Severe Loss of Clinical Attachment Level: An Independent Association With Low Hip Bone Mineral Density in Postmenopausal Females

Background: Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. The aim of this study is to assess the association between clinical attachment level (CAL) and bone mineral density (BMD) at the lumbar spine and hip, lifestyle, smoking, sociodemographic factors, and dental clinical variables in postmenopausal women. Methods: One hundred forty‐eight women were interviewed using a structured written questionnaire and clinically examined. The periodontal examination, which was performed by calibrated investigators, included CAL, probing depth, gingival recession, bleeding on probing (BOP), visible plaque, supragingival calculus, and mean tooth loss. The sample was stratified into two groups: moderate and severe CAL. The moderate group had all sites with CAL ≤5 mm. The severe group had ≥1 site with CAL >5 mm. BMD, measured using dual‐energy x‐ray absorptiometry, was assessed at the lumbar spine, femoral neck, and total femur (grams per square centimeters). Results: Severe CAL was identified in 86 women (58.1%). The multiple linear regression analysis using CAL (dependent variable), adjusted by menopause, education, and family income, demonstrated an inverse relationship of severe CAL with the BMD of the femoral neck (P = 0.015), as well as a positive association of severe CAL with tooth loss (P = 0.000), BOP (P = 0.004), and heavy smokers (P = 0.001). Conclusions: Our study demonstrated that severe CAL was associated with low BMD of the femoral neck and deleterious clinical dental parameters and smoking. Our findings suggest that, in addition to appropriate oral care, individuals with severe CAL may also require additional attention to their systemic bone health.     

Salivary and Serum Leptin Concentrations in Patients With Chronic Periodontitis

Background: The discovery of leptin has led to the elucidation of a robust physiologic system that not only maintains fat stores but is also an integral part of the host defense mechanism. However, leptin concentrations in the saliva of patients with chronic periodontitis (CP) has not been explored despite the potential role of salivary biomarkers in determining the presence, risk, and progression of periodontal disease. Methods: Eighty‐four participants (44 with generalized severe CP and 40 without periodontitis) were enrolled. For each patient, the values of periodontal parameters were recorded, such as plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and percentage of sites with bleeding on probing (BOP) and clinical AL ≥5 mm. Saliva and serum samples were collected to estimate the leptin concentrations using enzyme‐linked immunosorbent assay kits. Statistical analysis was performed using software. Results: Participants with CP demonstrated significantly higher BOP, PI, GI, and percentage of sites with clinical AL >5 mm (P <0.05). Leptin was detectable in all the clinical samples. Salivary leptin concentrations in patients with CP were significantly lower than in healthy volunteers (6,200.61 ± 2,322.11 versus 8,799.60 ± 901.70 pg/mL), whereas serum leptin concentrations were significantly higher in patients with CP than in healthy volunteers (11,600.00 ± 1,705.01 versus 7,616.62 ± 1,169.83 pg/mL). In addition, the results reflected a significant negative correlation of salivary leptin and a positive correlation of serum leptin with PD (P <0.05). Conclusion: The results suggest that leptin concentrations in saliva and serum are significantly altered in CP and relate closely to current disease activity; however, further studies are needed to confirm the findings.     

Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study

目的 比较牙周内窥镜辅助龈下刮治和根面平整（SRP）与传统SRP对慢性牙周炎患者基础治疗后残留牙周袋的临床疗效。方法 将牙周基础治疗后口内每个区至少有1个位点探诊深度（PD）≥5 mm的患者纳入研究,随机分为内窥镜组和SRP组,分别对残留牙周袋位点进行内窥镜辅助SRP治疗和传统SRP治疗。在治疗前（基线）、治疗后3、6个月检查PD、探诊出血（BOP）和附着丧失（AL）,采用SPSS 20.0统计学软件对数据进行统计分析。结果 与基线相比,治疗后3、6个月内窥镜组及SRP组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）。治疗后6个月与3个月相比,内窥镜组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）,而SRP组差异无统计学意义（P>0.05）。与SRP组相比,内窥镜组治疗后3及6个月PD≥5 mm位点百分比、PD均降低,治疗后6个月AL、BOP阳性位点百分比降低（P<0.05）。结论 牙周内窥镜辅助SRP对于基础治疗后的残留牙周袋（PD≥5 mm）的临床疗效优于传统SRP,尤其具有更好的远期预后。     

侵袭性牙周炎龈沟液中白介素-8 的检测

目的：检测侵袭性牙周炎（AgP）龈沟液中白细胞介素（IL-8）的总量和浓度并探讨其与牙周临床指标的关系。方法：采用常规滤纸条法收集侵袭性牙周炎实验组患牙（T1）和健康牙（T2）各位点及正常对照组（C）各位点的龈沟液（GCF）样本,用ELISA法检测各样本中IL-8的总量和浓度。结果：3组受检牙龈沟液中IL-8的总量和浓度不同。侵袭性牙周炎患牙组GCF中IL-8总量高于健康牙位组（P〈0．05）及正常对照组;而3组中IL-8浓度差异也有显著性,侵袭性牙周炎患牙组GCF中IL-8的浓度高于健康牙位组（P〈0．05）和正常对照组;虽然GCF中IL-8浓度与牙周探诊深度（PD）、牙龈出血指数（BOP）、附着丧失（AL）无相关关系;但IL-8总量与以上牙周临床指标相关。结论：在侵袭性牙周炎患者龈沟液中IL-8是参与牙周炎症反应的重要调节因子。     

内窥镜辅助下微创牙周基础治疗的临床疗效评价

目的 探讨牙周内窥镜辅助下超声龈下刮治及根面平整(subgingival scaling and root planning,SRP)对重度牙周炎治疗的临床疗效.方法 选取2017年6月至2019年1月于南京大学医学院附属口腔医院就诊的Ⅲ-Ⅳ期牙周炎患者19例,随机分为内窥镜组及对照组.内窥镜组在龈上洁治术1周后,牙周...     

Periodontal disease and cancer patients undergoing chemotherapy

Objective: The aim of this study was to evaluate periodontal status after periodontal treatment in patients with different malignant solid tumours submitted to chemotherapy. Methods: Fifty-four patients with newly diagnosed early-stage solid tumour malignancy treated by surgery and eligible for adjuvant chemotherapy were enrolled in this study. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated before chemotherapy (T0), 21 days after chemotherapy (T1) and 210 days after chemotherapy (T2). Patients were grouped into healthy or periodontally diseased subjects. All patients received oral hygiene instructions, and the diseased patients received periodontal treatment at baseline. Comparisons between the groups were performed using the McNemar test (P > 0.05) and the Wilcoxon test with Bonferroni correction (P < 0.02) using spss software. Results: Of 54 patients enrolled in the study, two did not present to the third assessment (T2). The prevalence of periodontitis was 35.2% at baseline and no significant difference was found in the follow-up assessments. There was a statistically significant reduction in probing depth (PD), plaque index (PI) and bleeding on probing (BOP) between baseline and follow-up assessments. The attachment level (AL) did not vary significantly between the different follow-up periods (P ≥ 0.06). Conclusions: Periodontal treatment was effective in reducing PI, BOP and PD and in maintaining AL in periodontitis cancer patients undergoing chemotherapy.Key words: Chemotherapy, cancer patients, periodontitis, periodontal treatment     

难治性牙周炎患者血清中瘦素(LEP)水平及其与牙周临床指数关系分析

目的: 探讨难治性牙周炎患者的血清瘦素水平以及其与牙周临床指数之间的关系。方法: 本文随机选取健康组、慢性牙周炎组以及难治性牙周炎组患者各40例,记录所有接受检测者的牙周炎临床指标牙周袋探诊深度(PD)、菌斑指数(PLI)、牙周附着水平(AL)以及探诊出血(BOP)的相关变化情况;然后采用高效液相关层析法检测所有接受检查患者的糖化血红蛋白(HBALC)以及空腹血糖(FPG)指标变化情况,并且同时使用酶联免疫吸附法(ELISA)检测患者血清中瘦素(LEP)表达水平变化情况。结果: 难治性牙周炎组中患者的血清中HBALC(10.902±2.129)%、FPG(9.783±2.109) mmoL/L、LEP(1.347±0.658) μg/L的浓度明显高于慢性牙周炎组和健康组HBALC(5.601±0.375)%、(5.142±0.319)%、FPG(5.689±0.712)、(5.432±0.467) mmoL/L、LEP(0.912±0.256)、(0.462±0.119) ng/mL(P<0.05);所有受试者的血清瘦素指标与PD、AL、PLI以及BOP指标值都呈正相关,R值依次分别为0.497、0.534、0.509和0.571(P<0.05)。结论: 难治性牙周炎患者血清中瘦素水平会逐渐升高,血清瘦素水平与PD、AL、PLI以及BOP指标呈正相关的关系。     

