Dysbiosis in the oral microbiomes of anti-CCP positive individuals at risk of developing rheumatoid arthritis.

OBJECTIVES: An increased prevalence of periodontitis and perturbation of the oral microbiome has been identified in patients with rheumatoid arthritis (RA). The periodontal pathogen Porphyromonas gingivalis may cause local citrullination of proteins, potentially triggering anti-citrullinated protein antibody production. However, it is not known if oral dysbiosis precedes the onset of clinical arthritis. This study comprehensively characterised the oral microbiome in anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals without clinical synovitis (CCP+at risk). METHODS: Subgingival plaque was collected from periodontally healthy and diseased sites in 48 CCP+at risk, 26 early RA and 32 asymptomatic healthy control (HC) individuals. DNA libraries were sequenced on the Illumina HiSeq 3000 platform. Taxonomic profile and functional capability of the subgingival microbiome were compared between groups. RESULTS: At periodontally healthy sites, CCP+at risk individuals had significantly lower microbial richness compared with HC and early RA groups (p=0.004 and 0.021). Microbial community alterations were found at phylum, genus and species levels. A large proportion of the community differed significantly in membership (523 species; 35.6%) and structure (575 species; 39.1%) comparing CCP+at risk and HC groups. Certain core species, including P. gingivalis, had higher relative abundance in the CCP+at risk group. Seventeen clusters of orthologous gene functional units were significantly over-represented in the CCP+at risk group compared with HC (adjusted p value <0.05). CONCLUSION: Anti-CCP positive at-risk individuals have dysbiotic subgingival microbiomes and increased abundance of P. gingivalis compared with controls. This supports the hypothesis that the oral microbiome and specifically P. gingivalis are important in RA initiation.

Awareness, practices, training, and confidence of Paediatric Diabetes Care Teams in relation to periodontitis.

Diabetes and periodontal disease are non-communicable chronic diseases that have a bi-directional relationship. The European Federation of Periodontology and International Diabetes Federation recommend patients with diabetes should be screened for periodontal disease and referred to a dental professional where appropriate. This study investigated the awareness among Paediatric Diabetes Care Teams across England and Wales of diabetes as a risk factor for periodontal disease. The study enquired to the practices, training, and confidence of health care professionals in relation to periodontal disease. A semi-structured online questionnaire was sent to all health care professionals working within Paediatric Diabetes Care Teams across England and Wales. Findings showed that 76.2% of participants were aware that periodontitis is a possible complication of diabetes. Only 5.2% screened for periodontal issues, while 27% of respondents stated that oral advice is not typically given to patients at their clinics and 92.3% said that there is no access to a periodontal service within their clinics. There were 76.4% participants who stated that patients are rarely or never referred to an external dental service for their periodontal health. Only 4.8% of respondents said they have received training for recognizing patients who require dental care for their periodontal health, while 23.2% feel confident identifying children who require referral and 85.4% of participants feel they would benefit from further training in periodontal health. In conclusion, patients are not routinely being informed of the risk of periodontitis or being screened or referred for it. Further training would be perceived as beneficial.

Conversation, discourse and linguistic analysis in dental communication: valuable but under-used approaches.

According to Dental Protection, 'good dentists are good communicators, it's that simple!' Unfortunately, dental communication is an under-researched field, so it is not yet clear exactly what good communication in this context entails. The dominant method of researching dental communication to date has followed a 'process approach' where the focus has been on evaluating the communicative competence of the clinician using a checklist of communicative functions; for example, 'the clinician explains the condition'. Conversation analysis, discourse analysis and linguistic analysis are discursive approaches that bring precision by analysing the actual language/discourses being used by patients and providers in interactions. These discursive approaches can be used to capture exactly how, for example, patient engagement is maintained in routine dental consultations, patient reassurance is achieved during invasive procedures and which communication strategies are the most likely to result in enhanced treatment outcomes in paediatric dentistry. In addition to shedding new light on the unique nature of dental communication, discursive approaches provide targeted new tools for developing needs-based training packages for dental professionals.

Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review.

Objectives: The association of periodontal disease in people diagnosed with RA is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease might benefit people with RA. We performed a systematic literature review to investigate the effect of periodontal treatment on RA disease activity. Methods: Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. The quality of included studies was assessed. Data were grouped and analysed according to RA disease outcome measures, and a narrative synthesis was performed. Results: We identified a total of 21 studies, of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA DAS-28 was the primary outcome for most studies. A total of 9 out of 17 studies reported a significant intra-group change in DAS-28. Three studies demonstrated a significant intra-group improvement in ACPA level after non-surgical periodontal treatment. Other RA biomarkers showed high levels of variability at baseline and after periodontal treatment. Conclusion: There is some evidence to suggest that periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer durations of follow-up are needed. The selection of the study population, periodontal interventions, biomarkers and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with prespecified disease characteristics.

