study included 50 fertile women and 50 women with unexplained infertility aged 21 to 39 years. Dental and periodontal parameters were examined to evaluate the oral health of the participants. According to the new periodontal disease classification, periodontitis severity was determined. RESULTS: In infertile women, the number of advanced caries lesions, the percentage of bleeding on probing (BOP), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were higher (P < 0.05). The DMFT and mean plaque index (PI) were not statistically different between the two groups. The PISA and PESA values were higher in women with unexplained infertility than in fertile women (P = 0.005 and P = 0.002, respectively). In multivariate analysis showed that association of DMFT and BOP variables with periodontitis was found to be significant for all women included in the study and for infertile women only (P = 0.000 and P = 0.012 for DMFT, respectively; P = 0.000 and P = 0.016 for BOP, respectively). CONCLUSION: The chronic inflammatory environment caused by periodontitis and advanced carious lesions in women with unexplained infertility should be of great concern as it may have a role in the etiology of infertility.

[Association between osteoporosis and severe periodontal attachment loss in postmenopausal women].

Objective: To investigate the association between osteoporosis and severe periodontal attachment loss in postmenopausal women. Methods: One hundred and ninety-five postmenopausal women aged 50-65 years old were included in the present study. The participant were recruited from patients in the Peking University International Hospital and through website from March, 2017 to August, 2018. Periodontal examination, filling out a structured questionnaire and bone mass density (BMD) examination were completed to each of the participants. The clinical attachment loss (CAL), oral hygiene index simplified (OHI-S), and bleeding on probing (BOP) were examined and recorded as periodontal parameters. The structured questionnaire was used to collect information of the physical activity, socioeconomic status, marital status, oral health habits, and so on. Bone mass density of the lumbar spine and left hip were scanned by using standardized dual energy X-ray absorptiometry. Based on the T-score of BMD (difference between the measured BMD and the mean value of young white women in terms of standard deviations), osteoporosis was defined as T-score≤-2.5 (according to the World Health Organization criteria). Fourteen risk factors were preliminarily screened by chi-square test, including age, duration of menopause, body mass index (BMI), exercise habit, economic status, marital status, level of education, habit of dental visit, tooth brushing habit, usage of interdental tools, OHI-S, BOP(+)%, osteoporosis in hip and osteoporosis in lumbar. Factors with P<0.05 were selected for multivariate Logistic regression analysis. Logistic regression was used to analysis the risk factors of severe periodontal attachment loss. Results: The mean age of 195 postmenopausal women was (57.8±4.3) years. After adjusting for ages, the economic status, habit of dental visit, OHI-S and BOP(+)%, there was an association of osteoporosis in hip and severe periodontal attachment loss in postmenopausal women [odds ratios (OR)=2.466, 95% confidence intervals (CI) was 1.173-5.185, P=0.017]. Conclusions: Postmenopausal women with osteoporosis in hip has a greater chance of presenting severe periodontal attachment loss.

Influence of Periodontal Disease on cardiovascular markers in Diabetes Mellitus patients.

The objective of the present study was to establish if individuals with Diabetes Mellitus (DM2) and periodontal diseases (gingivitis or periodontitis) presented an increase in the concentration of modified LDL (moLDL) and what is the influence of periodontal treatment on the decrease of moLDL particles with consequent improvement in the parameters of DM2. Twenty-four diabetic patients with periodontitis (Group 1) and twenty-four diabetic patients with gingivitis (Group 2) were followed up for a period of 12 months. Group 1 was treated with periodontal debridement, and Group 2 received supra-gingival scaling and prophylaxis. In both groups, periodontal clinical parameters: probing depth (PD), clinical attachment level (CAL), gingival resection (GR), bleeding on probing index (BOP) and plaque index; inflammatory serum markers (glycemia, A1c, total cholesterol, HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c), triglycerides and hs-CRP) and oxidized LDL (oxLDL) were measured at baseline, t = 6 and t = 12 months after treatment. Solutions of LDL were analyzed using the nonlinear optical Z-Scan and optical absorption techniques. The periodontal clinical parameters showed significant improvement (p < 0.05) in both Group after 12 months. For both groups, total cholesterol, HDL-c, LDL-c, triglycerides and A1c levels did not show significant reductions after periodontal therapy. hs-CRP levels in Group 1 presented a significant reduction after 12 months. The glycemic rate and the oxLDL concentrations did not show significant differences as a function of time. The optical measurements of LDL solutions revealed an improvement of the LDL-c quality in both groups. Periodontal debridement was able to improve periodontal parameters and the quality of LDL-c in diabetic patients but without changes in the oxLDL concentration in both groups. Considering the clinical relevance, the reduction of infectious and inflammatory sites present in the oral cavity through periodontal therapy may help with the control and prevention of hyperglycemia and precursors of cardiovascular diseases.