绝经期女性骨质疏松与牙周重度附着丧失的相关性研究

目的研究绝经期女性骨质疏松与牙周重度附着丧失的相关性。方法纳入2017年3月至2018年8月在北京大学国际医院就诊,以及在此期间通过网络招募的50至65岁绝经期女性195例,进行牙周检查、填写调查问卷并接受骨密度检查。牙周检查指标包括:临床附着丧失(clinical attachment loss,CAL)、简化口腔卫生指数(oral hygiene index simplified,OHI-S)、探诊出血阳性位点(bleeding on probing,BOP)百分比[BOP(+)%]。受试者口内牙齿存在CAL≥5 mm的位点不少于3处且位于不同象限时,计为重度CAL。受试者填写调查问卷,内容包括一般身体状况、生活习惯、社会经济背景、婚姻情况、口腔就诊情况和口腔卫生维护情况等。使用双能X线骨密度测量仪检查受试者左侧髋部以及腰椎的骨密度。按照世界卫生组织的标准,当骨密度与年轻白人健康女性骨密度峰值标准差的倍数(T值)≤-2.5时,诊断为骨质疏松。采用卡方检验,对年龄、绝经时间、体重指数、锻炼习惯、家庭收入、婚姻状况、教育程度、口腔就诊习惯、刷牙习惯、牙齿邻面清洁工具的使用、OHI-S、BOP(+)%、髋部骨质疏松、腰椎骨质疏松等14个因素进行初筛,选取P<0.05的因素进行多因素Logistic分析。采用Logistic回归分析评价骨质疏松与牙周重度CAL发生的相关性。结果195例绝经期女性年龄(57.8±4.3)岁,其中有重度牙周CAL者111例(56.9%),骨质疏松者89例(45.6%)。对年龄、家庭收入、口腔就诊习惯、OHI-S、BOP(+)%和髋部骨质疏松6个风险因素的回归分析结果显示,差异有统计学意义的3个因素OR值分别为:髋部骨质疏松(OR=2.466)、OHI-S(OR=2.262)、BOP(+)%(OR=7.274),这3个因素是绝经期女性发生重度CAL的危险因素。髋部骨质疏松的绝经期女性发生牙周重度CAL的风险是无骨质疏松者的2.466倍(P=0.017)。结论髋部骨质疏松的绝经期女性发生牙周重度附着丧失的风险增加。     

Salivary Biomarkers in a Biofilm Overgrowth Model

Background: The purpose of this study is to determine whether baseline salivary inflammatory biomarkers could discriminate between different clinical levels of disease and/or detect clinical changes over a 3‐week stent‐induced biofilm overgrowth (SIBO) period. Methods: A total of 168 participants were enrolled in a 21‐day experimental gingivitis investigation and grouped according to clinical measures of periodontal status of health and diseased individuals representing each of five biofilm gingival interface (BGI) periodontal groups: 1) health, all probing depth (PD) <3 mm and bleeding on probing (BOP) <10%; 2) gingivitis, all PD <3 mm and BOP ≥10%; 3) periodontitis (P)1, ≥1 site with PD >3 mm and BOP ≤10%; 4) P2, ≥1 site with PD >3 mm and BOP >10% but ≤50%; and 5) P3, ≥1 site with PD >3 mm and BOP >50%. Stents were used to prevent plaque removal during brushing over one maxillary and one mandibular posterior dental sextant for 21 days. Clinical periodontal parameters and unstimulated saliva were collected at screening, baseline, and each week during SIBO. Saliva samples were assessed for levels of 13 different biomarkers by multiplex immunoassay. Results: Higher salivary levels of interleukin (IL)‐1β, matrix metalloproteinase (MMP)‐3, MMP‐8, MMP‐9, and neutrophil gelatinase‐associated lipocalin (NGAL) were found in diseased groups compared with the healthy group at baseline. Conversely, higher IL‐1 receptor antagonist (ra) levels were found in healthy patients at baseline. In addition, during SIBO, MMP‐1, tissue inhibitor of metalloproteinase (TIMP)‐1, and TIMP‐2 levels increased across all participant groups. A stepwise linear regression model using all salivary biomarkers demonstrated that, at baseline, increased IL‐1ra (P = 0.004) and IL‐6 (P = 0.009) were significantly associated with change in PDs during SIBO. Conclusions: In summary, this investigation supports salivary levels of IL‐1ra and IL‐6 as potential indicators for PD changes during induced gingival inflammation. In addition, participants from the BGI‐P3 group (severe periodontitis) demonstrated elevated baseline levels of IL‐1β, MMP‐3, MMP‐8, MMP‐9, and NGAL compared with the other study groups, strengthening the relevance of participants’ biologic phenotype on expression of salivary biomarkers.     

