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Journal of Periodontology Jul 2022Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new...
BACKGROUND
Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies.
METHODS
Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from five countries; Argentina, Chile, Colombia, Ecuador, and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard.
RESULTS
According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as Stage I (39.2%) or Stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis whereas the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.91 (95% CI = 0.89-0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as Stage IV (81.3%) whereas Stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity for moderate (99.7%) and severe periodontitis (100%), but low specificity for both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.57 (95% CI = 0.53-0.62).
CONCLUSIONS
This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well when compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis.
Topics: Adolescent; Adult; Centers for Disease Control and Prevention, U.S.; Cross-Sectional Studies; Humans; Periodontal Diseases; Periodontics; Periodontitis; Prevalence; United States
PubMed: 34625960
DOI: 10.1002/JPER.21-0276 -
Journal of Clinical Periodontology Sep 2016To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP),... (Meta-Analysis)
Meta-Analysis Review
AIMS
To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression.
METHODS
Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with ChP and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies.
RESULTS
GCF levels of IL-1β, IL-6, IFN-γ and MCP-1/CCL2 were significantly higher in subjects diagnosed with ChP than periodontally healthy subjects. A significant decrease in GCF levels of IL-1β and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4.
CONCLUSION
Evidence for significant differences between periodontal health and ChP was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression.
Topics: Chemokines; Chronic Periodontitis; Cross-Sectional Studies; Cytokines; Gingival Crevicular Fluid; Humans; Periodontal Index
PubMed: 27027257
DOI: 10.1111/jcpe.12557 -
BMC Oral Health Feb 2016The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone.
METHODS
The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted.
RESULTS
A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm, p = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001).
CONCLUSION
Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.
Topics: Amoxicillin; Anti-Bacterial Agents; Dental Scaling; Humans; Metronidazole; Periodontal Pocket; Periodontitis; Root Planing; Treatment Outcome
PubMed: 26928597
DOI: 10.1186/s12903-015-0123-6 -
Quintessence International (Berlin,... 2018The aim of the present systematic review was to evaluate the periodontal tissue inflammation indexes in patients undergoing different orthodontic treatment. (Review)
Review
OBJECTIVE
The aim of the present systematic review was to evaluate the periodontal tissue inflammation indexes in patients undergoing different orthodontic treatment.
METHOD AND MATERIALS
The Cochrane Oral Health Group specialist trials, Medline, and Embase databases were used for the research. All the included studies had to report bleeding on probing (BOP) depth as primary outcome. Changes in probing depth, clinical attachment level, Gingival Index, and Periodontal Index were included in the review as secondary outcome measurements.
RESULTS
Ten studies reporting on 421 patients and different types of orthodontic treatment were selected for the analysis. Owing to the heterogeneity of studies present in the literature, it was not possible to perform a meta-analysis.
CONCLUSION
Within their limits, the results showed an increase of periodontal parameters after orthodontic treatment, indicating that it influences the accumulation and composition of the subgingival microbiota and subsequently induces more inflammation and higher BOP.
Topics: Biofilms; Humans; Orthodontics; Periodontal Index; Periodontitis
PubMed: 29114647
DOI: 10.3290/j.qi.a39225 -
JDR Clinical and Translational Research Jan 2024Partial-mouth recording protocols often result in underestimation of population prevalence and extent of periodontitis. We posit that multiple imputation of measures...
AIM
Partial-mouth recording protocols often result in underestimation of population prevalence and extent of periodontitis. We posit that multiple imputation of measures such as clinical attachment loss for nonselected tooth sites in partial-mouth samples can reduce bias in periodontitis estimates.
METHODS
Multiple imputation for correlated site-level dichotomous outcomes in a generalized estimating equations framework is used to impute site-level binary indicators for clinical attachment loss exceeding a fixed threshold in partial-mouth samples. Periodontitis case definitions are applied to the imputed "complete" dentitions, enabling estimation of prevalence and other summaries of periodontitis for partial-mouth samples as if for full-mouth examinations. A multiple imputation-bootstrap procedure is described and applied for point and variance estimation of these periodontitis measures. The procedure is evaluated with pseudo-partial-mouth samples based on random site selection protocols of 28 to 84 periodontal sites repeatedly generated from full-mouth periodontal examinations of 3,621 participants in the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) survey.
RESULTS
Multiple imputation applied to partial-mouth samples overestimated periodontitis mean extent, defined as the number of sites with clinical attachment loss 3 mm or greater, by 9.5% in random site selection protocols with 84 sites and overestimated prevalence by 5% to 10% in all the evaluated protocols.
