This randomized double-blind placebo-controlled clinical trial aimed to evaluate the adjunctive use of Streptococcus salivarius M18 probiotic lozenges in the treatment of periodontitis. Following non-surgical periodontal therapy (NSPT), 55 participants with stage III or IV periodontitis were administered either S. salivarius M18 lozenges (test group) or a placebo for 12 weeks. Clinical assessments, including pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP), and plaque index (PI), were performed at baseline (before treatment), immediately after treatment, and during post-treatment follow-ups at 12 and 24 weeks. Microbial analysis was conducted on the subgingival plaque samples collected. The test group demonstrated significantly improved PPD, BoP, and PI compared to the placebo group at post-treatment follow-ups, although no significant difference was observed in CAL. Microbiological analysis revealed a reduction in periodontal pathogens or a shift in the subgingival microbiota toward a decreased pathogenic profile in the test group. This trial is the first to demonstrate the safety and efficacy of S. salivarius M18 as an adjunctive treatment for periodontitis, supporting its potential for broader clinical use in managing periodontal health.

The online version contains supplementary material available at 10.1007/s13205-025-04363-w.

Periodontitis is a chronic inflammatory disease of the oral cavity, which is characterized by the excessive immune response to microbial stimuli and poses significant systemic health risks. The pro-inflammatory cytokine Interleukin-17 (IL-17) plays a pivotal role in the progression of periodontitis, by promoting immune cell recruitment and activating tissue-destructive molecules. This study explores the potential of fenugreek-derived phytochemicals-specifically isovitexin, rhaponticin, galactomannan, and quercetin-as inhibitors of IL-17 and its receptor, IL-17R, to mitigate inflammatory pathways in periodontitis. Using an in silico approach, molecular docking, molecular dynamics (MD) simulations, and binding affinity analysis were employed to assess the interaction of these compounds with the IL-17-IL-17R complex. Results indicate that isovitexin (IVI) and rhaponticin (RHA) exhibit strong binding affinities, with stable protein-ligand interactions throughout the simulations, supporting their potential as therapeutic agents. The study's findings contribute to the growing evidence of the anti-inflammatory benefits of fenugreek phytochemicals, suggesting that they may be utilized to develop novel therapeutic strategies for managing chronic inflammatory conditions such as periodontitis.

Periodontitis is a chronic inflammatory disease characterized by the progressive destruction of tooth-supporting tissues. Despite extensive research, the molecular mechanisms underlying its pathogenesis remain incompletely understood. This study aimed to investigate the role and regulatory mechanisms of miR-221/222-3p in experimental periodontitis. The expression of miR-221/222-3p in lipopolysaccharide (LPS)-stimulated periodontal ligament cells (PDLCs) and ligation-induced rat periodontitis were detected by RT-qPCR. miR-221/222-3p agomir were administrated topically in ligation-induced rat periodontitis. The therapeutic function of both miRNAs were assessed by micro-CT, TRAP staining, and immunohistochemistry. The mechanisms of miR-221/222-3p function in periodontitis were determined by cell assays. miR-221-3p and miR-222-3p expression were both downregulated in LPS-stimulated PDLCs and ligation-induced periodontitis rat. In vitro, miR-221-3p and miR-222-3p could alleviate the inflammatory damage of PDLCs upon LPS stimulation. Mechanically, PAK1 is demonstrated as a target gene of miR-221/222-3p. Additionally, STAT1 signaling pathway is activated by LPS treatment and STAT1 could bind to the upstream region of the miR-221/222-3p promoter and repress their expression. In vivo, miR-221/222-3p agomir rescued the alveolar bone loss, alleviated the infiltration of osteoclasts and the expression of inflammatory cytokines of periodontitis rats. Our results revealed a novel STAT1-miR-221/222-3p-PAK1 axis in the initiation and progression of periodontitis. Specific targeting this signaling pathway may provide a new therapeutic avenue for periodontitis.

This study aimed to evaluate the effects of periodontal basic therapy combined with various adjunctive treatments on periodontal inflammation and glycemic control in patients with periodontitis and type 2 diabetes mellitus (T2DM) using network meta-analysis.

Randomized controlled trials (RCTs) involving patients with periodontitis and T2DM were retrieved from PubMed, Embase, Cochrane Library, and Web of Science up to February 29, 2024. The Cochrane quality scoring system was applied to assess study quality, and data were analyzed using R and Stata. The study was registered in PROSPERO (Registration No.: CRD42024501722).

Thirty-seven RCTs involving 1,989 patients were included. Among the adjunctive therapies, scaling and root planing (SRP) with local satranidazole gel (SZ) achieved the best improvement in probing depth (PD) and clinical attachment level (CAL); SRP with systemic amoxicillin (AMX) significantly improved bleeding on probing (BOP); SRP with systemic doxycycline (Doxy) or antimicrobial photodynamic therapy (aPDT) was most effective for reducing glycated hemoglobin (HbA1c%); and SRP with diode laser (DL) improved fasting blood sugar (FBS) most effectively.

SRP combined with local SZ may improve PD and CAL in patients with periodontitis and T2DM. Systemic AMX may enhance BOP outcomes, while DOXY or aPDT may help reduce HbA1c. DL may contribute to better FBS improvement.

In this study, the relationships between periodontitis and total oxidant status (TOS), total antioxidant status (TAS), and selenium levels were investigated. A total of 122 participants, including 61 periodontitis patients and 61 periodontally healthy individuals, were included. Serum TOS, TAS, and selenium levels were measured, and the biochemical and clinical parameters were compared. The relationship between selenium levels and periodontitis was assessed through univariate analysis and multivariate logistic regression. Compared with the healthy group, the periodontitis group had significantly higher TOS and significantly lower TAS and selenium levels (p < 0.001). Logistic regression analysis also revealed a significant correlation between selenium levels and periodontitis (p < 0.001). Our study demonstrated that periodontitis was related to TOS, TAS, and selenium levels. The present study investigated the relationships of periodontitis with TOS, TAS, and selenium levels. Selenium levels could serve as an important biomarker for periodontal disease, as they are strongly correlated with the TOS value, the TAS value, and clinical parameters. Furthermore, lower selenium levels were observed in periodontitis patients than in healthy individuals.

Limited research exists on the association between periodontitis and Atherosclerotic Cardiovascular Disease (ASCVD) in American adults. Chronic inflammation from periodontitis may elevate ASCVD risk by promoting systemic inflammation and endothelial dysfunction, supporting the plausibility of this relationship. Therefore, we utilized data from the National Health and Nutrition Examination Survey (NHANES) database to investigate this association.