Immunomodulatory streptococci that inhibit CXCL8 secretion and NFκB activation are common members of the oral microbiota.

Introduction. Oral tissues are generally homeostatic despite exposure to many potential inflammatory agents including the resident microbiota. This requires the balancing of inflammation by regulatory mechanisms and/or anti-inflammatory commensal bacteria. Thus, the levels of anti-inflammatory commensal bacteria in resident populations may be critical in maintaining this homeostatic balance.Hypothesis/Gap Statement. The incidence of immunosuppressive streptococci in the oral cavity is not well established. Determining the proportion of these organisms and the mechanisms involved may help to understand host-microbe homeostasis and inform development of probiotics or prebiotics in the maintenance of oral health.Aim. To determine the incidence and potential modes of action of immunosuppressive capacity in resident oral streptococci.Methodology. Supragingival plaque was collected from five healthy participants and supragingival and subgingival plaque from five with gingivitis. Twenty streptococci from each sample were co-cultured with epithelial cells±flagellin or LL-37. CXCL8 secretion was detected by ELISA, induction of cytotoxicity in human epithelial cells by lactate dehydrogenase release and NFκB-activation using a reporter cell line. Bacterial identification was achieved through partial 16S rRNA gene sequencing and next-generation sequencing.Results. CXCL8 secretion was inhibited by 94/300 isolates. Immunosuppressive isolates were detected in supragingival plaque from healthy (4/5) and gingivitis (4/5) samples, and in 2/5 subgingival (gingivitis) plaque samples. Most were Streptococcus mitis/oralis. Seventeen representative immunosuppressive isolates all inhibited NFκB activation. The immunosuppressive mechanism was strain specific, often mediated by ultra-violet light-labile factors, whilst bacterial viability was essential in certain species.Conclusion. Many streptococci isolated from plaque suppressed epithelial cell CXCL8 secretion, via inhibition of NFκB. This phenomenon may play an important role in oral host-microbe homeostasis.

Prevalence of Periodontal Disease and Periodontopathic Bacteria in Anti-Cyclic Citrullinated Protein Antibody-Positive At-Risk Adults Without Arthritis.

Importance: The prevalence of periodontitis is increased in patients with rheumatoid arthritis (RA) and periodontopathic bacteria can citrullinate proteins. Periodontitis may, therefore, be an initiator of RA and a target for prevention. Periodontal disease and periodontal bacteria have not been investigated in at-risk individuals with RA autoimmunity but no arthritis. Objective: To examine periodontal disease and periodontopathic bacteria in anti-cyclic citrullinated protein (anti-CCP) antibody-positive at-risk individuals without arthritis. Design, Setting, and Participants: This cross-sectional study took place at a teaching hospital from April 27, 2015, to May 8, 2017. Forty-eight anti-CCP-positive individuals without arthritis (CCP+ at-risk) were recruited nationally. Twenty-six patients with early RA (ERA) and 32 healthy control individuals were recruited locally. Data were analyzed between June 1, 2017, and December 1, 2017. Interventions: Periodontal assessment and examination of joints using ultrasonography. Main Outcomes and Measures: Prevalence of diseased periodontal sites, clinical periodontitis, and periodontal inflamed surface area in CCP+ at-risk individuals compared with patients with ERA and healthy individuals matched for age and smoking. Paired-end sequencing of DNA from subgingival plaque from diseased and healthy periodontal sites was performed and DNA was profiled and analyzed. Results: A total of 48 CCP+ at-risk individuals (mean [SD] age, 51.9 [11.4] years; 31 [65%] female), 26 patients with ERA (mean [SD] age, 54.4 [16.7] years; 14 [54%] female), and 32 healthy individuals (mean [SD] age, 49.4 [15.3] years; 19 [59%] female) were recruited. Of 48 CCP+ at-risk individuals, 46 had no joint inflammation on ultrasonography. Thirty-five CCP+ at-risk individuals (73%), 12 healthy individuals (38%), and 14 patients with ERA (54%) had clinical periodontitis. The median (interquartile range) percentage of periodontal sites with disease was greater in CCP+ at-risk individuals compared with healthy individuals (3.3% [0%-11.3%] vs 0% [0%-0.7%]) and similar to patients with ERA (1.1% [0%-13.1%]). Median (interquartile range) periodontal inflamed surface area was higher in CCP+ at-risk individuals compared with healthy individuals (221 mm2 [81-504 mm2] vs 40 mm2 [12-205 mm2]). Patients with CCP+ at-risk had increased relative abundance of Porphyromonas gingivalis (but not Aggregatibacter actinomycetemcomitans) at healthy periodontal sites compared with healthy individuals (effect size, 3.00; 95% CI, 1.71-4.29) and patients with ERA (effect size, 2.14; 95% CI, 0.77-3.52). Conclusions and Relevance: This study found increased prevalence of periodontitis and P gingivalis in CCP+ at-risk individuals. This suggests periodontitis and P gingivalis are associated with disease initiation and could be targets for preventive interventions in RA.