CONCLUSIONS
In the 2013 to 2014 NHANES data, multiple imputation of site-level periodontal indicators provides less biased estimates of periodontitis prevalence and extent than has been reported from estimates based on the direct application of full-mouth case definitions to partial-mouth samples. Multiple imputation provides a promising solution to the longstanding, vexing problem of estimation bias in partial-mouth recording, with potential application to a wide array of case definitions, periodontitis measures, and partial recording protocols.
KNOWLEDGE TRANSFER STATEMENT
Partial-mouth sampling, while a resource-efficient strategy for obtaining oral disease estimates, often results in underestimation of periodontitis metrics. Multiple imputation for nonselected periodontal sites produces pseudo-full-mouth data sets that may be analyzed and combined to produce estimates with small bias.
Topics: Humans; Nutrition Surveys; Periodontal Index; Periodontitis; Bias
PubMed: 36645107
DOI: 10.1177/23800844221143683 -
Journal of Periodontology Dec 2016Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional... (Review)
Review
BACKGROUND
Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM).
METHODS
Only randomized controlled trials with: 1) at least 6 months of follow-up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment.
RESULTS
Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well-controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain.
CONCLUSION
In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well-controlled individuals and deep sites.
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Chronic Periodontitis; Dental Scaling; Diabetes Complications; Follow-Up Studies; Humans; Periodontal Index; Randomized Controlled Trials as Topic; Root Planing
PubMed: 27468792
DOI: 10.1902/jop.2016.160214 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2019Despite decades of research, our knowledge of several important aspects of periodontal pathogenesis remains incomplete. Epigenetics allows to perform dynamic analysis of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite decades of research, our knowledge of several important aspects of periodontal pathogenesis remains incomplete. Epigenetics allows to perform dynamic analysis of different variations in gene expression, providing this great advantage to the static measurement provided by genetic markers. The aim of this systematic review is to analyze the possible relationships between different epigenetic mechanisms and periodontal diseases, and to assess their potential use as biomarkers of periodontitis.
MATERIAL AND METHODS
A systematic search was conducted in six databases using MeSH and non-MeSH terms. The review fulfilled PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-analysis).
RESULTS
36 studies met the inclusion criteria. Due to the heterogeneity of the articles, it was not possible to conduct quantitative analysis. Regarding qualitative synthesis, however, it was found that epigenetic mechanisms may be used as biological markers of periodontal disease, as their dynamism and molecular stability makes them a valuable diagnostic tool.
CONCLUSIONS
Epigenetic markers alter gene expression, producing either silencing or over-expression of molecular transcription that respond to the demands of the cellular surroundings. Gingival crevicular fluid collection is a non-invasive and simple procedure, which makes it an ideal diagnostic medium for detection of both oral and systemic issues. Although further research is needed, this seems to be a promising field of research in the years to come.
Topics: Epigenesis, Genetic; Gingival Crevicular Fluid; Humans; Periodontal Diseases; Periodontics; Periodontitis
PubMed: 31433392
DOI: 10.4317/medoral.23008 -
Journal of Periodontology Feb 2017Chronic periodontitis is controlled without antibiotics by scaling and root planing (SRP) to remove dental biofilm. It has been previously reported that the epithelial...
BACKGROUND
Chronic periodontitis is controlled without antibiotics by scaling and root planing (SRP) to remove dental biofilm. It has been previously reported that the epithelial barrier to bacterial proinflammatory products is impaired when biofilm lysine falls below the minimal content of normal blood plasma. Aims were to examine whether being refractory and requiring antibiotics to supplement SRP were associated with low biofilm lysine contents.
METHODS
Sixteen patients with periodontitis and six periodontally healthy volunteers (HVs) (respective mean ages: 57 ± 6 and 36 ± 8 years) were examined. Patients with periodontitis received SRP and surgery, and HVs received prophylaxis. At quarterly maintenance or prophylaxis visits during the subsequent year, therapeutic response was good (GR, n = 9) or poor (PR, n = 7; including five cigarette smokers). Biofilm cadaverine, lysine, and other amino acid (AA) contents were determined by liquid chromatography. Cadaverine mole fraction of lysine plus cadaverine (CF) indicated biofilm lysine decarboxylase activity.
RESULTS
Biofilm lysine was 0.19 ± 0.10 and 0.20 ± 0.09 μmol/mg in GRs and HVs, but 0.07 ± 0.03 μmol/mg in PRs (Kruskal-Wallis: P <0.01). All AAs were depleted in biofilm from smokers, but only lysine was depleted in biofilm from non-smokers. CF was inversely associated with clinical attachment level (CAL) at baseline before therapy in all patients (R = 0.28, P <0.01) and with CAL change after therapy in GR (R = 0.49, P <0.05). Lysine and cadaverine contents discriminated PRs from GRs and HVs (Wilks' λ = 0.499, P <0.012).