Clinical indices and local levels of inflammatory biomarkers in per-implant health of obese and nonobese individuals.

BACKGROUND: Obesity seem to regulate peri-implant health. It is proposed that peri-implant crevicular fluid (PICF) levels of interleukin (IL)-1ß and IL-6 are higher in obese as compared to nonobese individuals. OBJECTIVE: The purpose of the present clinico-laboratory study is to estimate and compare the clinical and radiographic indices and PICF levels of IL-1ß and IL-6 among obese and nonobese patients. MATERIALS AND METHODS: Fifty patients were divided into two groups (25 obese with ≥27.5 kg/m2 and 25 nonobese with <27.5 kg/m2 individuals). Clinical indices for both periodontal and peri-implant evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and crestal bone loss (CBL) were recorded around teeth and implants. PICF was collected and assessed for the levels of IL-1ß and IL-6 using enzyme-linked immunosorbent assay. RESULTS: A significant difference was observed in PI and BOP around natural teeth and implants in obese patients, respectively (P < .05). CBL was found to be significantly higher among obese as compared to nonobese patients (P = .022). Peri-implant and periodontal PD was higher in obese as compared to nonobese but did not reach statistical significance. Levels of IL-1ß and IL-6 were statistically significantly higher among obese patients as compared to nonobese (P = .001). Pearson correlation analysis showed IL-1ß was positively correlated with CBL (P = .0079), whereas IL-6 showed positive correlation with both BOP (P = .0019) and CBL (P = .015) among obese patients. CONCLUSIONS: Clinical peri-implant parameters were worse and proinflammatory biomarkers were significantly higher in obese patients compared with nonobese subjects. The findings of the present study suggests that increased proinflammatory biomarkers in PICF of obese patients may modulate peri-implant inflammation around dental implants.

Periodontal complications with age.

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS).

OBJECTIVE: The aim of this study was to test a hypothesized positive association between low vitamin D (VitD) serum levels and the severity of periodontal disease in women with HIV infection. STUDY DESIGN: This was a cross-sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss (CAL) measurements were available for 74 women with HIV infection. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by obtaining the averages of measurements taken at 4 sites in each measured tooth. RESULTS: Average age of study participants (n = 74) was 39.6 years (standard deviation 7.2), and the majority were African Americans (70.3%) with VitD deficiency (58.1%). VitD deficiency was positively associated with higher mCAL (P = .012). After adjustment for race, age, smoking, and HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438; P = .036). CONCLUSIONS: We identified a previously unreported association between VitD deficiency and mCAL in women with HIV infection. Larger and more inclusive, multisite, longitudinal studies are warranted to investigate whether these findings can be generalized to all individuals with HIV infection in the current treatment era and to determine causality.

The severity of periodontitis and metabolic syndrome in Korean population: The Dong-gu study.

OBJECTIVES: We assessed the association between periodontal disease status and metabolic syndrome (MetS) and its individual components in Korean adults over 50 years old. MATERIAL AND METHODS: In the Dong-gu study, 5078 men and women aged over 50 years were included. They underwent a questionnaire survey, physical assessment, biochemical assessment and periodontal assessment. The percentages of sites with periodontal probing depth ≥4 mm, and clinical attachment loss ≥4 mm were recorded for each participant. Periodontal disease was also classified by the Centers for Disease Control and Prevention/American Academy of Periodontology definition of periodontitis and the American Academy of Periodontology definition (1999). MetS was defined by the 2009 guidelines of the International Diabetes Federation. This study used multivariate negative binominal regression analysis to assess the association between the severity of periodontitis and MetS, after age, smoking habits, alcohol consumption and physical activity related factors were adjusted for. RESULTS: Prevalence of MetS was 32.3%, 36.2% and 45.9% among men with no or mild, moderate and severe periodontitis, respectively. The severity of periodontitis was positively associated with the prevalent MetS in men but not in women. In men, severe periodontitis showed a higher risk of MetS than those with no or mild periodontitis (relative risk 1.43, 95% confidence interval 1.17-1.73) after adjusting for confounders. Periodontal probing depth was positively associated with the prevalence of MetS in both genders. In the analysis separated by individual MetS components, periodontitis severity was positively associated with hypertriglyceridemia and low high-density lipoprotein cholesterol in men, while positively associated with low high-density lipoprotein cholesterol and abdominal obesity in women. CONCLUSION: Increasing the severity of periodontitis was associated with the risk of prevalent MetS in Korean adults. This result confirmed that periodontal inflammation might be a contributive factor of MetS.

Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial.

AIM: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis. SUBJECTS AND METHODS: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients. RESULTS: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal-orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4-6 mm healed after periodontal-orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p = .03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal-orthodontic treatment duration was significantly longer for the control group (p < .01). CONCLUSIONS: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis.

