Periodontitis is associated with altered brain structure and function in normal cognition middle‐aged and elderly individuals
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Abstract Background Numerous studies have proposed that periodontitis is a potential risk factor for Alzheimer's disease. However, the association between periodontitis and brain normal cognition in aged and elderly individuals (NCs) is unclear. Such a link could provide clues to Alzheimer's disease development and strategies for early prevention. Objective To explore the associations between periodontal condition and metrics of both brain structure and function among NCs with the help of multimodal magnetic resonance imaging (MRI). Methods High‐resolution T1‐weighted structural data, resting‐state functional‐MRI data, and measures of periodontal condition were collected from 40 NCs. Cortical volume, thickness, and area as well as regional homogeneity were calculated with the aid of DPABISurf software. Correlation analyses were then conducted between each imaging metric and periodontal index. Results Consistent negative correlations were observed between severity of periodontitis (mild, moderate, severe) and cortical volume, area, and thickness, not only in brain regions that took charge of primary function but also in brain regions associated with advanced cognition behavior. Among participants with mild attachment loss (AL) and a shallow periodontal pocket depth (PPD), periodontal index was positively correlated with most measures of brain structure and function, while among participants with severe AL and deep PPD, periodontal index was negatively correlated with measures of brain structure and function (all p < .005 for each hemisphere). Conclusions Our results demonstrate that periodontitis is associated with widespread changes in brain structure and function among middle‐aged and elderly adults without signs of cognitive decline, which might be a potential risk factor for brain damage.Keywords:
Clinical attachment loss
Background: Periodontitis is associated with glycemic control in patients with diabetes. The purpose of this study was to determine if glycosylated hemoglobin is elevated in patients with periodontitis who are non-diabetic adults.
Materials and Methods: A total of 36 patients were selected and were divided into test and control groups. Test group included 18 adults without diabetes, but with periodontitis (having at least five teeth with probing depth (PD) ≥5 mm, bleeding on probing (BOP), and clinical attachment loss (>1 mm) on >5 teeth or radiographic bone loss), and the control group included 18 healthy adults (PDs ≤4 mm and BOP ≤15% and no clinical attachment loss). Glycosylated hemoglobin (HbA1c) was assessed in laboratory for these patients. Groups were compared using the t test,kruskal-wallis test, pearsson correlation.
Results: Both the groups showed similar HbA1c levels, but there was a marginal increase in levels in the test group (cases), which was not statistically significant (cases- 6.06%, controls-5.8%; P=0.101).There was no significant difference found in the mean HbA1c levels among males and females and among various age groups. Mean BMI among the cases and controls was found to be similar. When inter and intra group comparisons were done according to BMI categories among the cases and controls, we found similar mean HbA1c values.
Conclusion: Indians are at a high risk of developing periodontitis and diabetes. These data suggest a possible link between periodontitis and glycemic control in non-diabetic individuals. Periodontal disease may be a potential contributor to development of type 2 diabetes.
Materials and Methods: A total of 36 patients were selected and were divided into test and control groups. Test group included 18 adults without diabetes, but with periodontitis (having at least five teeth with probing depth (PD) ≥5 mm, bleeding on probing (BOP), and clinical attachment loss (>1 mm) on >5 teeth or radiographic bone loss), and the control group included 18 healthy adults (PDs ≤4 mm and BOP ≤15% and no clinical attachment loss). Glycosylated hemoglobin (HbA1c) was assessed in laboratory for these patients. Groups were compared using the t test,kruskal-wallis test, pearsson correlation.
Results: Both the groups showed similar HbA1c levels, but there was a marginal increase in levels in the test group (cases), which was not statistically significant (cases- 6.06%, controls-5.8%; P=0.101).There was no significant difference found in the mean HbA1c levels among males and females and among various age groups. Mean BMI among the cases and controls was found to be similar. When inter and intra group comparisons were done according to BMI categories among the cases and controls, we found similar mean HbA1c values.
Conclusion: Indians are at a high risk of developing periodontitis and diabetes. These data suggest a possible link between periodontitis and glycemic control in non-diabetic individuals. Periodontal disease may be a potential contributor to development of type 2 diabetes.
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Clinical attachment loss
Periodontist
Periodontal examination
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To determine the association between periodontitis stage and grade with oral-health-related quality of life (OHRQoL).This cohort was derived from the Porto Alegre study. The original sample was representative of more than 3 million inhabitants of a Brazilian urban area. Full-mouth periodontal examinations at six sites per tooth were performed at baseline and 5 years later. Periodontitis grade was determined by direct evidence of progression of attachment loss over the follow-up. Stage of periodontitis and OHRQoL, determined by the oral health impact profile version 14 (OHIP-14), were recorded at the follow-up examination. Mean ratios (MRs) and 95% confidence intervals (95% CIs) were estimated adjusting for age, sex, smoking, systemic diseases, tooth loss, and baseline periodontitis diagnosis.Five-hundred and ninety-nine individuals were analysed. Individuals with periodontitis grade C + stage II (MR = 1.49; 95% CI = 1.08-2.04) and stages III/IV (MR = 1.83; 95% CI = 1.25-2.66) had significantly higher OHIP scores than those without periodontitis or with periodontitis stage I/grade B. Individuals with periodontitis stages II and III/IV + grade B did not differ from those without periodontitis or with periodontitis stage I/grade B.Severity and progression rate of periodontitis are associated with poor OHRQoL.