We conducted a cross-sectional study using NHANES data from 1999-2004 and 2009-2014, including 5,380 individuals from the United States. Tooth loss and periodontitis were assessed through full-mouth periodontal examinations. The 10-year ASCVD risk was calculated based on the 2013 American College of Cardiology (ACC) and American Heart Association (AHA) recommendations. We employed univariate and multivariable logistic regression models, as well as subgroup and interaction analyses.

Among participants, 74.96% experienced tooth loss, 15.99% had moderate/severe periodontitis, and the average age was 59.64 years. ASCVD was found to be associated with moderate/severe periodontitis (OR 1.24, 95% CI 1.01-1.52, P= 0.0411) and tooth loss (OR 1.16, 95% CI 1.09-1.39, P= 0.0248) in logistic regression models after full adjustment.

Our study establishes a significant link between moderate/severe periodontitis and the increased risk of ASCVD over a decade in American adults aged 40-79 years.

Advanced periodontitis initiates with Porphyromonas gingivalis (P. gingivalis) infection, which subsequently triggers chronic inflammation, immune imbalance, and ultimately causes alveolar bone resorption. Traditional periodontal treatment focuses on the elimination of triggering factors, but tend to ignore the improvement of the inflammatory microenvironment and the remodeling of the osteogenic mineralization space. Herein, zinc-aluminum layered double hydroxide nanosheets (LDHs) loaded with icariin (ICA) are encapsulated into a gallic acid (GA)-modified hydroxybutyl chitosan hydrogel (GA-HBC), giving rise to a customized hydrogel system named GA-HBC-LIC, which can sequentially actualize antibacterial, anti-inflammatory, and remineralization functions. A neutral chemical-humoral space is created for osteogenesis via means of sequential regulation by the smart hydrogel. Concomitantly, appropriate mechanical properties and degradation performance of the hydrogel provide a desirable physical space for remineralization. In the spatiotemporal modulation of the hydrogel, zinc finger E-box-binding homeobox 1 (ZEB1) target of released zinc ions (Zn2+) action promotes macrophage polarization from M1 to M2 phenotype, thereby remodeling the immune microenvironment and releasing cytokines conducive to tissue regeneration. In sum, this study highlights the critical role of sequential inflammation regulation and the maintenance of osteogenic space in the regeneration of periodontal tissues, offering new insights for the clinical management of periodontitis.

Periodontitis is a severe infection affecting oral and systemic health and is traditionally diagnosed through clinical probing-a process that is time-consuming, uncomfortable for patients, and subject to variability based on the operator's skill. We hypothesized that computer vision can be used to estimate periodontal stability from radiographs alone. At the tooth level, we used intraoral radiographs to detect and categorize individual teeth according to their periodontal stability and corresponding treatment needs: healthy (prevention), stable (maintenance), and unstable (active treatment). At the patient level, we assessed full-mouth series and classified patients as stable or unstable by the presence of at least 1 unstable tooth. Our 3-way tooth classification model achieved an area under the receiver operating characteristic curve of 0.71 for healthy teeth, 0.56 for stable, and 0.67 for unstable. The model achieved an F1 score of 0.45 for healthy teeth, 0.57 for stable, and 0.54 for unstable (recall, 0.70). Saliency maps generated by gradient-weighted class activation mapping primarily showed highly activated areas corresponding to clinically probed regions around teeth. Our binary patient classifier achieved an area under the receiver operating characteristic curve of 0.68 and an F1 score of 0.74 (recall, 0.70). Taken together, our results suggest that it is feasible to estimate periodontal stability, which traditionally requires clinical and radiographic examination, from radiographic signal alone using computer vision. Variations in model performance across different classes at the tooth level indicate the necessity of further refinement.

This study aimed to investigate the effects of a sustained-release composite containing gelatin methacryloyl (Gel) and kaempferol (Ka, K) on experimental periodontitis symptoms in rats.

Forty 6-week-old male rats were randomly assigned to four treatment groups in a specific pathogen-free (SPF) environment: Control group (C), periodontitis model group (M), Gel alone group (G), and Gel_Ka composite-treated group (G_K). Treatment effects on the periodontal status of bilateral maxillary second molars in each rat group were assessed by micro-CT imaging and histology. Immunohistochemistry staining was employed to examine the effects on expression levels of inflammatory factors IL-6 and MMP9 (associated with M1 macrophages) and of the anti-inflammatory factor CD206 (associated with M2 macrophages). Additionally, treatment effects on oral and intestinal microbial communities were analyzed through 16S rDNA sequencing.

Local injection treatment with the G_K composite hydrogel effectively suppressed alveolar bone resorption and reduced periodontal attachment loss and inflammation infiltration in rats with periodontitis. It reduced the expression of inflammatory factors MMP9 and IL-6 but increased the anti-inflammatory factor CD206, and it also increased the abundance of gut microbial communities producing short-chain fatty acids.

Local treatment with the sustained-release G_K hydrogel composite demonstrates a substantial antiperiodontitis effect in rats by locally attenuating inflammation and is associated with enhancing the microbial composition of intestinal flora, thus aiding in mitigating the inflammatory progression of experimental periodontitis.

Periodontitis is a complex inflammatory disease in which the host genome, in conjunction with extrinsic factors, determines susceptibility and progression. Genetic predisposition is the strongest risk factor in the first decades of life. As people age, chronic exposure to the periodontal microbiome puts a strain on the proper maintenance of barrier function. This review summarizes our current knowledge on genetic risk factors implicated in periodontitis, derived (i) from hypothesis-free systematic whole genome-profiling studies (genome-wide association studies [GWAS] and quantitative trait loci [QTL] mapping studies), and independently validated through further unbiased approaches; (ii) from monogenic and oligogenic forms of periodontitis; and (iii) from syndromic forms of periodontitis. The genes include, but are not limited to, SIGLEC5, PLG, ROBO2, ABCA1, PF4, and CTSC. Notably, CTSC and PLG gene mutations were also identified in non-syndromic and syndromic forms of prepubertal and early-onset periodontitis. The functions of the identified genes in this review suggest that the pathways affected by the periodontitis-associated gene variants converge in functions involved in the maintenance and repair of structural integrity of the periodontal tissues. Particularly, these genes play a role in the healing of inflamed and ulcerated periodontal tissues, including roles in fibrinolysis, extrusion of cellular debris, extracellular matrix remodeling and angiogenesis. Syndromes that include periodontitis in their phenotype indicate that neutrophils play an important role in the regulation of inflammation in the periodontium. The established genetic susceptibility genes therefore collectively provide new insights into the molecular mechanisms and plausible causal factors underlying periodontitis.

