Periodontitis and metabolic diseases (diabetes and obesity): Tackling multimorbidity

Noncommunicable diseases (NCDs) are multifactorial, long-term, chronic conditions that represent a burden to health-care systems worldwide as they can only be controlled rather than cured; hence, they require long-term care. With the exponential increase in NCDs, the occurrence of individuals presenting with more than one chronic disease is also rapidly rising. “Multimorbidity,” defined as the presence of two or more long-term physical or mental disorders, is now considered a worldwide epidemic, affecting around 20% of the adult population. Periodontitis, diabetes, and obesity, all chronic inflammatory diseases, are an example of multimorbidity highly relevant to dental practitioners. Over the last three decades, the three-way relationship among the diseases has been vastly researched and accepted, with important contributions by European researchers. The interplay among periodontitis, diabetes, and obesity is sustained by shared biological mechanisms, such as systemic inflammation, insulin resistance, and metabolic dysfunction, as well as common lifestyle-related risk factors. As such, unhealthy lifestyles were found to generally increase systemic inflammation and insulin resistance and decrease immune function, hence, eventually increasing the risk of NCDs onset and the development of multimorbidity. This narrative review of the evidence supports the need for a paradigm shift from a “single-disease” to a “multiple-disease” framework, characterized by an integrated multidisciplinary approach, which should include lifestyle modification interventions to successfully tackle multimorbid periodontitis and metabolic diseases (diabetes and obesity). A multidisciplinary integrated care pathway in both dental and medical settings should be considered to further tackle the global health challenge of multimorbidity

Periodontitis and systemic inflammation: exploring the nature of the association.

Periodontitis has been associated with elevated inflammatory markers in otherwise healthy populations. However the nature of this association has not been determined. The aim of this work was to establish whether or not periodontitis causes systemic inflammation. A first pilot intervention trial indicated that standard periodontal therapy, in a cohort of 94 individuals suffering from severe generalized periodontitis, produced a 0,5 mg/L decrease in serum CRP concentration 6 months after therapy. This decrease was affected by the degree of clinical periodontal response and carriage of specific polymorphisms in inflammatory genes (IL-1 A, IL-6). Periodontal treatment, on the other hand, produced a moderate acute phase response of one week duration 10-fold increase in CRP (P<0.001) . Carriage of rare alleles in the CRP gene was associated with a greater acute CRP response to periodontal therapy after correcting for conventional cardiovascular and inflammatory factors. Standard (SPT) and an intensive periodontal therapy (IPT, including local delivery of antimicrobials) resulted in a significant reduction in serum CRP compared to an untreated control 2 months after treatment (0.5 0.2 mg/L, P=0.030 and 0.8 0.2 mg/L, P=0.001 respectively) in a randomized controlled trial involving 65 healthy subjects with severe generalized periodontitis. The IPT group showed also a decrease in total cholesterol and LDL-cholesterol. These data were confirmed by the results of a second randomized trial where a cluster of inflammatory and metabolic parameters were evaluated at baseline, 1, 2 and 6 months after either a SPT or IPT regimen. IPT patients showed significant reductions in inflammatory markers at one (p=O.04O6) and two (p=0.0060) months together with an improved metabolic state (2-6 months reduction in lipid markers p=0.0320 and p=0.0432 respectively). Periodontitis causes an increased reversible systemic inflammatory burden and an intensive therapy regimen is more effective in re-establishing a more favourable systemic homeostasis

Molecular markers relevant to myocardial injury following dental extraction in patients with or without coronary artery disease

Objectives The aim of this study was to characterize biological changes following dental extractions in patients with and without coronary artery disease (CAD). Materials and methods Forty-five patients (36 males and 9 females) referred for dental extraction underwent treatment and provided blood samples before, immediately after, and 24 h after the procedure. A broad array of biomarkers was employed to assess myocardial injury (highly sensitive troponin T, hs-TnT), bacterial burden (LPS endotoxin activity), and systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, and TNF-α). Results Dental extraction in patients with and without CAD was associated with rises in hs-TnT (p = 0.013), hs-CRP (p < 0.001), fibrinogen (p = 0.005), endotoxin activity (p < 0.001), IFN-γ (p < 0.001), IL-6 (p < 0.001), IL-8 (p = 0.011), and IL-12 (p < 0.001) at 24 h compared with immediately post procedure. Changes in systemic inflammation and endotoxin activity were more evident in those with hs-TnT rise. Conclusions Simple dental extractions may cause mild increase in hs-TnT, indicating minor myocardial injury in both patients with and without CAD. Acute systemic inflammation and endotoxemia could represent a possible link between invasive dental treatment and increased risk of acute cardiovascular events. These findings indicate that invasive dental treatment (as simple as a single dental extraction) may impact negatively on clinical outcomes in dental patients, especially those with CAD