Is there a temporal trend in the reported treatment efficacy of periodontal regeneration? A meta-analysis of randomized-controlled trials.

BACKGROUND/AIM: The aim of study was to conduct a meta-analysis to investigate whether or not there was a temporal trend in the treatment efficacy reported in the randomized-controlled trials (RCTs) on guided tissue regeneration (GTR) or enamel matrix protein derivatives (EMD) in the treatment of infrabony defects. MATERIAL AND METHODS: The treatment outcomes were changes in probing pocket depth (PPD) and clinical attachment level (CAL). Weighted multilevel and ordinary regression analyses were performed to test the temporal relationship between treatment effect difference or treatment effectiveness and publication years. RESULTS: For PPD reduction, non-significant positive relationships were found in the treatment effect difference or treatment effect of both GTR and flap operation. For CAL gain, a small positive relationship was found in the treatment effect difference, but a significant positive trend in the treatment effect of flap operation was found. No significant temporal trend was found in the treatment effect difference for EMD. CONCLUSIONS: There was no evidence to support or refute a temporal trend in the treatment effect of regenerative procedures, but a positive trend was observed in the control group. These results suggest that only RCTs should be included in the meta-analysis, as the treatment effect of the control group may not be constant.

Actinomyces spp. gene expression in root caries lesions.

BACKGROUND: The studies of the distribution of Actinomyces spp. on carious and non-carious root surfaces have not been able to confirm the association of these bacteria with root caries, although they were extensively implicated as a prime suspect in root caries. OBJECTIVE: The aim of this study was to observe the gene expression of Actinomyces spp. in the microbiota of root surfaces with and without caries. DESIGN: The oral biofilms from exposed sound root surface (SRS; n=10) and active root caries (RC; n=30) samples were collected. The total bacterial RNA was extracted, and the mRNA was isolated. Samples with low RNA concentration were pooled, yielding a final sample size of SRS=10 and RC=9. Complementary DNA (cDNA) libraries were prepared and sequenced on an Illumina(®) HiSeq 2500 system. Sequence reads were mapped to eight Actinomyces genomes. Count data were normalized using DESeq2 to analyse differential gene expression applying the Benjamini-Hochberg correction (false discovery rate [FDR]<0.001). RESULTS: Actinomyces spp. had similar numbers of reads (Mann-Whitney U-test; p>0.05), except for Actinomyces OT178 (p=0.001) and Actinomyces gerencseriae (p=0.004), which had higher read counts in the SRS. Genes that code for stress proteins (clp, dnaK, and groEL), enzymes of glycolysis pathways (including enolase and phosphoenolpyruvate carboxykinase), adhesion (Type-2 fimbrial and collagen-binding protein), and cell growth (EF-Tu) were highly - but not differentially (p>0.001) - expressed in both groups. Genes with the most significant upregulation in RC were those coding for hypothetical proteins and uracil DNA glycosylase (p=2.61E-17). The gene with the most significant upregulation in SRS was a peptide ABC transporter substrate-binding protein (log2FC=-6.00, FDR=2.37E-05). CONCLUSION: There were similar levels of Actinomyces gene expression in both sound and carious root biofilms. These bacteria can be commensal in root surface sites but may be cariogenic due to survival mechanisms that allow them to exist in acid environments and to metabolize sugars, saving energy.

Use of radiographs in the diagnosis of periodontal disease.

UNLABELLED: Radiographs are commonly used in the diagnosis of periodontal diseases. They can be used to assess bone loss and the pattern of loss as well as in the identification of other periodontally relevant features, such as overhanging restoration margins, calculus deposits and furcation lesions. Horizontal and vertical bitewings, panoramic radiographs and periapicals can be used for periodontal assessment. Referral (selection) criteria based on clinical signs can assist the decision of the radiographs to use. All exposures must be made in accordance with the Ionizing Radiation (Medical Examination) Regulations 2000 and each exposure justified. CLINICAL RELEVANCE: Following a clinical examination, optimum selection of radiographs can assist in the assessment of patients with periodontal diseases.