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Periodontology 2000 Oct 2018In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and... (Review)
Review
In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.
Topics: Dental Care; Disease Progression; Forecasting; Health Systems Plans; Humans; Periodontics; Periodontitis; Public Health; Risk Assessment; Socioeconomic Factors
PubMed: 30198135
DOI: 10.1111/prd.12228 -
Journal of Clinical Periodontology Jun 2022To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age).
AIM
To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age).
MATERIALS AND METHODS
This population-based study (n = 2515) modelled direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing [BoP], probing depth [PD] ≥ 4 mm, clinical attachment loss [CAL] ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP-AAP) periodontitis definitions, adjusting for sex, socio-economic status, smoking, and alcohol, through structural equation modelling (α = 5%).
RESULTS
Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient [SC] = -0.160; p < .001), moderate periodontitis (SC = -0.202; p < .001), and EFP-AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05).
CONCLUSIONS
Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.
Topics: Adolescent; Diet; Humans; Obesity; Periodontics; Periodontitis; Smoking
PubMed: 35415936
DOI: 10.1111/jcpe.13625 -
Clinical Oral Investigations Feb 2022The aim of this study was to investigate the effect of periodontal inflammation on oxidative stress in patients with atherosclerosis by considering serum and saliva...
OBJECTIVES
The aim of this study was to investigate the effect of periodontal inflammation on oxidative stress in patients with atherosclerosis by considering serum and saliva total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI).
MATERIALS AND METHODS
In the study, there were 4 groups, with 20 individuals in each group. These groups consisted of individuals who had periodontitis with atherosclerosis (group A-P), were periodontally healthy with atherosclerosis (group A-C), were systemically healthy with periodontitis (group P), and were systemically and periodontally healthy (group C). Clinical periodontal parameters were recorded. PISA values were calculated. Atherosclerosis severity was determined by the Gensini score. The ratio of TAS/TOS resulting in the OSI levels of the serum and saliva samples was examined biochemically.
RESULTS
Group A-P serum TAS and group C saliva OSI values were lower than those of the other groups (p < 0.05). Group A-P serum TOS and OSI values were higher than those of the other groups (p < 0.05). Groups A-C and P serum TOS and OSI values were higher than those of group C (p < 0.05). In the multivariate linear regression analysis, group A-P and PISA values were independently associated with serum TOS and OSI values (p < 0.05). Group A-P, group P, and PISA values were independently associated with saliva OSI values (p < 0.05).
CONCLUSIONS
Periodontitis and atherosclerosis may have systemic oxidative stress-increasing effects. The coexistence of periodontitis and atherosclerosis increases oxidative stress beyond that seen in either condition alone. Periodontitis can be associated with increased systemic TOS and OSI values in patients with atherosclerosis.
STATEMENT OF CLINICAL RELEVANCE
Oxidative status is affected more severely when periodontitis and atherosclerosis coexist rather than when either exists alone. Periodontitis can cause increasing effect on serum TOS and OSI and decreasing effect on TAS in patients with atherosclerosis. The increase in oxidative stress markers with the presence of periodontal disease in patients with atherosclerosis emphasizes that controlling periodontal diseases, a treatable disease, may contribute to the prognosis of atherosclerosis.
Topics: Antioxidants; Atherosclerosis; Chronic Periodontitis; Gingival Crevicular Fluid; Humans; Oxidants; Oxidative Stress; Periodontal Index
PubMed: 34415433
DOI: 10.1007/s00784-021-04144-8 -
Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective.Periodontology 2000 Jun 2020Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial... (Review)
Review
Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.
Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Local; Dental Scaling; Humans; Metronidazole; Periodontitis
PubMed: 32385884
DOI: 10.1111/prd.12325 -
Undersea & Hyperbaric Medicine :... 2023Hyperbaric oxygen (HBO2) has been the subject of research in many areas of dentistry. HBO2 seems to be a useable, additional treatment method. However, there are still... (Review)
Review
BACKGROUND AND OBJECTIVE
Hyperbaric oxygen (HBO2) has been the subject of research in many areas of dentistry. HBO2 seems to be a useable, additional treatment method. However, there are still no certain conclusions and clear guidelines for procedures. The aim of the study was to collect current literature assessing the use of hyperbaric oxygen therapy in the treatment of periodontitis.