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Background: Periodontitis is a multifactorial disease characterized by bacterial-dysbiosis-associated, host-mediated inflammation, which results in the loss of the tooth-supporting tissues. Vitamin D3 plays an important role in the tissue homeostasis and its deficiency might have a negative effect on the periodontitis progression and treatment outcomes. Objectives: The aim of the study was to evaluate the vitamin D3 serum levels among patients with periodontitis and healthy subjects. Materials and Methods: A total of 100 generally healthy adult participants (50 diagnosed with periodontitis, 50 with healthy periodontium) were enrolled in the study. The periodontal clinical parameters were measured, radiographs were performed and the 25-hydroxy vitamin D (25(OH)D) test was used to assess vitamin D3 levels. Results: Vitamin D3 levels were found to be statistically significantly lower among periodontitis patients (31.34; SD = 5.62) compared with healthy controls (39.64; SD = 8.77). Vitamin D3 deficiency was corresponding to the stage and grade of the disease as well as the clinical attachment and bone loss. Conclusion: Adequate monitoring of the vitamin D3 serum levels and supplementation could be of benefit in periodontitis treatment.
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This study estimated the prevalence, severity, and extent of periodontitis in the adult U.S. population, with data from the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. Estimates were derived from a sample of 3,742 adults aged 30 years and older, of the civilian non-institutionalized population, having 1 or more natural teeth. Attachment loss (AL) and probing depth (PD) were measured at 6 sites per tooth on all teeth (except the third molars). Over 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as 8.7%, 30.0%, and 8.5% with mild, moderate, and severe periodontitis, respectively. For adults aged 65 years and older, 64% had either moderate or severe periodontitis. Eighty-six and 40.9% had 1 or more teeth with AL ≥ 3 mm and PD ≥ 4 mm, respectively. With respect to extent of disease, 56% and 18% of the adult population had 5% or more periodontal sites with ≥ 3 mm AL and ≥ 4 mm PD, respectively. Periodontitis was highest in men, Mexican Americans, adults with less than a high school education, adults below 100% Federal Poverty Levels (FPL), and current smokers. This survey has provided direct evidence for a high burden of periodontitis in the adult U.S. population.
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Objective To propose a novel, three-level (severe, moderate, mild) case definition using probing depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) for epidemiologic studies on periodontitis. Methods Case definitions (DEF) 1-30 with PD, CAL and BOP were made. Based on data from epidemiologic research in Chengde (Hebei Province, China) in 1992, prevalence of periodontitis by DEF1-30 was calculated and compared with a reference (definitions by Centers for Disease Control and Prevention/American Academy of Periodontology in 2012). Sensitivity, specificity, Youden Index, Cohen's kappa coefficient (CKC) and the area under the receiver operator characteristic curve (AUC) were calculated for the definitions selected. Results DEF1 and DEF18 for periodontitis, DEF2, DEF3, DEF19 for moderate and severe periodontitis, and DEF5, DEF13, DEF14, DEF21 and DEF25 for severe periodontitis, which were similar for estimation of periodontitis prevalence compared with the reference, were selected. DEF18 for periodontitis, DEF19 for moderate and severe periodontitis, and DEF5 for severe periodontitis were selected because they showed higher values for the Youden Index, CKC and AUC, and formed a three-level definition. Conclusion A novel three-level case classification of periodontitis using three parameters of PD, CAL and BOP was proposed. The estimated periodontitis prevalence according to the novel proposed definition is close to the prevalence according to the CDC/AAP definition.
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Aggregatibacter actinomycetemcomitans
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Aggressive periodontitis
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Periodontal pathogen
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Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT.A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full-mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5-year interval.Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3).PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.
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Background: Periodontitis is a destructive chronic inflammatory disease causing irreversible loss of tooth-supporting tissues. Prostaglandin-endoperoxide synthase 2 (PTGS2) is an important inflammatory mediator that is overexpressed in periodontitis as well as other diseases. Periodontitis may contribute to an elevated plasma PTGS2 level.
Aims: To determine the level of PTGS2 in the plasma of chronic periodontitis patients in comparison to periodontally healthy controls. Also to investigate whether there is any correlation between PTGS2 plasma levels and clinical periodontal parameters.
Methods: Blood samples were collected from 60 chronic periodontitis (CP) cases (moderate to severe periodontitis) and 60 periodontally healthy controls. A questionnaire was used to collect information from each participant. Clinical Periodontal parameters were recorded. Blood samples were collected in EDTA containing tubes and centrifuged to obtain plasma samples which then were frozen at -70c. ELISA was performed to determine the PTGS2 level in the plasma samples.
Results: The mean clinical attachment loss (CAL) was 4.35mm in the CP cases. ELISA analysis showed a statistically significant elevation of PTGS2 concentration in the plasma of periodontitis cases compared to controls (p=0.001). However, the Person correlation coefficient revealed a negative correlation between PTGS2 plasma concentration and the clinical periodontal parameters in both cases and control groups.
Conclusion: Periodontitis may contribute to elevated plasma levels of PTGS-2 whose elevation is related to other diseases such as osteoarthritis, atherosclerosis, proliferative diseases, and preterm delivery. However, longitudinal studies and intervention trials are needed before any causative role can be assigned.
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