Patterns of periodontal disease progression based on linear mixed models of clinical attachment loss.

AIM: The goal of the present longitudinal cohort study was to examine patterns of periodontal disease progression at progressing sites and subjects defined based on linear mixed models (LMM) of clinical attachment loss (CAL). MATERIALS AND METHODS: A total of 113 periodontally healthy and 302 periodontitis subjects had their CAL calculated bimonthly for 12 months. LMMs were fitted for each site and the predicted CAL levels used to categorize their progression state. Participants were grouped based on the number of progressing sites into unchanged, transitional and active subjects. Patterns of periodontal disease progression were explored using descriptive statistics. RESULTS: Progression occurred primarily at molars (50% of progressing sites) and inter-proximal sites (72%), affected a higher proportion of deep than shallow sites (2.7% versus 0.7%), and pocketing was the main mode of progression (49%). We found a low level of agreement (47%) between the LMM and traditional approaches to determine progression such as change in CAL ≥3 mm. Fourteen per cent of subjects were classified as active and among those 93% had periodontitis. The annual mean rate of progression for the active subjects was 0.35 mm/year. CONCLUSION: Progressing sites and subjects defined based on LMMs presented patterns of disease progression similar to those previously reported in the literature.

Natural history of periodontitis: Disease progression and tooth loss over 40 years.

OBJECTIVES: To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. MATERIAL AND METHODS: Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. RESULTS: PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. CONCLUSIONS: These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Bayesian semiparametric variable selection with applications to periodontal data.

A normality assumption is typically adopted for the random effects in a clustered or longitudinal data analysis using a linear mixed model. However, such an assumption is not always realistic, and it may lead to potential biases of the estimates, especially when variable selection is taken into account. Furthermore, flexibility of nonparametric assumptions (e.g., Dirichlet process) on these random effects may potentially cause centering problems, leading to difficulty of interpretation of fixed effects and variable selection. Motivated by these problems, we proposed a Bayesian method for fixed and random effects selection in nonparametric random effects models. We modeled the regression coefficients via centered latent variables which are distributed as probit stick-breaking scale mixtures. By using the mixture priors for centered latent variables along with covariance decomposition, we could avoid the aforementioned problems and allow efficient selection of fixed and random effects from the model. We demonstrated the advantages of our proposed approach over other competing alternatives through a simulated example and also via an illustrative application to a data set from a periodontal disease study. Copyright © 2017 John Wiley & Sons, Ltd.

Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes.

BACKGROUND: Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. STUDY OBJECTIVE: This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. MATERIALS AND METHODS: The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. RESULTS: While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. CONCLUSION: This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes.

Obesity and oxidative stress in patients with different periodontal status: a case-control study.

BACKGROUND AND OBJECTIVE: Obesity has become an important global health concern as obesity-associated adiposity is supposedly related to systemic immunologic and inflammatory alterations. The aim of this study was to evaluate the effects of obesity on periodontally healthy and diseased tissue according to the changes in malondialdehyde (MDA), protein carbonyl (PC) and total antioxidant capacity (TAOC) levels in gingival crevicular fluid as biomarkers of oxidative stress (OS). MATERIAL AND METHODS: The study sample comprised systemically healthy normal-weight (n = 45) and obese (n = 48) adults. Obesity was diagnosed according to body mass index, waist circumference and waist/hip ratio. Periodontal status was evaluated according to plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level. Participants were distributed among six groups according to obesity and periodontal status, as follows: normal weight+periodontally healthy (NH); normal weight+gingivitis (NG); normal weight+generalized chronic periodontitis (NCP); obese+periodontally healthy (OH); obese+gingivitis (OG); and obese+generalized chronic periodontitis (OCP). MDA, PC and TAOC levels were measured using ELISA. RESULTS: The MDA and PC levels in gingival crevicular fluid varied among groups, as follows: NCP > NG > NH (p < 0.01) and OCP > OG > OH (p < 0.01). Conversely, the levels of TAOC in gingival crevicular fluid varied as follows: NCP < NG < NH (p < 0.01) and OCP < OG < OH (p < 0.01). Paired comparisons conducted according to periodontal status showed MDA and PC levels to be higher, and TAOC levels to be lower, in the OCP group than in the NCP group, in the OG group than in the NG group and in the OH group than in the NH group. However, only the differences between the OCP and NCP groups were significant (p < 0.01). In both obese and normal-weight individuals, clinical assessments showed significant, positive correlations with MDA and PC levels and negative correlations with TAOC levels (p < 0.01). CONCLUSION: Obesity may influence periodontal tissue destruction and disease severity by increasing the level of oxidative stress in the presence of periodontal disease.