MATERIALS AND METHODS
The following review was performed using medical databases Medline via PubMed and Google Scholar. The review presents articles which assess the effect of hyperbaric oxygen therapy in combination with non-surgical scaling and root planing (SRP) in patients with periodontitis as an adjunctive method to standard protocols.
RESULTS
There are potentially plausible mechanisms by which HBO2 could be beneficial. Further well-designed science research and clinical trials are needed. Due to a small body of literature, differences in methodology and observation periods the data are not sufficient for statistical analysis.
CONCLUSION
The use of HBO2 seems to be reasonable as an adjunct method of the periodontitis treatment. However, authors of this literature review could not unambiguously state that hyperbaric oxygen therapy could be commonly recommended as a potential method of periodontitis treatment. It is essential to develop consistent protocols for the procedure and further research in this area.
Topics: Humans; Hyperbaric Oxygenation; Periodontitis; Root Planing
PubMed: 36820803
DOI: 10.22462/01.01.2023.17 -
High Blood Pressure & Cardiovascular... Sep 2021An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation.... (Review)
Review
An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.
Topics: Dental Implantation; Humans; Hypertension; Italy; Periodontics; Periodontitis; Societies, Dental; Societies, Medical
PubMed: 34562228
DOI: 10.1007/s40292-021-00466-6 -
European Journal of Oral Sciences Feb 2020We aimed to identify response patterns to non-surgical periodontal therapy and to investigate whether the new classification system for periodontitis reflects response...
We aimed to identify response patterns to non-surgical periodontal therapy and to investigate whether the new classification system for periodontitis reflects response to treatment after 1 yr. At baseline, data on sociodemographic status, smoking, and diabetes were obtained from participants with periodontal disease. Clinical periodontal data and subgingival plaque were also collected. Participants underwent non-surgical periodontal therapy, and after 3 and 12 months, clinical data were reassessed. Factor analyses, group-based-trajectory modeling, and mixed-effects regression models were used for data analysis. Factor analysis of the baseline periodontal parameters revealed two different periodontitis dimensions: 'moderate' and 'severe'. Two response patterns for each of these periodontitis dimensions were identified. Periodontal therapy had a beneficial effect on both 'moderate' and 'severe' periodontitis; however, individuals with higher levels of disease at baseline experienced greater treatment effect. Regarding the new classification system, while the staging component distinguished different levels of 'moderate' and 'severe' periodontitis before and after treatment, the grading component did not. This study shows the beneficial effect of non-surgical periodontal therapy on both 'moderate' and 'severe' periodontitis. However, the benefit was limited among individuals with low levels of disease. The new classification system did not adequately reflect the periodontal response to therapy in this patient group.
Topics: Dental Scaling; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Phenotype; Root Planing
PubMed: 31995259
DOI: 10.1111/eos.12670 -
Journal of Clinical Periodontology Feb 2019This systematic review aimed to evaluate the impact of diabetes mellitus on clinical outcomes of non-surgical periodontal therapy. (Review)
Review
AIM
This systematic review aimed to evaluate the impact of diabetes mellitus on clinical outcomes of non-surgical periodontal therapy.
MATERIALS AND METHODS
Searches were conducted in electronic databases to screen studies published from January 1960 to August 2018. The included studies had at least two groups of patients: chronic periodontitis only (P) or both diabetes and chronic periodontitis (DMP). Outcomes of interest included the difference between the two groups in probing depth (PD) reduction and clinical attachment level (CAL) gain following non-surgical periodontal therapy. Meta-regression was conducted to evaluate the correlation between the outcomes of interest and contributing factors.
RESULTS
A total of 12 studies with a follow-up period up to 6 months were included. There was no significant difference in PD reduction (p = 0.55) or CAL gain (p = 0.65) between the two groups. A positive association between PD reduction and baseline PD difference (p = 0.03), and a negative association between PD reduction and age (p = 0.04) were found. The level of HbA1c at baseline did not significantly affect the difference in PD reduction (p = 0.39) or CAL gain (p = 0.44) between two groups.