Increasing evidence indicates that periodontitis contributes to systemic low-grade inflammation. Porphyromonas gingivalis is strongly associated with periodontitis, and antibodies against the bacterium may be used as a serological proxy to account for periodontal status, when studying diseases associated with periodontitis. The aim of the present study is to identify an easily accessible and reliable serological biomarker for determination of periodontal status and oral carriage of the bacterium.

Saliva and serum samples were collected from periodontally healthy controls (n = 27), and patients with periodontitis stage II (n = 12) or stages III or IV (n = 44). Serum levels of immunoglobulin G (IgG) antibodies against intact and fragmented P. gingivalis, recombinant gingipains (RgpA and RgpB), and the bacteria Escherichia coli and Capnocytophaga ochracea as controls were quantified with a multiplex bead-based assay. P. gingivalis was identified in saliva using quantitative polymerase chain reaction (qPCR).

Serum IgG antibodies against P. gingivalis whole bacteria were good indicators of periodontitis (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.64-0.85). The same was observed for levels of antibodies against P. gingivalis fragments (AUC: 0.78, 95% CI: 0.68-0.88). Likewise, levels of antibodies against P. gingivalis whole bacteria or P. gingivalis fragments were good indicators of oral carriage of P. gingivalis (AUC: 0.92, 95% CI: 0.86-0.98 and AUC: 0.96, 95% CI: 0.92-1, respectively). Conversely, antibodies against recombinant RgpA and RgpB were not good indicators of periodontitis or oral carriage of the bacterium. None of the antibody levels differed significantly between stage II and stage III or IV periodontitis.

Serum IgG antibody levels against heat-inactivated whole P. gingivalis proved to be the preferable biomarker for periodontitis and oral carriage of the bacterium.

Background/Objectives: As non-thermal atmospheric pressure plasma (NTP) is known to have advantages in application in the medical field, we consider its applicability to periodontitis, a representative chronic inflammatory disease. The purpose of this study was to evaluate the effect of NTP in inhibiting the progression of periodontitis in a rat model when additionally used in scaling and root planing (SRP). Methods: To induce experimental periodontitis in 20 rats, ligatures were placed in the maxillary second molar and lipopolysaccharide from Porphyromonas gingivalis was injected around the teeth. Then, NTP treatment was performed for 2 or 5 min, together with scaling and root planing (SRP). To evaluate alveolar bone loss, micro-computed tomography (micro-CT) analysis and hematoxylin-eosin (H-E) staining were performed. Tartrate-resistant acid phosphatase (TRAP) analysis was performed to compare the number of osteoclasts, while immunohistochemistry (IHC) analysis was performed to determine the expression levels of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG). Enzyme-linked immunosorbent assay (ELISA) analysis was performed for the detection of cytokines (TNF-α, IL-1β, and IL-10) in tissues and sera. Results: When SRP was combined with NTP, alveolar bone loss was decreased, the number of osteoclasts and RANKL expression were decreased, OPG expression was increased, and pro-inflammatory cytokine (TNF-α and IL-1β) levels were significantly decreased. Compared with the NTP treatment for 2 min, when treated for 5 min, less alveolar bone loss, fewer osteoclasts, a lower RANKL expression level, and a higher OPG expression level were observed. Conclusions: This study evaluated the adjunctive treatment effect of NTP in periodontitis-induced rats. Based on the results of this study, we suggest that supplemental NTP treatment may be a good option for non-surgical periodontal treatment; however, further studies are needed to elucidate the mechanism through which NTP suppresses periodontal inflammation.

The present article reviews the emerging role of melatonin (MT) and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration, highlighting their potential to delay the aging process of periodontal ligament stem cells (PDLSCs). Oxidative stress and cellular senescence are major obstacles in regenerative therapies, especially in an aging population. MT, a potent antioxidant, restores the morphology, proliferation, and osteogenic differentiation potential of PDLSCs under oxidative stress conditions. Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein expression, offering a promising therapeutic strategy to antagonize tissue degeneration. In addition, the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration. The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology, aimed at reducing oxidative stress. Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.

Periodontitis is a chronic inflammatory disease caused by dysbiotic biofilms and destructive host immune responses. Extracellular vesicles (EVs) are circulating nanoparticles released by microbes and host cells involved in cell-to-cell communication, found in body biofluids, such as saliva and gingival crevicular fluid (GCF). EVs are mainly involved in cell-to-cell communication, and may hold promise for diagnostic and therapeutic purposes. Periodontal research has examined the potential involvement of bacterial- and host-cell-derived EVs in disease pathogenesis, diagnosis, and therapy, but data remains scarce on immune cell- or microbial-derived EVs. In this narrative review, we first provide an overview of the role of microbial and host-derived EVs on disease pathogenesis. Recent studies reveal that Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans-derived outer membrane vesicles (OMVs) can activate inflammatory cytokine release in host cells, while M1 macrophage EVs may contribute to bone loss. Additionally, we summarised current in vitro and pre-clinical research on the utilisation of immune cell and microbial-derived EVs as potential therapeutic tools in the context of periodontal treatment. Studies indicate that EVs from M2 macrophages and dendritic cells promote bone regeneration in animal models. While bacterial EVs remain underexplored for periodontal therapy, preliminary research suggests that P. gingivalis OMVs hold promise as vaccine candidates. Finally, we acknowledge the current limitations present in the field of translating immune cell derived EVs and microbial derived EVs in periodontology. It is concluded that microbial and host immune cell-derived EVs have a role in periodontitis pathogenesis and hence may be useful for studying disease pathophysiology, and as diagnostic and treatment monitoring biomarkers.

Dental implants are now a standard solution for replacing missing teeth, even in patients with a history of chronic periodontitis. India is often referred to as the "diabetic capital of the world," a title that reflects the country's alarming rates of diabetes prevalence. However, the risk of complications, such as peri-implantitis and implant failure, remains a concern for these patients. This clinical case investigates the long-term success and survival of dental implants in patients with chronic periodontitis and diabetes mellitus. Results from an eight-year follow-up suggest that with appropriate periodontal treatment, careful implant placement, and regular maintenance, dental implants can remain functional and stable, even in individuals with chronic periodontal disease and diabetes mellitus.

