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Oral and Systemic Implications of Periodontal Disease – an Integrated Approach

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Dentistry and Oral Sciences".

Deadline for manuscript submissions: 25 May 2024 | Viewed by 17387

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Prof. Dr. Petra Surlin

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Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
Interests: stomatology; dentistry; periodontology
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Dear Colleagues,

Over the past few decades, periodontology has set itself as a modern dental specialty, not only by offering a comprehensive insight into the pathogenic and clinical characteristics of periodontal disease, but also by providing reliable and predictable treatment protocols for systemic affected patients. Extended research has proved that, while the accumulation of subgingival bacterial biofilm triggers the periodontal inflammatory reaction, a set of local and systemic risk factors can significantly influence its evolution and clinical outcome. In addition, the emerging, complementary, field of “periodontal medicine” has shown that the implications of periodontal disease extend further than the oral cavity, illustrating the existence of significant by-directional connections between the periodontal pathology and systemic diseases, such as diabetes mellitus, cardiovascular conditions, hepatic diseases and others.

The oral and systemic implications of periodontal disease require continued extensive research, in order to gain significant knowledge that would benefit fellow researchers and practitioners alike, eventually leading to the offering of better periodontal and dental care for patients. Thus, we invite you to contribute your research results to this Special Issue and to share your valuable scientific expertise.

Prof. Dr. Petra Șurlin
Guest Editor

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Keywords

periodontal disease
gingivitis
periodontitis
oral risk factors
systemic risk factors
periodontal medicine

Published Papers (10 papers)

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14 pages, 1289 KiB

Open AccessArticle

Relationship between Carotid Artery Calcification and Periodontitis in the Saudi Population: A Retrospective Study

by Wael I. Ibraheem, Ashok Kumar Bhati, Manar Ali Alhomood, Omaima Ahmed Allayl, Alzhouor Ali Qsadi, Tahani Ibrahim Mnaji Mohammed and Yahya Sulaiman Aljabri

Appl. Sci. 2023, 13(22), 12370; https://0-doi-org.brum.beds.ac.uk/10.3390/app132212370 - 15 Nov 2023

Viewed by 676

Abstract

Background: Atherosclerosis is the primary cause of cardiovascular death, wherein plaque accumulates in the carotid artery, resulting in the formation of carotid artery calcification (CAC). Chronic infections emulate atherosclerosis development. Periodontitis is a chronic disease commenced by biofilm aggregation on the surface of teeth, which then progresses via deregulated local and inflammatory immune responses. Aim: The aim of this study was to determine the prevalence of calcification in periodontitis patients and to determine if there is a relationship between carotid calcification and periodontitis with risk factors such as age, gender, hypertension, diabetes, smoking. Methods: The data and panoramic radiographs (PR) of 3000 patients from January 2017 to February 2022 were examined. On the basis of the inclusion and exclusion criteria, 500 patients were selected for determining carotid calcification. Non-periodontitis patients, patients <40 years of age, patients without any medical data or incomplete medical records and cases where the OPG was not clear were not included in this study. The data were analyzed using R and GraphPad Prism software version 4.1.2 and Microsoft Excel Worksheet Office 2019. Chi-square tests were used to check the dependency among the categorical variables. Mann–Whitney U-tests were used to compare the distribution of the variables across the groups, and p-values < 0.05 were interpreted as statistically significant. Result: Twenty-five (5%) patients showed carotid calcification. Carotid calcification was seen more in females than in males, which was statistically significant. Gender, percentage of alveolar bone loss and periodontal risk were found to be statistically significantly related to carotid artery calcification. Factors such as age, diabetes and hypertension were found to be statistically nonsignificant. Conclusions: More periodontal destruction was present in the CAC patients. Within the limitations of this study, it can be concluded that CAC is associated with periodontitis. Early recognition of carotid calcification is important, and patients in whom carotid artery calcification is observed via their PR should be referred to medical practitioners for further investigation and treatment care. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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10 pages, 1230 KiB

Open AccessArticle

Expression of C Reactive Protein in Gingival Crevicular Fluid of Patients with Periodontitis Wearing Metal-Ceramic Dental Crowns

by Alina-Ramona Dimofte, Dorin Nicolae Gheorghe, Dora Maria Popescu, Ioana Mitruț, Petre Costin Mărășescu, Horia Octavian Manolea, Mihail Virgil Boldeanu and Petra Şurlin

Appl. Sci. 2023, 13(19), 10993; https://0-doi-org.brum.beds.ac.uk/10.3390/app131910993 - 05 Oct 2023