The Mouth and Lupus

The oral cavity is often referred to as a “mirror of the body” and can be the first site with clinical signs of a sometimes distant systemic disease. The oral manifestations of various systemic conditions may precede or follow closely the involvement of other parts of the body and, in some instances, can be the dominant feature that warrants a particular emphasis upon investigation and/or treatment. Oral disease can sometimes be having the greatest negative impact upon a patient with systemic illness. The presence of oral ulcers (including nasopharyngeal ulcers) is one of the 11 criteria defined by the American College of Rheumatology for the diagnosis of systemic lupus erythematosus (SLE). A thorough examination of the oral tissues can provide useful information to clinicians for an early diagnosis of SLE. Oral lesions would normally improve if lupus is adequately controlled and their reoccurrence is often an indicator of a new disease flare-up. A wide spectrum of oral signs and symptoms caused by lupus has been described and might be related not only to the disease itself, but also to concomitant secondary conditions or be the effect of different medications

High strain rate behavior of aluminum die cast components

Abstract Research results of static and dynamic mechanical tests (ɛ = 1 * 10-3 s-1 and ɛ ~ 5 * 102 s-1 conducted on samples obtained from three different die cast products (component A, B and C) of AlSi10MnMg alloy are reported. All the components have thin-walled geometry except some thicker positions of component C. The dynamic (high strain rate) mechanical characterization shows an increase of tensile properties, in respect to static tensile ones (tensile strength increases approximately 15%, and the yield strength 30%, for all the die cast components) together with an evident plastic deformation, with consequent necked region in the fractured section, substantially negligible in case of static tensile tests. Moreover, fractographic observations are conducted on specimens undergone static and high strain rate test conditions, to observe the fracture morphology, together with metallographic analysis on the only polished or etched transverse specimens to reveal the porosity, and the microstructure of dendrite and inter-dendrite morphologies

Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis

Aim: To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. // Materials and Methods: Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. // Results: Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92–29.14). The latter group, however, ranked last in clinical VBG. // Conclusions: VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications

Effect of treatment of periodontitis on incretin axis in obese and non-obese individuals: A cohort study

CONTEXT: Periodontitis confers an increased risk of developing type 2 diabetes and, in patients with obesity, it might interfere with the incretin axis. The effect of periodontal treatment on glucoregulatory hormones remains unknown. OBJECTIVE: To evaluate the effect of periodontal treatment on incretin axis in obese and lean non-diabetic individuals. SETTING: King's College Dental Hospital and Institute, London, UK. PARTICIPANTS AND METHODS: The metabolic profile of obese and BMI-normal individuals affected by periodontitis was studied at baseline, 2 and 6 months after intensive periodontal treatment, by measuring plasma insulin, glucagon, GLP-1 and GIP and markers of systemic inflammation and oxidative stress. MAIN OUTCOME MEASURE(S): Circulating levels of incretins and inflammatory markers. RESULTS: At baseline, periodontal parameters were worse for obese than non-obese; this was accompanied by higher levels of circulating hs-CRP, insulin and GLP-1. The response to periodontal treatment was less favourable in the obese group, without significant variations of hs-CRP or malondialdehyde. Gluco-regulatory hormones changed differently after treatment: while insulin and glucagon did not vary at 2 and 6 months, GLP-1 and GIP significantly increased at 6 months in both groups. In particular, GLP-1 increased more rapidly in obese participants, while the increase of GIP followed similar trends across visits in both groups. CONCLUSIONS: Nonsurgical treatment of periodontitis is associated with increased GLP-1 and GIP levels in non-obese and obese patients; changes in GLP-1 were more rapid in obese participants. This might have positive implications for the metabolic risk of these individuals

Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review

AIM: To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life. MATERIALS AND METHODS: Systematic electronic searches were conducted to identify randomized controlled trials with minimum 6-month follow-up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable. RESULTS: Meta-analyses confirmed reductions of high-sensitivity C-reactive protein (hs-CRP) [0.56 mg/L, 95% confidence interval (CI) (−0.88, −0.25), p < .001]; interleukin (IL)-6 [0.48 pg/ml, 95% CI (−0.88, −0.08), p = .020], and plasma glucose [1.33 mmol/l, 95% CI (−2.41, −0.24), p = .016], and increase of flow-mediated dilation (FMD) [0.31%, 95% CI (0.07, 0.55), p = .012] and diastolic blood pressure [0.29 mmHg, 95% CI (0.10, 0.49), p = .003] 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed [0.77 risk ratio, 95% CI (0.60, 0.98), p = .036]. Limited evidence was reported on quality-of-life (QoL) outcomes in the included studies. CONCLUSIONS: Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials