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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 -
Journal of Periodontology Feb 2024The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals.
BACKGROUND
The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals.
METHODS
A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity.
RESULTS
Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD).
CONCLUSIONS
The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.
Topics: United States; Humans; Cross-Sectional Studies; Sleep Quality; Universities; Periodontitis; Periodontics
PubMed: 37477025
DOI: 10.1002/JPER.23-0209 -
Periodontology 2000 Oct 2020Severe/progressive periodontitis is associated with cardiovascular disease, cancer, Alzheimer's disease, and dozens of other serious diseases. Herpesviruses are... (Review)
Review
Severe/progressive periodontitis is associated with cardiovascular disease, cancer, Alzheimer's disease, and dozens of other serious diseases. Herpesviruses are implicated in severe periodontitis and in specific subsets of each of the above systemic diseases. That both periodontitis and herpesviruses are linked to the same nonoral diseases is consistent with a systemic pathogenic role of periodontal herpesviruses. Effective control of periodontitis-related systemic diseases requires collaboration between dentistry and medicine. Periodontology has emerged as an important preventive medical discipline, and periodontal teaching and practice need to adjust accordingly.
Topics: Cardiovascular Diseases; Focal Infection; Forecasting; Humans; Periodontal Diseases; Periodontics; Periodontitis
PubMed: 32844419
DOI: 10.1111/prd.12375 -
General Dentistry 2022This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with... (Review)
Review
This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Meta-Analysis as Topic; Periodontitis; Root Planing; Systematic Reviews as Topic
PubMed: 35993928
DOI: No ID Found -
International Journal of Environmental... Aug 2022The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties... (Review)
Review
BACKGROUND
The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use.
OBJECTIVE
To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients.
MATERIAL AND METHODS
A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened.
RESULTS
Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies).
CONCLUSIONS
Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.
Topics: Chlorhexidine; Chronic Periodontitis; Humans; Periodontal Diseases; Periodontitis; Root Planing; Treatment Outcome
PubMed: 36011693
DOI: 10.3390/ijerph191610061 -
Clinical and Experimental Dental... Feb 2022Changes in periodontal referral patterns over time have been reported from the United States and Australia. To date, comparable studies have not been published from...
OBJECTIVES
Changes in periodontal referral patterns over time have been reported from the United States and Australia. To date, comparable studies have not been published from Europe. The objectives of the present study were to examine changes in periodontal referral patterns in Norway in 2003 versus 2018 and to compare these with trends observed in the United States and Australia using universal criteria for grading of periodontal severity.
MATERIALS AND METHODS
A retrospective analysis of 369 charts from four Norwegian periodontics clinics was completed. Data on year of referral, gender, age, tobacco smoking, periodontal status and missing teeth at initial examination, teeth planned for extraction, and periodontal case type were collected using a survey format; case type I, II, III, and IV representing increasing severity of periodontitis, case type V representing referral for other periodontal conditions (peri-implantitis, refractory periodontitis, etc.). Chi-square, t-tests, and negative binomial regression were used for the statistical analysis.
RESULTS
Compared with 2003, the 2018 data showed an increase in mean age at referral (p < 0.05), overall distribution of case type III and V (p = 0.047), and number of missing teeth (p = 0.001). Further, a decrease in prevalence of smokers (p < 0.05), but no change in number of teeth planned for extraction (p = 0.104), were observed.
CONCLUSIONS
During a period of 15 years, changes in periodontal referral patterns in Norway are similar to those in the United States and Australia. The adoption of a guideline-based referral practice might be beneficial for both the dental profession and patients.
Topics: Humans; Periodontics; Periodontitis; Referral and Consultation; Retrospective Studies; Tooth Loss
PubMed: 34549548
DOI: 10.1002/cre2.491 -
Journal of the American Dental... Feb 2019In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States.
BACKGROUND
In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States.
METHODS
The authors used geospatial analysis to describe the distribution of periodontists and adults, periodontists vis-à-vis estimated density of adults with severe periodontitis, and their ratios to adults with severe periodontitis. The authors identified locations of 5,415 practicing periodontists through the 2014 National Provider Identifier Registry, linked them with the weighted census number of adults, and estimated the number of adults within a series of circular distance zones.
RESULTS
Approximately 60% of adults 30 through 79 years lived within 5 miles of a periodontist, 73% within 10 miles, 85% within 20 miles, and 97% within 50 miles. Proximity to a periodontist varied widely. In urban areas, 95% of adults resided within 10 miles of a periodontist and 100% within 20 miles. Only 24% of adults in rural areas lived within 10 miles of a periodontist. Most periodontists (96.1%) practiced in urban areas, clustering along the eastern and western coasts and in the Midwest, 3.1% in urban clusters elsewhere, and 0.8% in rural areas. Ratios of fewer than 8,000 adults with periodontitis to 1 or more periodontists within 10 miles were clustered mostly in the Northeast, central East Coast, Florida, West Coast, Arizona, and Midwest.
CONCLUSIONS
In this study, the authors identified wide variations in geographic proximity to a practicing periodontist for adults with severe periodontitis.
PRACTICAL IMPLICATIONS
Dental practitioners may provide preventive care and counseling for periodontitis and referrals for specialty care. Geographic proximity to specialized periodontal care may vary widely by locality.
Topics: Adult; Counseling; Dentists; Humans; Periodontics; Periodontitis; Referral and Consultation; United States
PubMed: 30470389
DOI: 10.1016/j.adaj.2018.09.021 -
Lasers in Medical Science Mar 2022This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify... (Meta-Analysis)
Meta-Analysis Review
Clinical effectiveness of adjunctive diode laser on scaling and root planing in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis.
This review aims to evaluate the adjunctive clinical effectiveness of diode laser (DL) to scaling and root planing (SRP) in the treatment of periodontitis, and identify the optimal combination of usage mode and application regimen of DL. Eight electronic databases were searched up to January 2021. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI) were assessed at short-term (4-6 weeks), 3-month, and 6-month follow-ups. Based on DL usage mode, studies were divided into three groups: inside, outside pocket, and combined modes. As for application regimen, studies in each group were further subdivided into single- and multiple-session subgroups. Thirty randomized controlled trials with 825 participants were included. For inside mode, single-session DL showed significant improvements for PPD (short-term, and 3-month, p < 0.05), CAL (short-term, and 3-month, p < 0.05), PI (3- and 6-month, p < 0.05), and GI (short-term, 3-month, and 6-month, p < 0.05). For outside mode, multiple-session DL showed notable improvements for most clinical outcomes (p < 0.05). The effect of combined mode was still uncertain. Adjunctive DL had additional clinical benefits in the treatment of periodontitis. One session laser treatment is suggested when DL is applied inside pocket in future clinical practice. Meanwhile, more than one session laser treatment presents better outcomes when DL is used outside pocket. PROSPERO: CRD42020156162.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Lasers, Semiconductor; Periodontal Index; Periodontitis; Randomized Controlled Trials as Topic; Root Planing; Treatment Outcome
PubMed: 34536183
DOI: 10.1007/s10103-021-03412-z -
Journal of the American Dental... Oct 2015
Topics: Anti-Infective Agents; Chronic Periodontitis; Humans; Periodontal Debridement
PubMed: 26409980
DOI: 10.1016/j.adaj.2015.08.004 -
Clinical Oral Investigations Mar 2021The purpose of this preliminary study was to explore blood microcirculation and somatosensory profiles in periodontitis patients before and after non-surgical...
OBJECTIVES
The purpose of this preliminary study was to explore blood microcirculation and somatosensory profiles in periodontitis patients before and after non-surgical periodontal therapy.
MATERIALS AND METHODS
Twenty patients (10 men and 10 women, 20 to 30 years old) and 20 age- and gender-matched healthy controls were included. Non-surgical periodontal therapy was performed for all patients. Clinical examination including pocket probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) were performed at baseline (BL), 1 week (1W), and 4 weeks (4W) after non-surgical periodontal therapy on 6 sites of tooth 32 and 42. Laser Doppler flowmetry (LDF) and quantitative sensory testing (QST) were applied at the attached gingiva of tooth 32 and 42 at BL, 1W, and 4W after non-surgical periodontal therapy. Data were analyzed with a two-way mixed-model of ANOVA.
RESULTS
The PPD, CAL and BOP significantly improved after non-surgical periodontal therapy (p < 0.001). Periodontitis patients demonstrated a higher tissue microvascular blood cell concentration (p = 0.015) and a significant gain in thermal (p = 0.037) and mechanical (p = 0.003) somatosensory function compared to controls. After non-surgical periodontal therapy, the flux (p = 0.002) and speed (p = 0.008) of blood flow decreased significantly and thermal (p = 0.029) and mechanical (p < 0.001) somatosensory function were reversed.
CONCLUSION
Gingival microcirculation and somatosensory function seem impaired in patients with periodontitis and are reversed following non-surgical periodontal therapy.
CLINICAL RELEVANCE
LDF and QST may be appropriate tools to further characterize gingival inflammation and treatment responses in periodontitis.
Topics: Adult; Female; Follow-Up Studies; Gingiva; Humans; Laser-Doppler Flowmetry; Male; Microcirculation; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Young Adult
PubMed: 32613435
DOI: 10.1007/s00784-020-03427-w