Viewed by 694

Abstract

Metal-ceramic crowns (MC) have long been considered as gold standard for dental prosthetic restorations. Our study aims to evaluate the influence of MC, with conventional technology used for the framework, on the periodontal parameters and levels of C reactive protein, an inflammatory marker, in gingival crevicular fluid in patients diagnosed with periodontitis. Two groups were established: the test group T-28 teeth from the lateral area wearing a MC crown and the control group C-28 teeth without any wearing. These parameters were evaluated: probing depth, Gingival Index, and longevity of crowns. The quantitative assessment through enzyme-linked immunosorbent assay of the targeted pro-inflammatory mediator was performed. There is a difference statistically significant between the groups T and C regarding the marker’s levels and gingival index, a very strong correlation between these levels and probing depth and a strong correlation between longevity and Gingival Index. Periodontal clinical parameters are more pronounced the longer the time elapsed since the application of the crowns. Expression of C reactive protein is higher in the presence of MC crowns. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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12 pages, 782 KiB

Open AccessArticle

Association between Non-Alcoholic Steatohepatitis-Related Hepatocellular Carcinoma and Periodontopathic Bacteria: A Cross-Sectional Pilot Study

by Ryo Takuma, Toshiya Morozumi, Yuko Yamamoto, Takashi Kobayashi, Takaaki Matsui, Masato Yoneda, Takaomi Kessoku, Asako Nogami, Muneaki Tamura, Yohei Kamata, Shuntaro Sugihara, Yoshiaki Nomura, Masahiro To, Masato Minabe, Kenji Mitsudo, Atsushi Nakajima and Motohiro Komaki

Appl. Sci. 2023, 13(6), 3893; https://0-doi-org.brum.beds.ac.uk/10.3390/app13063893 - 19 Mar 2023

Cited by 1 | Viewed by 1561

Abstract

The incidence of non-alcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC) is increasing annually as the metabolic syndrome factors increase. This study aimed to analyze the involvement of periodontopathic bacteria in NASH-related HCC (NASH-HCC). Questionnaire investigation, periodontal examination, medical examination, and specimen collection (saliva, mouth-rinsed water, and peripheral blood) were performed in 40 patients with NASH and in 20 patients with NASH-HCC. Immunoglobulin (Ig) G antibody titers against Porphyromonas gingivalis (p = 0.031) and Fusobacterium nucleatum (p = 0.003) were significantly higher in the NASH-HCC group than in the NASH group. P. gingivalis and F. nucleatum ratios were higher in the NASH-HCC group than in the NASH group; however, only F. nucleatum ratio was significant (p = 0.009). The Shannon index of salivary bacterial flora was significantly lower in the NASH-HCC group than in the NASH group (p < 0.001). The NASH-HCC group had a significantly lower salivary IgA concentration (p = 0.007) and a slower salivary IgA flow rate (p = 0.003). In all participants, the salivary IgA flow rate and the F. nucleatum ratio showed a significant negative correlation (p = 0.02). Oral P. gingivalis and F. nucleatum were possibly associated with NASH-HCC pathogenesis, and salivary IgA levels were correlated with F. nucleatum. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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14 pages, 1807 KiB

Open AccessArticle

Periodontal Disease Diagnosis in the Context of Oral Rehabilitation Approaches

by Laura Elisabeta Checherita, Magda Ecaterina Antohe, Ovidiu Stamatin, Ioana Rudnic, Iulian Costin Lupu, Irina Croitoru, Amelia Surdu, Daniel Cioloca, Irina Gradinaru, Laurian Francu, Iolanda Foia, Bogdan Mihai Vascu and Ana Maria Fătu

Appl. Sci. 2022, 12(18), 9067; https://0-doi-org.brum.beds.ac.uk/10.3390/app12189067 - 09 Sep 2022