Effect of Fluoxetine on Periodontal Status in Patients With Depression: A Cross‐Sectional Observational Study

Background: Fluoxetine, a selective serotonin reuptake inhibitor, has been reported to reduce periodontal disease severity in a rat ligature‐induced periodontitis model. The objective of the present study is to investigate the influence of fluoxetine intake on periodontal parameters in patients with periodontitis with clinical depression. Methods: A sample of 236 patients with chronic periodontitis and clinical depression were assessed for clinical parameters of periodontal disease. Of these, 115 patients were taking fluoxetine (20 mg/day) for ≥2 months, and 121 patients were not. Participants taking fluoxetine were further analyzed for correlation between duration of drug intake and periodontal parameters. Results: All periodontal parameters, except plaque index, were significantly lower in participants taking fluoxetine (P <0.01). Partial correlation analysis, adjusted for confounders, revealed a significant and negative correlation between duration of fluoxetine intake and attachment loss (AL) (R² = ?0.321, P <0.05). Logistic regression analysis revealed that fluoxetine intake was associated with a lower risk of having AL ≥3 (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.96) and lower odds of increased bleeding on probing (BOP) percentage values (OR = 0.62, 95% CI = 0.34 to 0.97). Conclusion: In this observational study, use of fluoxetine was associated with lower BOP percentages and reduced AL.     

宁夏地区2 628名成年人牙周健康状况的研究

目的了解宁夏地区回族和汉族成年人的牙周健康状况,为该地区开展口腔健康预防保健工作提供理论依据。方法采用世界卫生组织口腔健康调查方法及第三次全国口腔健康流行病学调查方案,对宁夏地区2 628名成年人的牙周健康状况进行检查,检查项目包括牙龈出血（即探诊后出血,BOP）、牙石、探诊深度（PD）及附着丧失（AL）情况。应用SPSS 15.0软件对数据进行统计分析。结果1）BOP位点阳性率、牙石检出率、PD在36～45岁、46～59岁组达到高峰但在大于等于60岁组反而降低;牙周炎患病率、AL≥4 mm位点百分比随着年龄的增长而逐渐增加。2）除AL≥4 mm位点百分比外,其他各项指标在性别之间均无统计学差异。3）山区人群的BOP位点阳性率、牙石检出率、PD、牙周炎患病率及AL≥4 mm位点百分比均高于川区。4）回族人群的BOP位点阳性率、牙石检出率、PD、牙周炎患病率及AL≥4 mm位点百分比均低于汉族。结论宁夏地区成年人牙周健康状况受年龄、性别、民族和地区的影响。     

应激性唾液标志物与牙周炎临床参数的相关性分析

目的：探讨应激性唾液标志物嗜铬粒蛋白A（chromogranin A,CgA）、皮质醇、α淀粉酶、β内啡肽与牙周炎临床参数龈沟出血指数（sulcus bleeding index,SBI）、牙周探诊深度（periodontal probing depth,PD）、附着丧失（attachment loss,AL）的相关性。方法：选择2017年12月-2018年12月江西省中西医结合医院口腔科收治的慢性牙周炎患者105例为牙周炎组,同期在院健康体检者105例为对照组,检测2组唾液中CgA、皮质醇、α淀粉酶、β内啡肽水平及SBI、PD、AL。采用SPSS 22.0软件包分析应激性唾液标志物与牙周炎临床参数的相关性,利用多因素Logistic回归分析明确牙周炎有关的危险因素。结果：牙周炎组唾液中CgA、皮质醇、α淀粉酶、β内啡肽水平显著高于对照组(P<0.05),牙周炎组SBI、PD、AL显著高于对照组(P<0.05),唾液中CgA、皮质醇、α淀粉酶、β内啡肽水平与SBI均呈正相关 (P<0.05）,唾液中CgA、皮质醇、α淀粉酶、β内啡肽水平与PD均呈正相关 (P<0.05）,唾液中CgA、皮质醇、α淀粉酶、β内啡肽水平与AL均呈正相关 (P<0.05）,CgA、皮质醇、α淀粉酶、β内啡肽是牙周炎的独立危险因素(P<0.05)。结论：应激性唾液标志物CgA、皮质醇、α淀粉酶、β内啡肽与牙周炎临床参数显著相关,提示应激性唾液标志物能在一定程度上反映牙周炎的病情进展,为牙周炎诊断和疗效监测提供有益参考。     