Periodontitis is a chronic inflammatory disease driven by the accumulation of bacterial plaque and the host's immune response, leading to the destruction of periodontal tissues. Nutrition, particularly the intake of micronutrients with anti-inflammatory and antioxidant properties, plays a crucial role in maintaining periodontal health. This review explores the impact of various micronutrients-vitamins (A, B, C, D, E), minerals (calcium, iron, zinc, potassium, copper, manganese, selenium), and omega-3 fatty acids-on periodontal disease prevention and management. Deficiencies in these nutrients can exacerbate periodontal tissue damage by impairing immune responses, promoting oxidative stress, and reducing bone and tissue regeneration capabilities. While certain populations may be more vulnerable to these deficiencies, such as those following Western diets or living in low- and middle-income countries, even in developed nations, suboptimal nutrient intake is associated with worse periodontal outcomes. Although some studies suggest that supplementation of specific micronutrients may benefit periodontal therapy, the evidence remains inconclusive, necessitating further randomized clinical trials. This review underscores the importance of considering nutritional guidance in periodontal treatment protocols and highlights the need for tailored recommendations based on recent findings.

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Periodontitis is a chronic inflammatory disease characterized by progressive soft tissue and alveolar bone loss due to interactions between microbial dental plaque and the host response. Despite extensive research on biomarkers from saliva or gingival crevicular fluid (GCF) for diagnosing periodontitis, clinical and radiological parameters remain the primary diagnostic tools.

This review discusses the ongoing research into salivary biomarkers for periodontitis diagnosis, emphasizing the need for reliable biomarkers to differentiate between periodontal health and disease. Salivary biomarker research has gained momentum with advancements in proteomic technologies, enabling noninvasive sample collection and revealing potential candidate biomarkers.

Proteomic research since the early 2000s has identified promising biomarkers and provided insights into the pathogenesis of periodontitis. Bioinformatic analysis of proteomic data elucidates the underlying biological mechanisms. This review summarizes key findings and highlights common potential biomarkers identified through proteomic research in periodontology.

Periodontal disease (PD) is an infectious and inflammatory condition that affects the tissues surrounding and supporting the teeth. It has been suggested that PD may be associated with cardiovascular disease (CVD), one of the leading causes of mortality worldwide. Our study aimed to investigate the association between PD and CVD through an umbrella review.

A comprehensive search was conducted until April 2024 across various electronic databases, including PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews with or without meta-analysis were considered for inclusion, without any limitations on time or language, provided they examined primary studies linking PD with CVD. The AMSTAR-2 tool was employed to assess the quality and overall confidence of the included studies.

After the initial search, a total of 516 articles were identified. Following the application of selection criteria, 41 articles remained for further consideration. All these studies indicated an association between PD and CVD, with odds ratios and risk ratios ranging from 1.22 to 4.42 and 1.14 to 2.88, respectively.

Systematic reviews with high overall confidence support the association between PD, tooth loss, and cardiovascular diseases. However, it is crucial to interpret these results with caution due to methodological limitations. The potential public health relevance justifies preventive and corrective oral health strategies. Additionally, the need for rigorous future research is highlighted to strengthen the evidence and guide effective public health strategies.

Nonsurgical therapies have been recommended and employed as a less invasive and cost-effective modality in managing periodontitis. In this context, different therapeutic protocols have been tested in the last decades. Therefore, mapping the scientific trends and patterns provides critical insights into the state of research in the field, which has not been explored for overall nonsurgical periodontitis treatment studies. Articles from 2001 to 2020 were retrieved from the Web of Science database using appropriate terms and keywords. Article selection and data extraction were performed by calibrated examiners. All articles focusing on nonsurgical periodontitis treatment were included. Descriptive, bivariate, and multivariate logistic regression analyses were conducted. 1,519 articles were included. Randomized clinical trials (RCTs) were the most used design (44.1%), and professional biofilm control was the topic most studied (35.6%). Europe published the most significant number of articles (41.1%). The USA was the country that collaborated more with other countries. Asia (p<0.001), South America (p=0.004), and Oceania/Africa (p=0.016) showed a lower chance to have international collaboration. Studies from North America were more likely to be RCTs than studies from Europe (p=0.050); studies focusing on professional biofilm control (p<0.001) and other topics (p<0.001) were less likely to be evaluated by RCTs. The nonsurgical periodontitis treatment field mainly conducted RCTs, and the topic most explored by all studies was professional biofilm control. International collaboration and conduct of RCTs in this field occurred mainly among high-income countries. Decentralizing scientific resources, making integrative connections globally, and evaluating new topics may improve evidence-based periodontology.

The aim of this study is to examine the potential correlation between periodontitis and the risk of cardiovascular mortality and all-cause mortality in individuals diagnosed with hypertension, despite the established association between periodontitis and hypertension.

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in 1999-2014 involving hypertensive individuals. Following the criteria proposed by Eke et al., periodontitis was classified. Survival estimates were calculated using Kaplan Meier analyses and a Kaplan Meier curve was generated. Weighted multivariate cox regression were employed to assess the association between periodontitis and all-cause mortality, as well as cardiovascular mortality.

Of the 21,645 individuals, 6,904 individuals were diagnosed with periodontitis. The Kaplan-Meier survival analysis revealed significantly higher rates of all-cause mortality (34.766% vs. 14.739%) and cardiovascular mortality (12.469% vs. 3.736%) in the periodontitis group compared to the non-periodontitis group. Hazard ratios (HRs) for all-cause mortality were 3.19 (95% CI 2.88-3.53) and for cardiovascular mortality were 3.80 (95% CI 3.13-4.61) in individuals with periodontitis compared to those without periodontitis.

Periodontitis is a risk factor for mortality in patient with hypertension, especially if it is moderate to severe. Improving periodontal health could lead to better outcomes for these patients.

The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD).

A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss.

Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low.

Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients.

Even though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

This review meticulously examined the connection between vitamin C and periodontal disease, as well as the potential of vitamin C to prevent this condition. To gather relevant data, comprehensive electronic searches were conducted across various databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, focusing on studies that explored the relationship between vitamin C and periodontal disease in individuals aged between 18 and above. From an initial pool of 421 articles, 14 were ultimately chosen for detailed analysis. This selection encompassed seven cross-sectional studies, two case-control studies, two cohort studies, and three randomized controlled trials. The analysis of these studies revealed a consistent negative association between vitamin C intake, as well as its levels in the blood, and the incidence of periodontal disease across all seven cross-sectional studies. This indicates that higher vitamin C intake and blood levels are linked to a decreased risk of developing periodontal disease. In the two case-control studies, individuals suffering from periodontitis were found to have both a lower intake of vitamin C and reduced levels of vitamin C in their blood compared to those without the disease, further underscoring the potential protective role of vitamin C against periodontal disease. The progression of periodontal disease was observed to be more rapid in patients with lower dietary intake or blood levels of vitamin C compared to controls. Regarding the effects of vitamin C administration as an intervention, there was an improvement noted in gingival bleeding among patients with gingivitis; however, no significant benefits were observed in cases of periodontitis, specifically concerning alveolar bone absorption. Through the meticulous examination of available studies, this systematic review underscores the notion that adequate vitamin C intake and maintaining sufficient levels of vitamin C in the blood can contribute significantly to reducing the risk of periodontal disease.

Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.

Since the human population realized how important it was to maintain overall health and the weight of disease, they have been looking for therapeutic qualities in natural environments. The use of plants having medicinal qualities for the treatment and prevention of illnesses that may have an impact on general health is known as herbal medicine. There has been a noticeable increase in interest lately in the combination of synthetic contemporary medications and traditional herbal remedies. About 80 % of people rely on it for healthcare, particularly in developing nations. One important aspect of overall health is said to be oral healthcare. The World Health Organization views oral health as a crucial component of overall health and well-being. Because they are more readily available, less expensive, and have fewer adverse effects than pharmaceutical treatments, using natural medicines to treat pathologic oro-dental disorders can make sense. The current evaluation of the literature sought to investigate the range and scope of the use of herbal products and their secondary metabolites in maintaining oral health, encompassing several oral healthcare domains such as halitosis, gingivitis, periodontitis, and other oral disorders. Therefore, there are many herbs discussed in this work and their mechanism in the treatment and improvement of many oral ailments. Besides, compounds that are useful in oral treatment with their natural sources and the cases where they can be used. To prevent any possible side effects or drug interactions, a doctor's consultation is necessary before using dental medicine. Although herbal therapy is safe and with minimum side effects, it is also strongly advised to do a more thorough preclinical and clinical evaluation before using herbal medicines officially.

Live micro-ecological agents, such as probiotics, have demonstrated a significant role in the preservation of human health, encompassing oral health maintenance and regulation of oral microbiota. Here, a total of 20 patients diagnosed with chronic periodontitis were recruited and randomly assigned into two cohorts based on completion of physiotherapy: a placebo group (n = 10) and a probiotic group (n = 10). The actual efficacy was assessed by administering chewable tablets (5 × 109 CFU/tablet) containing the probiotics Lactobacillus salivarius LS97, Lactobacillus paracasei LC86, and Lactobacillus acidophilus LA85 to patients with chronic periodontitis. For the placebo group, chewable tablets without probiotics were administered, while maintaining consistency with the rest of the ingredients used in the probiotic group. Saliva and plaque samples were collected at different time points (0, 1, and 3 months) and subjected to 16S amplicon sequencing for microbial structure analysis. Salivary IgA content was determined using enzyme immunoassay, whereas clinical chronic periodontal pocket depth (PD) and bleeding on probe index (BOP +) were employed to evaluate the actual efficacy of probiotic-assisted physiological intervention in chronic periodontitis treatment. Compared to the placebo group, the probiotic intervention resulted in a significant increase in salivary IgA levels among patients, accompanied by a notable decrease in PD and BOP + levels. Furthermore, the probiotic intervention led to a substantial reduction in Fusobacterium and Porphyromonas counts, while significantly increasing Lactobacillus abundance within the dental plaque microbiota of patients. Importantly, no significant alterations were observed in the overall structure of both salivary and dental plaque microbiota following the probiotic intervention. The administration of this live probiotic agent consistently and significantly enhances the oral immune response in patients with chronic periodontitis, thereby augmenting the effectiveness of physical interventions for this condition. Moreover, it effectively reduces the abundance of pathogenic microbes associated with chronic periodontitis without causing substantial alterations to the salivary and dental plaque microbiota composition. Trial registration: Chinese Clinical Trial Registry (ChiCTR) ( https://www.chictr.org.cn ) under the registration number ChiCTR2300074108.

Background: Without mechanical cleaning, gingivitis can develop within three weeks. The first clinical sign is bleeding on positive probing. The accumulation of dental biofilm triggers an inflammatory gingival response. In the past decade, attention has focused mainly on interproximal areas and the use of customized interproximal toothbrushes. The aim of this study was to evaluate the effectiveness of individualized oral hygiene education and its role in dental disease prevention among patients with dental problems. Methods: Altogether, 102 patients, 38 males and 64 females, were included in the study. All patients were aged over 18 years. Before treatment, patients were clinically and radiologically examined, their full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and bleeding on brushing (BOB) were recorded, and matrix-metalloproteinase-8 (MMP-8) was measured by using a chair-side MMP-8 measuring system. Patients in group A had gingivitis but no periodontal damage, and group B had periodontal damage. Patients in both groups were divided into four subgroups based on their toothbrushing habits and the oral health education they received. Three months after the initial examination, each patient was examined three more times (2, 4, and 12 weeks later). Results: It was concluded that subjects in groups A1 and B1 showed a significant reduction in BOB, MMP-8, FMBS, and FMPS levels after two weeks. Solo Prophylaxis (A1 and B1) remained a well-constructed protocol and caused the complete resolution of interdental inflammation after two weeks. Other subgroups achieved significant reductions only after 12 weeks. Conclusions: BOB and MMP-8 tests are valuable complements in preventive dentistry, and are able to detect potential pathological processes. The clinical relevance of BOB testing, in addition to FMBS, FMPS and gingival inflammation testing, can be demonstrated to patients, which may increase compliance.

Increasing evidence has shown that environmental factors play a crucial role in the pathogenesis of periodontitis. Humans are simultaneously exposed to a variety of environmental brominated flame retardants (BFRs). However, the relationship between BFRs in periodontitis remains unclear. This study aimed to investigate the overall association between BFRs and periodontitis in a nationally representative US population and to further identify important chemicals.

Data from 3322 NHANES participants from 2009 to 2016 were used. Serum BFRs were registered, including PBDE-28, PBDE-47, PBDE-85, PBDE-99, PBDE100, PBDE-153, PBDE-154, PBDE-183, PBDE-209 and PBB-153. Survey weighted generalized logistic regression models, restricted cubic splines (RCS) were conducted to assess single BFRs exposure with periodontitis. Meanwhile, weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) were used to evaluate the overall association of BFRs mixtures with periodontitis and to identify significant chemicals.

