Recent epidemiologic trends in periodontitis in the USA

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial‐mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full‐mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009‐2014, yielding complete data for 10 683 dentate community‐dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009‐2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%‐15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self‐reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state‐based surveys. These items were also included in the 2009‐2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30‐79 years is better understood because of application of valid periodontitis case definitions to full‐mouth periodontal examination, in combination with reliable information on demographic and health‐related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/1/prd12323.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153044/2/prd12323_am.pd

Enfermedad de Creutzfeld Jakob, desafío diagnóstico : reporte de dos casos en la ciudad de Mendoza

La enfermedad de Creutzfeldt-Jakob (ECJ) es una afección neurodege-nerativa rápidamente progresiva y mortal producida por priones. Es la más común de las encefalopatías espongiformes. La hipótesis prevalente sugiere que se inicia y propaga por conversión de una proteína priónica normal (PrP) en una isoforma conformacional anormal (PrPreS), que se acumula en el cerebro causando destrucción neuronal. Se reporta el caso de dos pacientes asistido en el Servicio de Neurología del Hospital Lagomaggiore de la ciudad de Mendoza en el período de 2 años: mujer de 49 años con cuadro de deterioro cognitivo rápidamente progresivo asociado a trastorno de la marcha y ataxia de 2 meses de evolución; y varón de 54 años con conductas inapropiadas y desorientación temporo-espacial de 20 días de evolución. Ambos con EEG compatible y proteína 14.3.3 positiva, falleciendo semanas después del diagnóstico. Se discute ambos casos, los cuales representaron un desafío diagnóstico dada la baja frecuencia y escaso reconocimiento de esta entidad en nuestro medio, debiendo debe ser considerado en pacientes que evolucionan a una demencia rápidamente progresiva.Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and fatal neurodegenerative disease caused by prions. It is the most common of spongiform encephalopathies. The most accepted hypothesis suggests that it initiates and propagates through conversion of normal prion protein (PrP) in an abnormal conformational isoform (PrPres), which accumulates in the brain causing neuronal destruction. The cases of two patients assisted in the Department of Neurology of Hospital Lagomaggiore city of Mendoza in 2-year period are reported: A 49-year old female patient with symptoms of rapidly progressing cognitive impairment associated with gait disturbance and ataxia of 2 months of progression; and a 54-year old male with misconduct and temporo-spatial disorientation of 20 days of evolution. In both cases, EEG was compatible with CJD and 14.3.3 protein was positive, dying weeks after diagnosis. Both cases are discussed, which represented a diagnostic challenge given the low frequency and little recognition of this entity in our environment, must be considered in patients who develop a rapidly progressive dementia.Fil: Galiana, Graciana Lourdes. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Farfan Alé, F.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: De Monte, M.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Sánchez, C.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Torres, A.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Ianardi, S.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Genco, J.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Genco, D.. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Castellino, G.. Hospital Luis Lagomaggiore (Mendoza, Argentina

Glycemic Control and Alveolar Bone Loss Progression in Type 2 Diabetes

This study tested the hypothesis that the risk for alveolar bone loss is greater, and bone loss progression more severe, for subjects with poorly controlled (PC) type 2 diabetes mellitus (type 2 DM) compared to those without type 2 DM or with better controlled (BC) type 2 DM. The PC group had glycosylated hemoglobin (HbA1) ≥ 9%; the BC group had HbA1 < 9%. Data from the longitudinal study of the oral health of residents of the Gila River Indian Community were analyzed. Of the 359 subjects, aged 15 to 57 with less than 25% radiographic bone loss at baseline, 338 did not have type 2 DM, 14 were BC, and 7 were PC. Panoramic radiographs were used to assess interproximal bone level. Bone scores (scale 0–4) corresponding to bone loss of 0%, 1% to 24%, 25% to 49%, 50% to 74%, or ≥ 75% were used to identify the worst bone score (WBS) in the dentition. Change in worst bone score at follow‐up, the outcome, was specified on a 4‐category ordinal scale as no change, or a 1‐, 2‐, 3‐, or 4‐category increase over baseline WBS (WBS1). Poorly controlled diabetes, age, calculus, time to follow‐up examination, and WBS1 were statistically significant explanatory variables in ordinal logistic regression models. Poorly controlled type 2 DM was positively associated with greater risk for a change in bone score (compared to subjects without type 2 DM) when the covariates were included in the model. The cumulative odds ratio (COR) at each threshold of the ordered response was 11.4 (95% CI = 2.5, 53.3). When contrasted with subjects with BC type 2 DM, the COR for those in the PC group was 5.3 (95% CI = 0.8, 53.3). The COR for subjects with BC type 2 DM was 2.2 (95% CI = 0.7, 6.5), when contrasted to those without type 2 DM. These results suggest that poorer glycemic control leads to both an increased risk for alveolar bone loss and more severe progression over those without type 2 DM, and that there may be a gradient, with the risk for bone loss progression for those with better controlled type 2 DM intermediate to the other 2 groups. Ann Periodontol 1998;3:30–39.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142262/1/aape0030.pd