Routine Prophylaxes Every 3 Months Improves Chronic Periodontitis Status in Type 2 Diabetes

Background: Periodontitis and type 2 diabetes mellitus (T2DM) are major health problems, especially in low‐income populations with little access to dental care. Low‐cost models for treatment of periodontal disease have not been tested in controlled studies in low‐income populations. Dental prophylaxis, which includes removal of supragingival calculus and plaque, has been shown to arrest the progression of periodontitis. A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM. Methods: Twenty‐six patients with T2DM and chronic periodontitis (CP) and 26 without T2DM with CP were selected. Periodontal probing depth (PD), gingival bleeding on probing (BOP), clinical attachment level (CAL), and surfaces with plaque were recorded at baseline and 3, 6, and 9 months after initial treatment. All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months. Glycated hemoglobin (HbA1c) levels were measured at baseline and every 3 months in patients with T2DM. Results: A significant improvement of PD, BOP, and sites with plaque was observed 3 months after treatment in patients with T2DM (P = 0.001). In controls, mean PD significantly improved after 6 months compared with baseline (P = 0.001). No significant improvement of CAL occurred in either group. No significant differences in periodontal parameters between the groups were detected, and no participant showed progression of CP during the 9‐month study period. Dental prophylaxis did not influence HbA1c levels, and no association among HbA1c concentration, pretreatment metabolic status, and severity of CP was found. Conclusion: Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well‐controlled patients with T2DM.     

Salivary interleukin-1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and healthy controls: a case-control study

Background: The role of interleukin (IL)‐1β in periodontal disease pathogenesis is well researched. This study aimed to assess and compare the salivary IL‐1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and periodontally healthy controls. Further, relationships between IL‐1β levels and various clinical parameters were explored. Methods: Twenty‐eight patients with moderate‐to‐severe generalized chronic periodontitis and 24 age‐, race‐, and ethnicity‐matched controls participated in this study. Saliva samples were obtained from all patients. The clinical parameters recorded were clinical attachment loss (AL), probing depth, bleeding on probing, periodontal index, and gingival index. Clinical evaluation and sample collection were repeated 1 month after periodontal phase I therapy in patients with periodontitis. IL‐1β levels were assessed using enzyme‐linked immunosorbent assay. Results: Mean IL‐1β levels in patients with periodontitis at baseline (1,312.75 pg/mL) were significantly higher (P <0.0001; eight‐fold) than in controls (161.51 pg/mL). Although treatment in patients with periodontitis resulted in significant reduction in IL‐1β levels (mean: 674.34 pg/mL; P = 0.001), they remained significantly higher (P <0.0001; four‐fold) than control levels. There were significant correlations between IL‐1β levels and all clinical parameters (P <0.01) except percentage sites with clinical AL >2 mm (P >0.05). Conclusions: The data indicate that IL‐1β levels are raised in the saliva of patients with chronic periodontitis, which are reduced after phase I therapy, suggesting a close association between salivary IL‐1β and periodontitis. Additional longitudinal studies are needed to validate salivary IL‐1β as a marker for periodontal disease.     