A total of 3322 participants were included in the study, of whom 1795 had periodontitis. After adjusting for potential confounders, multiple logistic regression analysis revealed significant positive associations between serum levels of PBDE-28, PBDE-47, PBDE-85, PBDE-99, PBDE-100, PBDE-154, PBDE-183, and PBB-153 and the risk of periodontitis (all P < 0.05). A dose-response relationship was observed for many of these BFRs, with higher quantiles associated with an increased risk of periodontitis. WQS regression identified PBDE-183 (38.60%), PBDE-153 (21.20%), PBDE-209 (14.40%), and PBDE-99 (11.90%) as the BFRs with the largest weights contributing to the overall mixture effect on periodontitis risk. BKMR analysis further supported the positive association between serum BFRs and periodontitis, with most individual BFRs showing a positive trend, except for PBDE-153. Restricted cubic spline analysis revealed a generally increasing probability of periodontitis with increasing concentrations of BFRs, albeit with some nonlinear patterns for certain compounds.

In conclusion, this study provides compelling evidence of a significant association between exposure to brominated flame retardants (BFRs) and an increased risk of periodontitis in a nationally representative sample of U.S. adults. Elevated serum levels of several BFRs, including PBDE-28, PBDE-47, PBDE-85, PBDE-99, PBDE-100, PBDE-154, PBDE-183, and PBB-153, were found to be positively associated with periodontitis, exhibiting a dose-response relationship.

Probiotics demonstrated effectiveness in modulating oral microbiota and improving oral health in humans and rodents. However, its effects and applications on the oral microbiota of cats remain underexplored. Twelve healthy cats were randomly assigned to a control group (CON) and a composite probiotic group (CPG) for a 42-day trial. The CPG diet included additional supplementation of Bifidobacterium animalis subsp. lactis HN019, Lactobacillus acidophilus NCFM, and Lactobacillus casei LC-11, each at approximately 1 × 1010 CFU/kg. On days 0 and 42, microbial samples were collected from the gingiva, tooth surfaces, and tongue of all cats for 16S rRNA gene sequencing. Bacteroidetes, Firmicutes, and Proteobacteria were the dominant phyla across all oral sites. The CPG treatment enriched seven genera, such as Moraxella, Actinomyces, and Frederiksenia in the gingiva. Meanwhile, Bergeyella and Streptococcus were enriched on the tooth surfaces, while Bergeyella, Flavobacterium, and Luteimonas were enriched on the tongue. Furthermore, the composite probiotic effectively suppressed eight genera, such as Bacteroides, Desulfovibrio, and Filifactor in the gingiva of CPG cats, as well as Helcococcus, Lentimicrobium, and Campylobacter on tooth surfaces, and Porphyromonas, Treponema, and Fusibacter on the tongue. These findings suggest that the composite probiotic used in this study modulates the feline oral microbiota by supporting beneficial or commensal bacteria and inhibiting oral pathogens, demonstrating potential to improve oral health in cats.

The bacterial plaque in the tooth-supporting tissues is the main cause of inflammatory conditions called periodontal diseases. Thus, the aim of this study is to determine the levels of intercellular matrix protein (ICTP) in patients with gingivitis and periodontitis and those who are periodontally healthy, both before and after treatment at different times.

Thirty clinical parameters (bleeding on probing, probing pocket depth, and clinical attachment loss) were measured at baseline, one month, three months, and six months after the patients were divided into three groups of 60.

There was a significant difference between the two groups at all time intervals; the difference at one month was 34.77 (p=0.000). At three months, the difference became 31.25 (p=0.000) which increased to 36.62 (p=0.000) at six months.

When periodontal deterioration occurs, ICTP levels are higher, and when they are reduced, periodontal health is demonstrated.

The focus of this article was to evaluate the link between obstructive sleep apnea syndrome (OSAS) and periodontitis, considering various hypotheses supporting the relationship between respiratory disorders and periodontitis. The literature review for this study was performed using the PubMed, Google Scholar, Cochrane library, and Proquest databases. The review process was guided by the PRISMA guidelines. The PECOS protocol (Population, Exposure, Control, Outcome, Study) was followed in developing the search strategy to ensure consistent and accurate selection of articles. To evaluate quality, cross-sectional studies were reviewed using the Joanna Briggs Institute (JBI) critical appraisal tool. Case-control studies were assessed with the Newcastle-Ottawa Scale (NOS). The research included a total of 10 studies, encompassing 88,040 participants. The meta-analysis observed a statistically significant association between OSAS and periodontitis, with an odds ratio OR = 2.4620 (95%-CI: 1.7345-3.4946 p ≤ 0.0001). The results suggest a potential association between OSA and periodontitis. Further investigations are warranted to confirm this association and elucidate its underlying mechanism.

The purpose of this research was to investigate the effect of toluidine blue (TB) mediated photodynamic therapy (PDT) on the inhibition of lipopolysaccharide (LPS)-induced inflammation in rat gingival fibroblasts through in vitro experiments. Rat gingival fibroblasts were divided into five groups: (1) control, (2) LPS treatment, (3) laser treatment, (4) TB treatment (1.0 µg/mL), and (5) PDT treatment (TB plus laser irradiation at 320 mW/cm2 for 240 s). After 24 h, cell growth activity was measured using MTT assay. The levels of receptor activator for nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in the cell culture supernatant were measured using enzyme-linked immunosorbent assay (ELISA). Nuclear proteins were extracted and the phosphorylation levels of phosphorylated nuclear factor-κB/p65 (p-p65) and phosphorylated inhibitor of nuclear factor-κB (p-IκBα) were determined using Western Blot. MTT results showed no significant difference in cell viability between the groups (P > 0.05). After LPS induction, OPG expression decreased, RANKL expression increased, and the OPG/RANKL ratio decreased, which was different from the control group (P < 0.05). After PDT treatment, OPG expression increased, RANKL expression decreased (P < 0.05), and the OPG/RANKL ratio increased (P < 0.05). Compared to the control group, there was no significant difference in OPG and RANKL expression or the OPG/RANKL ratio (P > 0.05). The activation of NF-κB was closely related to the phosphorylation levels of p-p65 and p-IκBα. LPS significantly up-regulated p-p65 and p-IκBα expression (P < 0.05), while PDT treatment decreased their phosphorylation levels (P < 0.05). TB-PDT treatment can inhibit NF-κB signaling pathway activation, decrease RANKL and OPG expression, and reduce the OPG/RANKL ratio, thereby reducing inflammation and playing a role in periodontitis treatment.