CONCLUSIONS
Refractory responses requiring antibiotic therapy result from smoking and/or microbial infections that starve the biofilm and epithelial attachment of lysine. Biofilm CF is associated with periodontitis severity pretherapy and extent of therapeutic response post-therapy.
Topics: Adult; Anti-Bacterial Agents; Biofilms; Cadaverine; Chromatography, Liquid; Chronic Periodontitis; Combined Modality Therapy; Dental Scaling; Female; Humans; Lysine; Male; Middle Aged; Root Planing; Smoking
PubMed: 27620654
DOI: 10.1902/jop.2016.160302 -
Journal of Periodontology Feb 2022Fetuin-A has garnered recognition in the etiopathogenesis of several systemic disorders. It has been recently acknowledged as an anti-inflammatory marker for periodontal...
BACKGROUND
Fetuin-A has garnered recognition in the etiopathogenesis of several systemic disorders. It has been recently acknowledged as an anti-inflammatory marker for periodontal disease. This study aimed to compare and correlate salivary and serum fetuin-A levels in health and patients with stages II-III periodontitis along with evaluating the effect of non-surgical periodontal therapy (NSPT) on the same.
METHODS
Group 1 comprised of 30 healthy subjects. Group 2 embodied 30 patients with stages II-III periodontitis. Clinical periodontal parameters were recorded. Saliva and serum samples were assembled. Periodontitis patients received non-surgical periodontal treatment. They were recalled after 6 months, and collection of samples and recording of clinical parameters were reiterated. Fetuin-A levels were analyzed using ELISA.
RESULTS
Salivary and serum fetuin-A levels were significantly lower in periodontitis patients when compared with the healthy subjects (P < 0.001) at baseline. Their concentrations significantly upregulated 6 months after active periodontal therapy (P < 0.001). Salivary fetuin-A levels revealed a significant positive correlation with their serum levels in Group 1 at baseline (P < 0.001). They also displayed a positive correlation in Group 2 at baseline and 6 months post periodontal therapy, nevertheless failed to establish a statistically significant association.
CONCLUSION(S)
Our study concluded that salivary and serum fetuin-A levels diminished with increasing severity of periodontal inflammation, and NSPT remarkably improved their levels. They also displayed a significant positive correlation in health, and a non-significant, yet positive correlation in patients with periodontitis.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Periodontal Diseases; Periodontitis; Root Planing; Saliva; alpha-2-HS-Glycoprotein
PubMed: 33997977
DOI: 10.1002/JPER.21-0179 -
Periodontology 2000 Oct 2016The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population... (Review)
Review
The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population will be affected by noncommunicable chronic diseases, including diabetes mellitus, cardiovascular disease and cognitive impairment. This important demographic shift includes a reduction in tooth loss/edentulism, particularly in older adults of the developed countries in North America, western Europe and north-east Asia. Therefore, in the future, dental providers will be required to care for an expanded number of older adults who have retained teeth and are medically complex. As the linkage of oral disease and systemic disease has focused on the relationship of periodontitis and noncommunicable chronic diseases, a broad review of 'geriatric periodontology' is both timely and important. This volume of Periodontology 2000 covers a range of subjects under this heading. Included are the demographics of an aging world; the effect of aging on stem cell function in the periodontium; the periodontal microbiota associated with aging; the host response in the periodontium of aging individuals; an analysis of the prevalence of periodontitis in the USA on a national, state-wide and community basis; differentiation of physiologic oral aging from disease; treatment of periodontal disease in older adults; implant therapy for older patients; oral disease and the frailty syndrome; the relationship of tooth loss to longevity and life expectancy; and the relationship of periodontal disease to noncommunicable chronic diseases. Although 'geriatric dentistry' is not a recognized specialty in dentistry, and 'geriatric periodontology' is a descriptive title, the subject of this volume of Periodontology 2000 is critical to the future of clinical dentistry, dental public health and dental research. Any comprehensive focus on older patients can only be accomplished with an emphasis on interprofessional education and practice. If embraced, this shift will allow the dental profession to be more closely aligned with the larger health-care environment, and can improve both oral health and health outcomes for patients seen in the dental office.
Topics: Aged; Aging; Cardiovascular Diseases; Cognitive Dysfunction; Dental Caries; Dental Research; Diabetes Complications; Diabetes Mellitus; Humans; Oral Health; Periodontal Diseases; Periodontics; Periodontitis; Risk Factors; Stem Cells; Tooth Loss
PubMed: 27501487
DOI: 10.1111/prd.12157