烤瓷冠修复对非依赖型糖尿病患者牙周状况的影响

目的：研究非依赖型糖尿病患者经牙周基础治疗后,进行烤瓷冠修复对牙周情况的影响。方法：选择非依赖型糖尿病与非糖尿病患者各一组,经牙周基础治疗,对比两组在烤瓷冠修复前、修复后学年及1年的口腔菌斑指数（PLI）、牙龈指数（GI）、探诊出血指数（BI）、探诊深度（PD）和临床附着丧失（AL）5项指标。结果：统计学分析,两组病人牙周情况在修复前、修复后半年及1年均无显著性意义。结论：经良好的牙周基础治疗与口腔健康维护,烤瓷冠修复对糖尿病患者牙周情况影响甚微。     

Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study

BACKGROUND: Bone loss in periodontitis results from inflammatory reactions that stimulate osteoclastic bone resorption. Bisphosphonates inhibit bone resorption and increase bone mass. This study evaluated the effect of bisphosphonate therapy as an adjunct to non-surgical periodontal treatment in patients with moderate to severe chronic periodontitis. METHODS: Patients were randomized (2:1) to one of two bisphosphonate therapies or placebo for 1 year. All patients received non-surgical periodontal treatment (scaling, root planing) and periodontal maintenance therapy every 3 months. Clinical assessments at baseline and 6 and 12 months included clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP). Periodontal bone mass was assessed by dental radiographs at baseline and 12 months using fractal analysis and digital subtraction radiography (DSR). RESULTS: Seventy patients were randomized, 43 to the bisphosphonate group and 27 to the placebo group. Bisphosphonate therapy significantly improved CAL, PD, and BOP relative to the placebo group during the 6- to 12-month period (CAL, P = 0.0002; PD, P = 0.0156; BOP, P = 0.0079). There was no difference in the change in periodontal bone mass between the bisphosphonate and placebo groups as measured by fractal analysis and DSR. CONCLUSION: These data suggest that bisphosphonate treatment improves the clinical outcome of non-surgical periodontal therapy and may be an appropriate adjunctive treatment to preserve periodontal bone mass.     

Periodontitis and Endothelial Dysfunction: Periodontal Clinical Parameters and Levels of Salivary Markers Interleukin‐1β, Tumor Necrosis Factor‐α, Matrix Metalloproteinase‐2, Tissue Inhibitor of Metalloproteinases‐2 Complex,and Nitric Oxide

Background: Periodontitis has been associated with a greater risk for atherosclerotic cardiovascular disease (ACD). Endothelial dysfunction (ED) is a parameter of early ACD, and its association with periodontitis has rarely been investigated to date. The objective of this study is to evaluate the association between periodontitis and ED by means of periodontal clinical parameters and salivary markers interleukin (IL)‐1β, tumor necrosis factor (TNF)‐α, nitric oxide (NO), and matrix metalloproteinase (MMP)‐2 and tissue inhibitor of metalloproteinases (TIMP)‐2 complex. Methods: Forty‐seven individuals were divided into two groups: 1) 24 individuals with chronic periodontitis (CP); and 2) 23 individuals without CP. Periodontal examinations of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were performed. ED was evaluated by means of flow‐mediated dilatation (FMD) of the brachial artery. Salivary concentrations of IL‐1β, TNF‐α, and MMP‐2/TIMP‐2 complex were assessed using enzyme‐linked immunosorbent assay. NO determination was based on the reaction of Griess. Results: Individuals with CP presented higher occurrence of ED than individuals without CP (P = 0.03 after reactive hyperemia; P = 0.05 after sublingual nitrate). A significant association among the production of MMP‐2/TIMP‐2 complex with the presence of CP (P = 0.008) and periodontal parameters PD, CAL, and BOP was identified. Concentration of salivary markers IL‐1β, TNF‐α, and NO was similar in individuals with and without CP. A significant positive correlation between NO and ED was also identified. Conclusions: Periodontitis was positively associated with ED, expressed by a smaller percentage of FMD of the brachial artery and higher salivary levels of MMP‐2/TIMP‐2 complex. Additionally, salivary levels of NO were significantly associated with better functioning of the vascular endothelium.     

Periodontal Parameters and Whole Salivary Cytokine Profiles Among Habitual Gutka Chewers and Non‐Chewers

