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Journal of Clinical Periodontology Oct 2018This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis.
MATERIALS AND METHODS
Forty-one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed.
RESULTS
The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days.
CONCLUSION
The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).
Topics: Bifidobacterium; Chronic Periodontitis; Dental Scaling; Humans; Probiotics; Root Planing
PubMed: 30076613
DOI: 10.1111/jcpe.12995 -
International Journal of Dental Hygiene Nov 2019To evaluate the results of active non-surgical treatment in patients diagnosed with adult periodontitis treated in a specialized clinic for periodontology.
OBJECTIVE
To evaluate the results of active non-surgical treatment in patients diagnosed with adult periodontitis treated in a specialized clinic for periodontology.
MATERIAL & METHODS
In total, 1182 patients with adult periodontitis received active non-surgical therapy, which involved professional oral hygiene instruction, scaling and root planing, supragingival polishing and elective systemic antimicrobial medication. The results of this therapy were based on a full-mouth periodontal chart as assessed at the time of evaluation. Successful treatment as periodontal pocket depth (PPD) ≤5 mm was the main outcome parameter with bleeding on pocket probing as secondary outcome. Patient-related factors such as smoking and severity of periodontitis at baseline and site-related factors such as tooth type, furcation involvement and endodontic treatment were analysed. Possible relations with assessed parameters and the success of active periodontal therapy were evaluated.
RESULTS
Overall 39% of the patients reached the successful treatment objective and a mean bleeding on pocket probing tendency of 14%. Treatment success appeared to be dependent on tooth type where the results at single-rooted front teeth (85%) and premolar teeth (78%) were more successful than at molar teeth (47%). Analysis revealed that in 55% of the cases furcation involvement at molars was associated with the absence of success. Endodontic treatment was associated with absence of success in 8%-11% of the cases. Smoking negatively influences successful treatment outcome (P < 0.001).
CONCLUSION
Active non-surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. Sub-analysis showed that the outcome appeared to be dependent on tooth type, furcation involvement, severity of periodontal disease at intake and smoking status.
Topics: Adult; Chronic Periodontitis; Dental Scaling; Follow-Up Studies; Humans; Periodontal Index; Retrospective Studies; Root Planing; Tooth Loss; Treatment Outcome
PubMed: 30942938
DOI: 10.1111/idh.12399 -
Medicina (Kaunas, Lithuania) Mar 2021Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic... (Review)
Review
Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice.
Topics: Dental Care; Humans; Periodontal Diseases; Periodontics; Periodontitis; Precision Medicine
PubMed: 33802358
DOI: 10.3390/medicina57030233 -
The Cochrane Database of Systematic... Jan 2018Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs).
OBJECTIVES
To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria.
MAIN RESULTS
We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution.
AUTHORS' CONCLUSIONS
Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chronic Periodontitis; Dental Plaque; Humans; Middle Aged; Periodontal Debridement; Periodontics; Photochemotherapy; Randomized Controlled Trials as Topic; Tooth Loss
PubMed: 29291254
DOI: 10.1002/14651858.CD009376.pub2 -
Trials Jul 2019Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent...
BACKGROUND
Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects.
METHODS
This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes.
DISCUSSION
This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.
Topics: Adult; Aged; Alveolar Bone Loss; Dental Scaling; Equivalence Trials as Topic; Female; Guided Tissue Regeneration, Periodontal; Humans; London; Male; Middle Aged; Minimally Invasive Surgical Procedures; Periodontal Debridement; Periodontitis; Root Planing; Severity of Illness Index; Surgical Flaps; Time Factors; Treatment Outcome; Young Adult
PubMed: 31351492
DOI: 10.1186/s13063-019-3544-8 -
Journal of Clinical Periodontology Jul 2018The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and radiographic parameters of periodontal regeneration.
MATERIALS AND METHODS
In this randomized controlled trial, 29 chronic periodontitis patients presenting one deep intrabony defect and requiring extraction of one vital tooth were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of minimally invasive surgical technique. The dental pulp of the extracted tooth was mechanically dissociated to obtain micrografts rich in autologous DPSCs. Test sites (n = 15) were filled with micrografts seeded onto collagen sponge, whereas control sites (n = 14) with collagen sponge alone. Clinical and radiographic parameters were recorded at baseline, 6 and 12 months postoperatively.
