Polymicrobial periodontal disease triggers a wide radius of effect and unique virome.

Periodontal disease is a microbially-mediated inflammatory disease of tooth-supporting tissues that leads to bone and tissue loss around teeth. Although bacterially-mediated mechanisms of alveolar bone destruction have been widely studied, the effects of a polymicrobial infection on the periodontal ligament and microbiome/virome have not been well explored. Therefore, the current investigation introduced a new mouse model of periodontal disease to examine the effects of a polymicrobial infection on periodontal ligament (PDL) properties, changes in bone loss, the host immune response, and the microbiome/virome using shotgun sequencing. Periodontal pathogens, namely Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Fusobacterium nucleatum were used as the polymicrobial oral inoculum in BALB/cByJ mice. The polymicrobial infection triggered significant alveolar bone loss, a heightened antibody response, an elevated cytokine immune response, a significant shift in viral diversity and virome composition, and a widening of the PDL space; the latter two findings have not been previously reported in periodontal disease models. Changes in the PDL space were present at sites far away from the site of insult, indicating that the polymicrobial radius of effect extends beyond the bone loss areas and site of initial infection and wider than previously appreciated. Associations were found between bone loss, specific viral and bacterial species, immune genes, and PDL space changes. These findings may have significant implications for the pathogenesis of periodontal disease and biomechanical properties of the periodontium. This new polymicrobial mouse model of periodontal disease in a common mouse strain is useful for evaluating the features of periodontal disease

Intraplaque hemorrhage, a potential consequence of periodontal bacteria gathering in human carotid atherothrombosis

Periodontal diseases are multifactorial inflammatory diseases, caused by a bacterial biofilm involving both innate and adaptative immunity, characterized by the destruction of tooth-supporting tissues. In the context of periodontitis, the spread of weak pathogenic bacteria into the bloodstream has been described. These bacteria will preferentially localize to existing clot within the circulation. Atherothrombosis of the carotid arteries is a local pathology and a common cause of cerebral infarction. Intraplaque hemorrhages render the lesion more prone to clinical complications such as stroke. The main objective of this study is to explore the biological relationship between carotid intraplaque hemorrhage and periodontal diseases. This study included consecutive patients with symptomatic or asymptomatic carotid stenosis, admitted for endarterectomy surgical procedure (n=41). In conditioned media of the carotid samples collected, markers of neutrophil activation (myeloperoxidase or MPO, DNA-MPO complexes) and hemoglobin were quantified. To investigate the presence of DNA from periodontal bacteria in atherosclerotic plaque, PCR analysis using specific primers was performed. Our preliminary results indicate an association between neutrophil activation and intraplaque hemorrhages, reflected by the release of MPO (p<0,01) and MPO-DNA complexes (p<0,05). Presence of DNA from periodontitis-associated bacteria was found in 32/41 (78%) atheromatous plaque samples. More specifically, DNA from Pg, Tf, Pi, Aa was found in 46%, 24%, 34% and 68% of the samples, respectively. Hemoglobin levels were higher in conditioned media in carotid samples where the bacteria were found, but this was not statistically significant. Our data confirm the relationship between intraplaque hemorrhage and neutrophil activation. In addition, the presence of periodontal bacteria DNA in carotid atheromatous plaque, may contribute to this activation. Further analysis is needed to fully explore the raw data and specimens

Education as a Predictor of Chronic Periodontitis: A Systematic Review with Meta-Analysis Population-Based Studies

The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66–2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30–1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions

Periodontal bacteriemia and human atherosclerosis evolution

Depuis la fin des années 1980, de nombreuses études épidémiologiques ont montré une association positive et indépendante entre les maladies cardiovasculaires et les maladies parodontales. Les maladies parodontales, responsables de bactériémies transitoires et répétées, ont la capacité d’initier ou d’aggraver les lésions d’athérosclérose. Deux mécanismes pathogéniques majeurs sont aujourd’hui avancés. L’un est indirect par augmentation des médiateurs de l’inflammation induite par les parodontites et l’autre est direct lié au microbiote oral. Cette hypothèse majeure repose sur deux mécanismes non exclusifs, la translocation des bactéries parodontales au sein des plaques d’athérosclérose par la circulation générale et sur la modification du microbiote intestinal. L’objectif de la thèse était d'explorer l'association entre l’exposition systémique aux bactéries parodontales et leur présence au sein des plaques d’athérosclérose sur les complications cardio- et neuro-vasculaires chez l’homme. Les résultats obtenus montrent que les bactéries parodontales sont associées à un phénotype vulnérable des plaques d’athérosclérose coronariennes et carotidiennes. Les lésions d’athérosclérose compliquées par des hémorragies intraplaques sont le siège d’une activation plus intense des neutrophiles. Les effets délétères des leucocytes sur les tissus vasculaires sont potentiellement augmentés et entretenus par les bactéries majorant la vulnérabilité à la rupture des plaques d’athérosclérose. La confirmation clinique de la relation biologique entre le microbiote parodontal et les complications cardio- et neuro-vasculaires de l’athérosclérose est une perspective importante de cette thèse.Since the late 1980s, many epidemiological studies have shown a positive and independent association between cardiovascular disease and periodontal disease. Periodontal disease inducing transient bacteraemia, can initiate or worsen atherosclerotic lesions. Two major pathophysiologic mechanisms are supported by evidence. One is by indirect increase in inflammatory systemic periodontitis-induced mediators and the other is directly related to the oral microbiota. This major hypothesis is based on two non-exclusive mechanisms, the translocation of periodontal bacteria in atherosclerotic plaques by the general circulation and the impact on the gut microbiota.The aim of the thesis was to explore the association between systemic exposure to periodontal bacteria and their presence in atherosclerotic plaques on the cardiovascular and neurovascular complications in human.The results obtained show that periodontal bacteria are associated to a vulnerable phenotype of coronary and carotid atherosclerotic plaques. Atherosclerotic lesions complicated by intraplaque haemorrhage are the trigger of a super activation of neutrophils. The deleterious effects of leukocytes to the vascular tissues are potentially increased and maintained by the bacteria which increase the atherosclerotic plaques vulnerability to rupture.The clinical confirmation of the biological relationship between periodontal microbiota and cardio- and neurovascular complications of atherosclerosis is an important perspective of this thesis