Background: Whole salivary interleukin (IL)‐1β, IL‐6, matrix metalloproteinase (MMP)‐8, and MMP‐9 levels among habitual gutka chewers and non‐chewers (controls) have not been investigated. The aim of the present study is to assess clinical periodontal parameters and whole salivary IL‐1β, IL‐6, MMP‐8, and MMP‐9 levels among habitual gutka chewers and controls. Methods: Forty‐five gutka chewers and 45 controls were included. Demographic information regarding age, sex, duration and daily frequency of gutka chewing, duration of gutka placement in the mouth, and daily toothbrushing habits were collected using a questionnaire. Periodontal parameters, including plaque index (PI), bleeding on probing (BOP), probing depth (PD) >3 mm, clinical attachment loss (AL), marginal bone loss (MBL), and number of missing teeth, were recorded. Unstimulated whole saliva samples were collected, and unstimulated whole salivary flow rate (UWSFR) was determined. Levels of IL‐6, IL‐1β, MMP‐8, and MMP‐9 were measured in UWS using an enzyme‐linked immunosorbent assay. Results: PI (P <0.01), BOP (P <0.01), PD >3 mm (P <0.01), and clinical AL (P <0.01) were significantly higher in gutka chewers than controls, as were whole salivary IL‐6 (P <0.01), IL‐1β (P <0.01), MMP‐8 (P <0.01), and MMP‐9 (P <0.01) concentrations. There was no significant difference in UWSFR, number of missing teeth, or MBL among habitual gutka chewers and controls. Conclusion: Periodontal inflammatory conditions were worse, and whole salivary IL‐6, IL‐1β, MMP‐8, and MMP‐9 levels were higher among gutka chewers than non‐chewers.     

Evidence Linking the Role of Placental Expressions of Peroxisome Proliferator‐Activated Receptor‐γ and Nuclear Factor‐Kappa B in the Pathogenesis of Preeclampsia Associated With Periodontitis

Background: Peroxisome proliferator‐activated receptor (PPAR)‐γ activation leads to suppression of production of a broad range of proinflammatory molecules. It plays a role in differentiation of trophoblasts and helps in normal placentation and formation of vascular exchange interface. Activation of nuclear factor‐kappa (NF‐κ) B triggers proinflammatory molecules inducing abnormal placentation and premature labor. This study aims to explore expression of PPAR‐γ and NF‐κB in placentas of women with periodontitis‐associated preeclampsia compared with that in normotensive pregnant women. Methods: Fifty pregnant women were included. Twenty‐five were controls (normotensive pregnant women) and 25 were pregnant women with preeclampsia, including those with gestational hypertension. Demographic data, pregnancy characteristics, and periodontal parameters were recorded, including: 1) plaque index; 2) gingival index; 3) bleeding on probing (BOP); 4) probing depth; and 5) attachment loss (AL). Placental tissue samples were collected from both groups and analyzed to quantify expression of PPAR‐γ and NF‐κB using real‐time polymerase chain reaction. Results: BOP and AL were significantly higher in pregnant women with preeclampsia compared with normotensive pregnant women (P <0.05). Expression of PPAR‐γ was downregulated in patients with preeclampsia compared with that of healthy normotensive patients, which was statistically significant (P <0.05), whereas NF‐κB was significantly activated (P <0.05) in pregnant women with preeclampsia compared with normotensive pregnant women. Conclusions: Higher periodontal disease prevalence is found among pregnant women with preeclampsia, with increased percentage of sites with BOP and greater AL. This study provides novel information on host response to systemic inflammation induced by periodontal pathogens through mechanisms involving downregulation of PPAR‐γ and increased activation of NF‐κB.     

Comparison of Clinical and Radiographic Periodontal Status Between Habitual Water‐Pipe Smokers and Cigarette Smokers

Background: There is a dearth of studies that have compared clinical and radiologic markers of periodontal inflammation between water‐pipe smokers (WPs) and cigarette smokers (CSs). The aim of the present study is to compare the clinical and radiographic periodontal status between habitual WPs and CSs. Methods: In total, 200 males (50 WPs, 50 CSs, and 100 controls) with comparable mean age and education were included. Demographic information was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) and numbers of missing teeth (MT) were recorded. Results: The duration of each smoking session for WPs and CSs was 50.2 ± 6.7 and 15.3 ± 0.4 minutes, respectively. Number of MT [P <0.0001], PI [P <0.0001], AL [P <0.0001], PD ≥4 mm [P <0.0001], and MBL [P <0.0001]) was significantly higher among WPs and CSs than controls. BOP was significantly higher among controls than WPs (P <0.0001) and CSs (P <0.0001). There was no statistically significant difference in the aforementioned parameters between WPs and CSs. Conclusions: Males in a Saudi Arabian community who were CSs or WPs had more MT and poorer periodontal condition than never smokers. The periodontal condition of WPs was equally as poor as CSs. Additional clinical observational studies with emphasis on sex and sociodemographic characteristics are needed.