Viewed by 1430

Abstract

Periodontal diseases generally correspond to a disturbance in the balance between the host’s defense and the micro-organisms colonizing the periodontal environment. The exact mechanisms underlying the destruction of the periodontium remain to be fully elucidated. Our study aims to quantify the main bacteria pool involved in periodontal pathology and associate it with other factors involved in the onset of periodontal disease so that an accurate diagnosis with profound implications for the therapeutic algorithm can be developed. Micro-Ident tests, based on the polymerase chain reaction (PCR) technique, were used for the study group, chosen for their high specificity in identifying periodontopathogenic bacteria and determining their relative numbers. The results of our study indicate an increased concentration of 4.50 (number of strains) for Capnocytophaga, followed by Tannerella forsythia, in a concentration of 3.50; the next highest concentration percentages are for Treponemei denticola, and Prevotela intermedia, low concentrations were found for Fusobacterium nucleatum and Porphyromonas. The concentration of each type of bacteria is reflected in the clinical picture and constitutes the starting point for a targeted antibiotic therapy. Following the effects of antibiotic-targeted therapy obtained from the evaluation of the micro-IDent B test results on the periodontium of the supporting teeth, we observed that the values of the periodontal indices change slightly at 3-month intervals with a predominance of plaque, bleeding, and gingival indices, and less in the indices concerning the depth of the probing pocket and the loss of attachment on the buccal and oral surfaces. In conclusion, our study emphasizes a direct relationship between the subgingival tartar presence and the patients age, gingival recession, presence of periodontal pockets, dental mobility, as well as the periodontal indexes: plaque index, bleeding index, and gingival index. The correlation of negative values of periodontal indices with the nature of the involved bacteria materializes in relevant starting points in the elaboration of the periodontal diagnosis of the therapeutic plan and predictability of the prognosis of oral rehabilitation. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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11 pages, 1597 KiB

Open AccessArticle

Domiciliary Management of Periodontal Indexes and Glycosylated Hemoglobin (HbA1c) in Type 1 Diabetic Patients with Paraprobiotic-Based Toothpaste and Mousse: Randomized Clinical Trial

by Andrea Butera, Maurizio Pascadopoli, Simone Gallo, Mario Alovisi, Elisabetta Lovati, Elisa Mutti and Andrea Scribante

Appl. Sci. 2022, 12(17), 8610; https://0-doi-org.brum.beds.ac.uk/10.3390/app12178610 - 28 Aug 2022

Cited by 5 | Viewed by 1282

Abstract

Background: Periodontal disease is a chronic inflammation of periodontal tissues. Several systemic diseases are related to this condition. One of the strongest associations is that of periodontitis and type 2 diabetes mellitus (T2DM). On the contrary, the link with type 1 diabetes mellitus (T1DM) has not been extensively investigated. The objective of the present report is to evaluate and compare the effect of two domiciliary oral hygiene protocols on the periodontal clinical status as well as on the metabolic control in patients affected by T1DM. Methods: Sample size calculation required 20 patients per group, therefore 40 patients were equally and randomly assigned to the following home oral care protocols: a probiotic-based one (trial group) and a natural extracts-based one (control group). At the beginning of the study, after 3 and 6 months, the following periodontal indexes were collected: Probing Pocket Depth (PPD), Plaque Index (PI), Clinical Attachment Level (CAL), Bleeding on Probing (BoP), and Glycosylated Hemoglobin (HbA1c). Data underwent statistical analysis (significance threshold: p < 0.05). Results: In both groups, significant decreases in the periodontal clinical indexes were found at various time frames, whereas the levels of HbA1c significantly decreased only in the control group. Conclusions: Both the domiciliary treatments administered can significantly improve PPD, PI, CAL, and BOP parameters, whereas only the natural extracts-based gel seems to decrease HbA1c levels of T1DM patients. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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11 pages, 279 KiB

Open AccessArticle

Evaluation of Salivary Mucin, Amylase, Protein Profile, and Periodontal Parameters among Hypertensive and Diabetic Patients

by Madiha Anwar, Beenish F. Alam, Saqib Ali, Sahibzadi F. Tariq, Khalid Aali, Eisha Abrar, Dalal H. Alotaibi, Aljoharah A. Alsinaidi, Ali Alrahlah and Fahim Vohra

Appl. Sci. 2022, 12(15), 7407; https://0-doi-org.brum.beds.ac.uk/10.3390/app12157407 - 23 Jul 2022