RESULTS
Test sites exhibited significantly more probing depth (PD) reduction (4.9 mm versus 3.4 mm), clinical attachment level (CAL) gain (4.5 versus 2.9 mm) and bone defect fill (3.9 versus 1.6 mm) than controls. Moreover, residual PD < 5 mm (93% versus 50%) and CAL gain ≥4 mm (73% versus 29%) were significantly more frequent in the test group.
CONCLUSIONS
Application of DPSCs significantly improved clinical parameters of periodontal regeneration 1 year after treatment.
Topics: Alveolar Bone Loss; Dental Pulp; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Attachment Loss; Periodontal Pocket; Regeneration; Stem Cells; Treatment Outcome
PubMed: 29779220
DOI: 10.1111/jcpe.12931 -
Annals of African Medicine 2023Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control.
MATERIALS AND METHODS
A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean "AND" and "OR." The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis.
RESULTS
In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, -0.024, 95% confidence interval, -0.42-.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I for heterogeneity 81%.
CONCLUSION
Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.
Topics: Humans; Glycated Hemoglobin; Diabetes Mellitus, Type 2; Periodontitis; Root Planing
PubMed: 37026192
DOI: 10.4103/aam.aam_53_22 -
International Journal of Environmental... Jun 2021The association between periodontal disease and dementia/cognitive impairment continues to receive increasing attention. However, whether periodontal disease is a risk... (Meta-Analysis)
Meta-Analysis Review
The association between periodontal disease and dementia/cognitive impairment continues to receive increasing attention. However, whether periodontal disease is a risk factor for dementia/cognitive impairment is still uncertain. This meta-analysis was conducted to comprehensively analyze the effect of periodontitis on dementia and cognitive impairment, and to assess the periodontal status of dementia patients at the same time. A literature search was undertaken on 19 October 2020 using PubMed, Web of Science, and Embase with different search terms. Two evaluators screened studies according to inclusion and exclusion criteria, and a third evaluator was involved if there were disagreements; this process was the same as that used for data extraction. Included studies were assessed with the Newcastle-Ottawa Scale (NOS), and results were analyzed using software Review Manager 5.2. Twenty observational studies were included. In the comparison between periodontitis and cognitive impairment, the odds ratio (OR) was 1.77 (95% confidence interval (CI), 1.31-2.38), which indicated that there was a strong relationship between periodontitis and cognitive impairment. There was no statistical significance in the effect of periodontitis on dementia (OR = 1.59; 95%CI, 0.92-2.76). The subgroup analysis revealed that moderate or severe periodontitis was significantly associated with dementia (OR = 2.13; 95%CI, 1.25-3.64). The mean difference (MD) of the community periodontal index (CPI) and clinical attachment level (CAL) was 0.25 (95%CI, 0.09-0.40) and 1.22 (95%CI, 0.61-1.83), respectively. In this meta-analysis, there was an association between periodontitis and cognitive impairment, and moderate or severe periodontitis was a risk factor for dementia. Additionally, the deterioration of periodontal status was observed among dementia patients.
Topics: Cognitive Dysfunction; Dementia; Humans; Periodontal Diseases; Periodontal Index; Periodontitis
PubMed: 34202071
DOI: 10.3390/ijerph18136823 -
BMC Oral Health Jun 2023There are differences in vitamin D levels between periodontitis and healthy individuals, but the effect of vitamin D on periodontitis is controversial. The purpose of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There are differences in vitamin D levels between periodontitis and healthy individuals, but the effect of vitamin D on periodontitis is controversial. The purpose of this Meta-analysis is twofold: (1) compare vitamin D levels in individuals with or without periodontitis; (2) assess the effects of vitamin D supplementation during scaling and root planing (SRP) on periodontal clinical parameters in individuals with periodontitis.