Diabète et maladies parondontales

Le diabète et les maladies parodontales sont deux pathologies chroniques dont la prévalence mondiale est élevée et qui entretiennent des relations cliniques et biologiques complexes. L’augmentation de l’incidence et de la sévérité des parodontites chez les diabétiques est prouvée par de nombreuses études épidémiologiques. Les spécificités du traitement parodontal chez le diabétique sont liées à l’immunodépression qui engendre des retards de cicatrisation mais son efficacité est démontrée. Cependant les mécanismes pathogéniques sont encore loin d’être parfaitement élucidés. Depuis quelques années, la relation inverse entre parodontites et diabète a été l’objet de nombreuses recherches. De récentes revues systématiques indiquent que les parodontites augmentent l’incidence, le contrôle et les complications du diabète et que le traitement parodontal classique (détartrage-surfaçage) diminue le taux d’hémoglobine glyquée de 0,4 %. Là encore, les mécanismes biologiques sous-jacents restent à démontrer même si l’inflammation et le stress oxydant semblent impliqués

Periodontitis and atherosclerotic cardiovascular disease: A critical appraisal

International audienceIn spite of intensive research efforts driving spectacular advances in terms of prevention and treatments, cardiovascular diseases (CVDs) remain a leading health burden, accounting for 32% of all deaths (World Health Organization. &quot;Cardiovascular Diseases (CVDs).&quot; WHO, February 1, 2017, https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)). Cardiovascular diseases are a group of disorders affecting the heart and blood vessels. They encompass a collection of different conditions, among which atherosclerotic cardiovascular disease (ASCVD) is the most prevalent. CVDs caused by atherosclerosis, that is, ASCVD, are particularly fatal: with heart attack and stroke being together the most prevalent cause of death in the world. To reduce the health burden represented by ASCVD, it is urgent to identify the nature of the &quot;residual risk,&quot; beyond the established risk factors (e.g., hypertension) and behavioral factors already maximally targeted by drugs and public health campaigns. Remarkably, periodontitis is increasingly recognized as an independent cardiovascular risk factor

Eating disorders through the periodontal lens

International audiencePeople with eating disorders suffer from a mental disorder that negatively affects their physical and/or mental health. The three most frequent eating disorders are binge eating disorder, bulimia nervosa, and anorexia nervosa. Environmental and genetic factors are involved in the pathogenesis of eating disorders in vulnerable persons. Although treatment varies among different types of eating disorders, nutrition, medical care combined with psychotherapy and medications are standard of care. The aim of this review is to give an overview of the oral health impact of eating disorders with a special emphasis on the periodontium. Oral health professionals have a unique role to play in the early diagnosis of eating disorders because of the important impact that eating disorders have on the oral cavity. In vomiting-associated eating disorders, the risk of erosive tooth wear is mainly localized to the palatal surfaces of the incisors. Emerging evidence also indicates a high frequency of gingivitis and gingival recessions associated with compulsive toothbrushing. A holistic approach, including oral health and functional rehabilitation, should be promoted by physicians, psychiatrists, and dentists for people with eating disorders

Risk factors for oral health in anorexia nervosa: Comparison of a self-report questionnaire and a face-to-face interview

International audienceBehavioral, nutritional, and local risk factors for oral health are frequent in people with anorexia nervosa. However no self-report questionnaire is available for screening in clinical practice or for research purposes. The objective of this study was to design a questionnaire to identify risk factors and symptoms of oral diseases and to test its reliability as a self-report form among people with anorexia nervosa. A 26-item questionnaire was designed based on a sound literature review performed by a group of dentists, psychiatrists, and epidemiologists specialized in the field of eating disorders. Sixty-nine anorexia nervosa inpatients (mean age 18.72 ± 5.1) were included from four specialized units. The questionnaire was first self-reported by the patients, then the same questionnaire was administrated by a dentist during a structured face-to-face interview as the gold standard. The concordance between the two forms was evaluated globally and item per item using Cohen’s kappa statistical tests. The overall concordance between the self-report questionnaire and the face-to-face structured interview was 55%. Of the 26 items, 19 showed significant concordance. Items relating to water intake, extracted teeth, gingival status, and oral hygiene had the best concordance (all kappa coefficients > 0.4). A questionnaire that identifies risk factors and symptoms of oral diseases in anorexia nervosa was developed and tested. The 26-item form of the questionnaire (long version) is moderately reliable as a self-reported form. A short version of the questionnaire, including the 10 most reliable items, is recommended for oral risk assessment in patients with anorexia nervosa. The clinical value of the self-administered questionnaire remains to be evaluated