CONCLUSIONS
Recognizing the study's limitations, we conclude that diabetes mellitus (HbA1c ≤ 8.5%) does not appear to significantly affect short-term clinical periodontal outcomes of non-surgical periodontal treatment.
Topics: Chronic Periodontitis; Dental Scaling; Diabetes Mellitus; Follow-Up Studies; Humans; Periodontal Attachment Loss; Root Planing
PubMed: 30536853
DOI: 10.1111/jcpe.13044 -
Journal of Feline Medicine and Surgery Jan 2015Periodontal disease is commonly encountered in feline practice. Gingivitis, followed by inflammation of the rest of the periodontal tissues, can lead to chronic oral... (Review)
Review
PRACTICAL RELEVANCE
Periodontal disease is commonly encountered in feline practice. Gingivitis, followed by inflammation of the rest of the periodontal tissues, can lead to chronic oral infection, bacteraemia, pain and ultimately tooth loss. Given adequate plaque control and thorough, consistent dental home care, gingivitis is a reversible and controllable condition. Periodontitis, however, is an essentially irreversible and progressive condition. Treatment aims to control tissue inflammation, returning the gingiva to clinical health and preventing destruction of the periodontium in other parts of the mouth.
CLINICAL CHALLENGES
Diagnosis must be established using a combination of oral examination under anaesthesia and dental radiography. Periodontitis leads to tooth attachment loss, and given the short length of most cat teeth, probing depths of 1 mm or more should alert the clinician to the presence of periodontitis. The decision of whether to extract or preserve affected teeth needs careful consideration. In practice, as periodontitis is often associated with type 1 tooth resorption, extraction is often required, but the slender and delicate nature of feline tooth roots, compounded by the destructive nature of tooth resorption, can frustrate extraction attempts. As highlighted in this article, iatrogenic damage to teeth is also a real risk if periodontal therapy procedures (including scaling and polishing) are not performed carefully. The challenges of providing home care in the cat are additionally discussed.
EVIDENCE BASE
The authors have drawn upon, wherever possible, an evidence base relating strictly to the feline patient. Where there is a lack of published research, evidence from canine and human studies is assessed.
Topics: Animals; Cat Diseases; Cats; Dental Plaque; Dental Prophylaxis; Disease Progression; Gingivitis; Periodontal Diseases; Periodontitis; Prognosis
PubMed: 25527493
DOI: 10.1177/1098612X14560099 -
Clinical Oral Investigations Sep 2022P4 Medicine is based on a proactive approach for clinical patient care incorporating the four "pillars" of prediction, prevention, personalization, and participation for... (Review)
Review
OBJECTIVES
P4 Medicine is based on a proactive approach for clinical patient care incorporating the four "pillars" of prediction, prevention, personalization, and participation for patient management. The purpose of this review is to demonstrate how the concepts of P4 medicine can be incorporated into the management of periodontal diseases (particularly periodontitis) termed P4 periodontics.
METHODS
This is a narrative review that used current literature to explore how P4 periodontics can be aligned with the 2018 Classification of Periodontal Diseases, current periodontal treatment paradigms, and periodontal regenerative technologies.
RESULTS
The proposed model of P4 periodontics is highly aligned with the 2018 Classification of Periodontal Diseases and represents a logical extension of this classification into treatment paradigms. Each stage of periodontitis can be related to a holistic approach to clinical management. The role of "big data" in future P4 periodontics is discussed and the concepts of a treat-to-target focus for treatment outcomes are proposed as part of personalized periodontics. Personalized regenerative and rejuvenative periodontal therapies will refocus our thinking from risk management to regenerative solutions to manage the effects of disease and aging.
CONCLUSIONS
P4 Periodontics allows us to focus not only on early prevention and intervention but also allow for personalized late-stage reversal of the disease trajectory and the use of personalized regenerative procedures to reconstruct damaged tissues and restore them to health.
CLINICAL SIGNIFICANCE
P4 Periodontics is a novel means of viewing a holistic, integrative, and proactive approach to periodontal treatment.
Topics: Dental Care; Humans; Periodontal Diseases; Periodontics; Periodontitis
PubMed: 35344104
DOI: 10.1007/s00784-022-04469-y