METHODS
A systematic search was conducted in five databases (PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library), published from the database inception to 12 September 2022. The Cochrane Collaboration Risk of bias (ROB) assessment tool, the risk of bias in non-randomized studies of intervention (ROBINS-I) tool, the Newcastle-Ottawa Quality Assessment Scale (NOS), and Agency for Healthcare Quality and Research (AHRQ) were used to evaluate randomized controlled trial (RCT), non-RCT, case-control study, and cross-sectional study, respectively. Statistical analysis was performed using RevMan 5.3 and Stata 14.0 software, with weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence intervals (CI) as the effect measures, and heterogeneity was tested by subgroup analysis, sensitivity analysis, Meta-regression.
RESULTS
A total of 16 articles were included. The results of Meta-analysis showed that periodontitis was associated with lower serum vitamin D levels compared to normal population (SMD = -0.88, 95%CI -1.75 ~ -0.01, P = 0.048), while there was no significant difference in serum or saliva 25(OH)D levels between periodontitis and normal population. Additionally, the Meta-analysis showed that SRP + vitamin D and SRP alone had a statistically significant effect on serum vitamin D levels in individuals with periodontitis (SMD = 23.67, 95%CI 8.05 ~ 32.29, P = 0.003; SMD = 1.57, 95%CI 1.08 ~ 2.06, P < 0.01). And SRP + vitamin D could significantly reduce clinical attachment level compared to SRP alone (WMD = -0.13, 95%CI -0.19 ~ -0.06, P < 0.01), but had no meaningful effect on probing depth, gingival index, bleeding index, respectively.
CONCLUSION
The evidence from this Meta-analysis suggests that the serum vitamin D concentration of individuals with periodontitis is lower than that of normal people, and SRP along with vitamin D supplementation has been shown to play a significant role in improving periodontal clinical parameters. Therefore, vitamin D supplementation as an adjuvant to nonsurgical periodontal therapy has a positive impact on the prevention and treatment of periodontal disease in clinical practice.
Topics: Humans; Dental Scaling; Periodontal Diseases; Periodontitis; Root Planing; Vitamin D; Clinical Trials as Topic
PubMed: 37312090
DOI: 10.1186/s12903-023-03120-w -
BMC Oral Health May 2022Periodontitis has been associated with adverse pregnancy outcomes. Little is known about the burden and risk factors for periodontitis among reproductive age women in...
BACKGROUND
Periodontitis has been associated with adverse pregnancy outcomes. Little is known about the burden and risk factors for periodontitis among reproductive age women in sub-Saharan Africa. This analysis aimed to determine the prevalence and correlates of periodontitis among Kenyan women planning to conceive.
METHODS
HIV-seronegative, reproductive-age women who were planning to conceive were enrolled and underwent a periodontal examination. Following the US Centers for Disease Control and Prevention clinical case definitions, the presence and severity of periodontitis was determined by establishing the level of clinical periodontal attachment loss and graded in three categories: no/mild, moderate, and severe. Secondary outcomes included the scores on the Gingival Index and Decayed, Missing, and Filled Teeth (DMFT) Index. Correlates of periodontitis were examined using univariable and multivariable logistic regression.
RESULTS
Of the 647 women in the study, 84% (n = 541) had no/mild periodontitis, 15% (n = 97) had moderate periodontitis, and 1% (n = 9) had severe periodontitis. Mild gingivitis was present in 61% (n = 396) of women, while 27% (n = 176) had moderate gingivitis, and 1% (n = 9) had severe gingivitis. The majority (75%, n = 487) of women had a DMFT index in the very low range (score < 5). Periodontitis was observed in 12% (12/101) of nulliparous women compared to 13% (36/286) of women with one prior delivery (prevalence ratio [PR] 1.03, 95% confidence interval [95% CI] 0.57-1.96), 21% (36/170) of women with two prior deliveries (PR 1.78, 95% CI 0.97-3.26), and 24% (22/90) of women with 3 or more prior deliveries (PR 2.06, 95% CI 1.08-3.92).
CONCLUSION
This study demonstrated a substantial prevalence of moderate-severe periodontitis among women planning to conceive in Kenya. These results highlight the need to address the oral care needs of reproductive age women, particularly those with multiple prior pregnancies.
Topics: Female; Gingivitis; Humans; Kenya; Periodontal Index; Periodontitis; Pregnancy; Prevalence
PubMed: 35642032
DOI: 10.1186/s12903-022-02243-w