Cited by 3 | Viewed by 1860

Abstract

Systemic and localized oral disease instigates alterations in salivary composition and content. The objective of the study was to evaluate the levels of salivary amylase, mucin, total protein levels, and periodontal inflammatory parameters in Type 2 Diabetes mellitus (T2DM), hypertensive (HTN) patients, and healthy controls. The study sample was divided into three groups: healthy, T2DM, and HTN. Salivary samples were collected from the included participants and salivary flow rate (SFR) and pH were measured. The salivary levels of amylase, mucin, and total protein concentration were analyzed using an enzyme-linked immunosorbent assay. The effect of anti-hypertensive and hypoglycemic drugs on the salivary flow rate, salivary pH, mucin, amylase, and total protein concentrations was evaluated. The results were analyzed with Chi-squared and analysis of variance to compare the means and standard deviations of variables among the study groups. SFR was significantly (p < 0.01) lower among diabetics (0.78 ± 0.45 mL/min) in comparison to healthy (1.52 ± 0.62 mL/min) and hypertensive (1.07 ± 0.7 mL/min) subjects. PISA values were significantly higher in T2DM (1029 ± 234.6 mm²) and HTN (799.4 ± 155.05 mm²) subjects when compared to controls, indicating a high inflammatory burden of oral cavity caused by these conditions, and showed statistically significant difference between the groups (p-value < 0.001). Mucin levels were significantly higher (p-value < 0.05) in hypertensive patients (4.6 ± 1.17 units) compared to diabetics (3.59 ± 1.03 unit/mL) and healthy (2.26 ± 1.09 units/mL) subjects. Amylase levels were significantly higher among healthy subjects (1.76 ± 0.75 mg/mL) compared to both hypertensive (1.33 ± 1.0 mg/mL) and diabetic (0.88 ± 0.57 mg/mL) patients. Total protein concentration was significantly raised (p-value < 0.001) in diabetics (37.67 ± 3.12 mg/mL) compared to healthy (29.3 ± 3.22 mg/mL) subjects. Significant differences in BOP, CAL, and PPD was observed (p-value < 0.001). Use of antihypertensive and hypoglycemic drugs showed a significant influence on salivary flow rate, protein, mucin, and amylase levels. T2DM and HTN induced irregularities in salivary flow rate, pH, amylase, and mucin levels and showed an increased incidence of moderate to severe periodontitis in patients. UWS levels of SFR, mucin, amylase, and total protein can be used as diagnostic and therapeutic biomarkers in patients with T2DM and HTN with oral disease. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

14 pages, 716 KiB

Open AccessArticle

TNF-α, IL-1β, MMP-8 Crevicular Profile in Patients with Chronic Kidney Disease and Periodontitis

by Alina Maria Andronovici, Irina-Draga Caruntu, Mihai Onofriescu, Loredana Liliana Hurjui, Simona-Eliza Giusca, Andreea Simona Covic, Radu Braescu and Liliana-Georgeta Foia

Appl. Sci. 2022, 12(2), 736; https://0-doi-org.brum.beds.ac.uk/10.3390/app12020736 - 12 Jan 2022

Cited by 1 | Viewed by 2025

Abstract

Increasing evidence sustains the potential of periodontitis as a risk factor for chronic kidney disease (CKD). Our study aimed to analyze several periodontal specific inflammatory biomarkers within the gingival crevicular fluid (GCF) of patients with CKD, compared to patients with normal kidney function, providing an inflammatory profile of the dialysis patient. The study comprised 79 patients divided into: group 1 (59 subjects with periodontitis and CKD) and group 2 (20 patients with periodontitis, without other systemic conditions). Clinical diagnosis was performed via dental and periodontal examination. GCF samples were collected from each patient, and the levels of TNF-α, IL-1β and MMP-8 were determined by using ELISA assay. In group 1, the average values were: 22.85 ± 5.87 pg/mL for TNF-α, 33.00 ± 39.68 pg/mL for IL-1β and 18.80 ± 27.75 ng/mL for MMP-8. In group 2, the mean values were: 2.10 ± 1.34 pg/mL for TNF-α, 0.71 ± 2.42 pg/mL for IL-1β and 5.35 ± 0.37 ng/mL for MMP-8. Statistical analysis revealed significant differences between groups as referring to all three biomarkers and, TNF-α and MMP-8, in certain stages of periodontitis. The level of TNF-α, IL-1β and MMP-8 points out the increased inflammatory status of the dialysis patient with PD, supporting the mutual connection of the two pathologies. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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13 pages, 281 KiB

Open AccessArticle

The Effect of Inhaled Corticosteroid Therapy on Periodontal Status in Patients with Asthma

by Elżbieta Dembowska, Aleksandra Jaroń, Karolina Skoczek-Szlosser, Ewa Gabrysz-Trybek, Joanna Bladowska and Grzegorz Trybek

Appl. Sci. 2022, 12(1), 240; https://0-doi-org.brum.beds.ac.uk/10.3390/app12010240 - 27 Dec 2021