Periodontitis is a severe gum infection that begins as gingivitis and can lead to gum recession, bone loss, and tooth loss if left untreated. It is primarily caused by bacterial infection, which triggers inflammation and the formation of periodontal pockets. Notably, periodontitis is associated with systemic health issues and has been linked to heart disease, diabetes, respiratory diseases, adverse pregnancy outcomes, and cancers. Accordingly, the presence of chronic inflammation and immune system dysregulation in individuals with periodontitis significantly contributes to the initiation and progression of various cancers, particularly oral cancers. These processes promote genetic mutations, impair DNA repair mechanisms, and create a tumor-supportive environment. Moreover, the bacteria associated with periodontitis produce harmful byproducts and toxins that directly damage the DNA within oral cells, exacerbating cancer development. In addition, chronic inflammation not only stimulates cell proliferation but also inhibits apoptosis, causes DNA damage, and triggers the release of pro-inflammatory cytokines. Collectively, these factors play a crucial role in the progression of cancer in individuals affected by periodontitis. Further, specific viral and bacterial agents, such as hepatitis B and C viruses, human papillomavirus (HPV), Helicobacter pylori (H. pylori), and Porphyromonas gingivalis, contribute to cancer development through distinct mechanisms. Bacterial infections have systemic implications for cancer development, while viral infections provoke immune and inflammatory responses that can lead to genetic mutations. This review will elucidate the link between periodontitis and cancers, particularly oral cancers, exploring their underlying mechanisms to provide insights for future research and treatment advancements.

Periodontal diseases are the most frequently diagnosed problem in cats. It has been well-established that periodontal diseases could not only cause various oral health issues but could also contribute to systemic diseases. Oxidative stress is a possible link between systemic diseases and periodontitis. Our study aimed to illustrate the influence of periodontitis on oxidative stress development in cats. Furthermore, the changes in the bacterial flora of the gums were investigated.

Based on the clinical and laboratory examinations, fifty cats were divided into two groups normal (n = 25) and moderate to advanced periodontitis (n = 25). Serum total antioxidant capacity (TAC), total oxidant status (TOS), reduced (GSH) and oxidized glutathione (GSSG) were measured. In addition, samples were taken from the subgingival plaques of all cats for bacterial culture.

Serum TOS, GSSG, GSSG to GSH ratio, and oxidative stress index (OSI), calculated as the ratio of TOS to TAC in cats with periodontal disease were significantly higher, and TAC was significantly lower (p < 0.05) compared with controls. The results of bacterial culture indicated that the number of isolated bacterial colonies is higher in patients than in the control group. Additionally, the analysis of these data showed a positive association between periodontal index and oxidative stress.

Our results revealed that periodontitis in cats is related to a main oxidative stress. Furthermore, oxidant factors such as TOS and OSI, compared to antioxidant factors, may better indicate the presence of oxidative stress conditions in patients with periodontitis.

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Periodontal diseases are highly prevalent chronic diseases, and severe periodontitis creates functional and esthetic problems and decreases self-esteem for a large percentage of the older population worldwide. In many cases of periodontitis, there is no distinct tell-tale pain that motivates a patient to seek treatment, rather the signs become clinically detectable late, and typically when the disease has progressed to a problematic level for the life of the dentition. Early periodontal screening and diagnostics tools will provide early recognition of periodontal diseases and facilitate timely management of the disease to reduce tooth loss. To this goal, gingival crevicular fluid is easily sampled, can be repeatedly and non-invasively collected, and can be tested for potential biomarkers. Moreover, the site specificity of periodontal diseases enhances the usefulness of gingival crevicular fluid sampled from specific sites as a biofluid for diagnosis and longitudinal monitoring of periodontal diseases. The present review aimed to provide up-to-date information on potential diagnostic biomarkers with utility that can be assayed from gingival crevicular fluid samples, focusing on what is new and useful and providing only general historic background textually and in a tabulated format.

The aim of this study was to investigate the effect of 4μ8c, an inhibitor targeting the endoplasmic reticulum stress-associated factor IRE1α, on macrophage polarization in an experimental model of diabetic periodontitis through ex vivo experiments.

Local alveolar bone parameters were evaluated using Micro-CT following intraperitoneal administration of 4μ8c in mice with experimental diabetic periodontitis. Surface markers indicating macrophage polarization were identified using immunofluorescence. In vitro experiments were performed employing bone marrow-derived macrophages and gingival fibroblasts. Macrophage polarization was determined using flow cytometry. Principal impacted signaling pathways were identified through Western blot analysis.

Results from both in vitro and in vivo experiments demonstrated that 4μ8c mitigated alveolar bone resorption and inflammation in mice with diabetic periodontitis. Furthermore, it modulated macrophage polarization towards the M2 phenotype and augmented M2 macrophage polarization through the MAPK signaling pathway.

These findings suggest that inhibiting IRE1α can modulate macrophage polarization and alleviate ligature-induced diabetic periodontitis via the MAPK signaling pathway. This unveils a novel mechanism, offering a scientific foundation for the treatment of experimental diabetic periodontitis.

 Periodontal debridement involves conventional scaling and root planing (SRP) along with variant forms of adjunctive therapies. In the present clinical trial, we investigated if the adjunctive use of HybenX gel or diode laser along with SRP could provide a favorable outcome for the treatment of chronic periodontitis.

 The present study involved 60 subjects diagnosed with chronic periodontitis who were randomly assigned as test groups (laser or HybenX) or control group (SRP alone). The primary outcomes of the clinical trial were pocket probing depth (PPD) and clinical attachment level (CAL), which was evaluated at baseline and at third-month time interval. Additionally, secondary outcomes included estimation of reduction in inflammatory mediators interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) in gingival crevicular fluid using enzyme-linked immunosorbent assay at baseline and third-month intervals.

 Normality determination was checked using Shapiro-Wilk test. Since the data was not normally distributed, nonparametric tests were applied. The comparison of clinical parameters between the groups was analyzed with Kruskal-Wallis test. Wilcoxon sign rank test was used to compare the pairwise comparison of clinical parameters among the groups from baseline to third-month follow-up. The inflammatory mediators at various time points were compared using a One-way analysis of variance test, and the inflammatory mediators in each study group were compared using a paired t-test.

 Both the test groups demonstrated a decrease in PPD and CAL. However, the HybenX group exhibited statistically significant reduction at the end of the third-month study interval compared to the laser group and SRP alone. Further, the secondary outcome IL-1β and TNF-α analysis exhibited statistically significant reduction in all the groups posttherapy.

 The adjunctive application of HybenX gel yielded an advantage compared to laser and SRP for the treatment of chronic periodontitis.

 Adjunctive use of the oral tissue desiccant (HybenX gel) combined with SRP improved the periodontal pocket disinfection process and enhanced tissue healing devoid of adverse effects.