Cited by 2 | Viewed by 2643

Abstract

Asthma belongs to a broad group of allergic diseases and is the most common chronic disease found in children and adults up to four decades of age. Already published studies suggest that the use of inhaled anti-asthmatic medications affects both general health and oral health. The study included 120 adult patients aged 18 to 71 divided into three groups: I “PERIO-ASTHMA”—with asthma and periodontitis, II “ASTHMA”—with asthma without periodontitis, and control group III “CONTROL”—without asthma and periodontitis. The patients were monitored for oral health status for six months. Oral health was assessed by dental indices: DMF index, PI, BoP, PD, and CAL at interproximal sites. Significantly deeper pockets in the lateral segments of the dentition were observed in all study groups. In addition, the bronchial-only group had significantly deeper pockets in the lateral sextants than the control group at all time points. There was no significant worsening of periodontal status by CAL and PD in asthma patients treated with inhalation, irrespective of baseline periodontal status. Depending on the severity of asthma, an increase in BOP was observed in the central sextant in patients without periodontitis. The history of asthma and the use of ICS has an impact on the periodontal status of patients. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

8 pages, 859 KiB

Open AccessArticle

Chronic Periodontitis and Acute Respiratory Infections: A Nationwide Cohort Study

by Jae-Hong Lee and Seong-Nyum Jeong

Appl. Sci. 2021, 11(20), 9493; https://0-doi-org.brum.beds.ac.uk/10.3390/app11209493 - 13 Oct 2021

Cited by 1 | Viewed by 1319

Abstract

Chronic periodontitis (CP) may increase the risk of exacerbation of and hospitalization for respiratory infections. The aim of the present study was to determine whether CP is associated with acute respiratory infections by analyzing a population-based longitudinal database from the National Health Insurance Service—National Sample Cohort. Univariate and multivariate logistic regression analyses were conducted to assess the association between CP and acute respiratory infections, including acute nasopharyngitis, acute pharyngitis, acute tonsillitis, acute laryngitis and tracheitis, acute bronchitis, and acute bronchiolitis, while adjusting for the confounding effects of sociodemographic variables (sex, age, household income, and smoking status) and comorbidities (diabetes mellitus). Among 545,416 recruited participants, 98,490 (18.1%) had CP. Multivariate analysis, adjusted for sociodemographic variables and comorbidities, showed that except influenza and pneumonia, total acute respiratory infections (odds ratio (OR), 1.33; 95% confidence interval (CI), 1.28–1.38; p < 0.001), acute upper respiratory infections (OR, 1.26; 95% CI, 1.22–1.29; p < 0.001), and acute lower respiratory infections (OR, 1.23; 95% CI, 1.20–1.26; p < 0.001) were significantly associated with CP. The findings of the current cohort study suggest an association between CP and acute respiratory infections. Particularly, CP seems to increase the risk of acute upper and lower respiratory infections. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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Review

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17 pages, 1306 KiB

Open AccessReview

Acute Myocardial Infarction and Periodontitis: Importance of Awareness and Prevention in Latin America

by Javier González-Ramírez, Gustavo Martínez-Coronilla, Laura Dayanara López-Rocha, Ana Gabriela Leija-Montoya, Adrián Hernández-Díazcouder, Zureya Fontes-Garcia, Marina Silva-Mancilla and Fausto Sánchez-Muñoz

Appl. Sci. 2022, 12(6), 3131; https://0-doi-org.brum.beds.ac.uk/10.3390/app12063131 - 18 Mar 2022

Cited by 2 | Viewed by 2752

Abstract

By 2030, non-communicable diseases will have accounted for more than three-quarters of deaths worldwide. Cardiovascular diseases (CVDs) have been the leading cause of death worldwide for several years. Acute myocardial infarction (AMI) is a CVD characterized by necrosis of the heart at the myocardial level due to prolonged ischemia caused by the reduction or sudden absence of coronary blood supply. The prevalence of AMI is higher in men at all ages. The incidence of AMI has decreased in industrialized nations; however, it has been on the rise in Latin America (LATAM) due to lifestyle changes. These changes have caused the combined incidence of CVDs and unresolved health concerns in LATAM, such as infections and malnutrition. It is well known that periodontitis, a highly prevalent chronic infectious inflammatory disease, has been associated with systemic diseases, such as diabetes, kidney diseases, and AMI. This review addresses proposed aspects of the correlation between periodontitis and AMI, explains the importance of preventing periodontitis and CVDs, and analyzes the preventative measures being implemented in LATAM, particularly in Mexico. Full article

(This article belongs to the Special Issue Oral and Systemic Implications of Periodontal Disease – an Integrated Approach)

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