Systemic antibiotics are an effective adjunct in the treatment of periodontitis, but their judicious use is necessary as antimicrobial resistance is a growing global concern. This review aims to explore the current understanding and insight related to antibiotic resistance in the subgingival microbiota of periodontitis patients. A search of MEDLINE (PubMed) was carried out from 1 January 2012 to 25 November 2021 for studies related to antibiotic resistance in periodontitis patients. Of the 90 articles identified, 12 studies were selected for inclusion. A significant incidence of antibiotic resistant isolates was reported for Porphyromonas gingivalis, Prevotella intermedia, Prevotella denticola, Prevotella melaninogenica, Fusobacterium nucleatum, Tanerella forsythia, Aggretibacter actinomycetemcomitans, Streptococcus constellatus, Streptococcus intermedius, and Parvimonas micra, but resistance to specific antibiotics did not reach above 10% of isolates in most studies except for amoxicillin resistance in Aggretibacter actinomycetemcomitans. The highest frequency of resistance across all bacterial species was for amoxicillin, clindamycin, and metronidazole. However, resistance patterns were widely variable across geographical locations, and the high heterogeneity between antibiotic-resistant isolates across studies precludes any clinical recommendations from this study. Although antibiotic resistance has yet to reach critical levels in periodontitis patients, an emphasis on antibiotic stewardship interventions such as point-of-care diagnostics and education for key stakeholders is needed to curb a growing problem.

Although a growing number of studies have investigated the relationship between psychosocial factors and periodontitis, studies investigating the association between bipolar disorder (BD) and periodontitis are lacking. Using the Taiwan National Health Insurance Research Database, 4251 adolescents with BD and 17,004 age- and sex-matched controls were included. They were followed up from enrollment to the end of 2011 or death. Periodontitis was diagnosed during the follow-up. Cox regression analysis indicated that adolescents with BD had a higher risk of periodontitis (hazard ratio [HR]: 2.96, 95% confidence interval [CI] 2.77-3.17) than did controls. Subanalyses stratified by sex revealed a higher risk of periodontitis in male (HR: 2.83, 95% CI 2.56-3.14) and female (HR: 3.01, 95% CI 2.74-3.30) adolescents with BD than their respective controls. The long-term use of mood stabilizers was associated with a higher risk of periodontitis (HR: 1.19, 95% CI 1.06-1.35) in the BD cohort. Our study highlighted an increased risk of periodontitis in adolescents with BD compared with controls during the follow-up. We recommend that more attention should be paid to the prevention of periodontitis in adolescents with BD, especially those who are female or receiving mood stabilizers.

This article forms part of the themed issue on dental implants, with the general dentist being the main intended reader and with particular relevance to primary care dental professionals. It aims to describe the various characteristics of the implant in health, address contemporary developments in implant dentistry and offer some novel insights on the prevention of peri-implant diseases. A healthy implant exhibits specific histological, clinical and radiographic characteristics. Understanding such aspects leads to proper diagnosis and measures to maintain tissue integrity and prevent the development and progression of peri-implant diseases. Moreover, internationally and widely accepted definitions and recommendations based on expert consensus have been put forward to guide day-to-day clinical practice. This information should provide general practitioners with the means necessary to achieve the best possible outcome for their patients.

The purpose of the present research is to evaluate the salivary levels of leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in periodontal health and disease (gingivitis and stage III periodontitis) and also to compare the discriminative efficiencies of both biomarkers in periodontal disease.

LRG is a new acute-phase protein whose functions are still being investigated. LRG and CRP are both biomarkers that are increased by inflammation. No clinical study has yet investigated the comparison of the level of LRG and CRP in periodontal health, gingivitis and periodontitis in saliva samples.

A total of 60 individuals, including 20 periodontally healthy (control group/group C), 20 with gingivitis (group G), and 20 with Stage III periodontitis (group P), who were systemically healthy and non-smokers, participated in this study. Periodontal charts were used for recording clinical periodontal parameters and saliva LRG and CRP levels were measured by ELISA. Analyzing the area under the curve (AUC) was performed by the receiver-operating characteristics curve.

Salivary levels of LRG and CRP were significantly higher in disease groups than in group C (p < .05). Positive statistically significant correlations were observed between both biomarkers and clinical parameters (p < .05). There was also a strong positive correlation between two biomarkers (p < .05). In distinguishing periodontal disease from periodontal health, LRG (AUC = 0.833) and CRP (AUC = 0.826) were found to have similar accuracy (p = .923).

LRG and CRP may be useful and similarly effective biomarkers in the diagnosis of periodontal diseases based on the findings of this study.

In this review, we summarize the current evidence that suggests that neutrophils play a key role in facilitating damage to local bone structures.

Neutrophil infiltration is a hallmark of inflammatory bone diseases such as rheumatoid arthritis (RA) and periodontitis disease (PD). Both of these human diseases are marked by an imbalance in bone homeostasis, favoring the degradation of local bone which ultimately leads to erosions. Osteoclasts, a multinucleated resident bone cell, are responsible for facilitating the turnover of bone and the bone damage observed in these diseases. The involvement of neutrophils and neutrophil extracellular trap formation have recently been implicated in exacerbating osteoclast function through direct and indirect mechanisms. We highlight a recent finding that NET proteins such as histones and elastase can generate non-canonical, inflammatory osteoclasts, and this process is mediated by post-translational modifications such as citrullination and carbamylation, both of which act as autoantigens in RA. It appears that NETs, autoantibodies, modified proteins, cytokines, and osteoclasts all ultimately contribute to local and permanent bone damage in RA and PD. However, more studies are needed to fully understand the role of neutrophils in inflammatory bone diseases.

Periodontitis, a complex inflammatory disease initiated by bacterial infections, presents a significant challenge in public health. The increased levels of reactive oxygen species and the subsequent exaggerated immune response associated with periodontitis often lead to alveolar bone resorption and tooth loss. Herein, we develop multifunctional metal-phenolic composites (i.e., Au@MPN-BMP2) to address the complex nature of periodontitis, where gold nanoparticles (AuNPs) are coated by metal-phenolic networks (MPNs) and bone morphogenetic protein 2 (BMP2). In this design, MPNs exhibit remarkable antibacterial and antioxidant properties, and AuNPs and BMP2 promote osteogenic differentiation of bone marrow mesenchymal stem cells under inflammatory conditions. In a rat model of periodontitis, treatment with Au@MPN-BMP2 leads to notable therapeutic outcomes, including mitigated oxidative stress, reduced progression of inflammation, and the significant prevention of inflammatory bone loss. These results highlight the multifunctionality of Au@MPN-BMP2 nanoparticles as a promising therapeutic approach for periodontitis, addressing both microbial causative factors and an overactivated immune response. We envision that the rational design of metal-phenolic composites will provide versatile nanoplatforms for tissue regeneration and potential clinical applications.