Non‐Insulin Dependent Diabetes Mellitus and Alveolar Bone Loss Progression Over 2 Years

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141702/1/jper0076.pd

Periodontal Pathogens and Risk of Incident Cancer in Postmenopausal Females: The Buffalo OsteoPerio Study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142052/1/jper0257.pd

Porphyromonas gingivalis and related bacteria: from colonial pigmentation to the type IX secretion system and gliding motility

Porphyromonas gingivalis is a gram-negative, non-motile, anaerobic bacterium implicated as a major pathogen in periodontal disease. P. gingivalis grows as black-pigmented colonies on blood agar, and many bacteriologists have shown interest in this property. Studies of colonial pigmentation have revealed a number of important findings, including an association with the highly active extracellular and surface proteinases called gingipains that are found in P. gingivalis. The Por secretion system, a novel type IX secretion system (T9SS), has been implicated in gingipain secretion in studies using non-pigmented mutants. In addition, many potent virulence proteins, including the metallocarboxypeptidase CPG70, 35 kDa hemin-binding protein HBP35, peptidylarginine deiminase PAD and Lys-specific serine endopeptidase PepK, are secreted through the T9SS. These findings have not been limited to P. gingivalis but have been extended to other bacteria belonging to the phylum Bacteroidetes. Many Bacteroidetes species possess the T9SS, which is associated with gliding motility for some of these bacteria

Models to Evaluate the Role of Stress in Periodontal Disease

We evaluated the association of stress, distress, and coping behaviors with periodontal disease in 1,426 subjects, aged 25 to 74, in Erie County, NY. Demographic characteristics, medical and dental history, and tobacco and alcohol consumption, as well as clinical assessments of supragingival plaque, subgingival flora, gingival bleeding, calculus, probing depth, clinical attachment level (CAL), and radiographic alveolar bone loss (ABL) were obtained for each subject. Subjects also completed a set of 5 psychosocial instruments that measured life events, daily strains, hassles and uplifts, distress, and coping behaviors. Internal consistencies of all subscales on the instruments were high, with Cronbach’s alpha ranging from 0.88 to 0.99. Logistic regression indicated that financial strain was significantly associated with greater attachment and alveolar bone loss (OR 1.70; 95% CI, 1.09–2.65; and 1.68; 95% CI, 1.20–2.37, respectively) after adjusting for age, gender, and smoking. When those with financial strain were stratified with respect to coping behaviors, it was found that those who exhibited high emotion‐focused coping (inadequate coping) had an even higher risk of having more severe attachment loss (OR 2.24; 95% CI, 1.15–4.38) and alveolar bone loss (OR 1.91; 95% CI, 1.15–3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. After further adjusting for number of visits to the dentist, those with financial strain who were high emotion‐focused copers still had higher levels of periodontal disease based on CAL (OR 2.12; 95% CI, 1.07–4.18). In contrast, subjects with high levels of financial strain who reported high levels of problem‐based coping (good coping) had no more periodontal disease than those with low levels of financial strain. Salivary cortisol levels were higher in a test group exhibiting severe periodontitis, a high level of financial strain, and high emotion‐focused coping, as compared to a control group consisting of those with little or no periodontal disease, low financial strain, and low levels of emotion‐focused coping (11.04 ± 4.4 vs. 8.6 ± 4.1 nmol/L salivary cortisol, respectively). These findings suggest that psychosocial measures of stress associated with financial strain are significant risk indicators for periodontal disease in adults. Further prospective studies are needed to help establish the time course of stress, distress, and inadequate coping on the onset and progression of periodontal disease, as well as to evaluate the mechanisms by which stress exerts its effects on periodontal infections. Ann Periodontol 1998;3:288–302.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142261/1/aape0288.pd

Association of Plasma 25â Hydroxyvitamin D Concentrations and Pathogenic Oral Bacteria in Postmenopausal Females

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141146/1/jper0944.pd

The effect of periodontal therapy on lymphocyte blastogenesis to plaque associated microorganisms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66105/1/j.1600-0765.1983.tb00340.x.pd

Association Between Metabolic Syndrome and Periodontal Disease Measures in Postmenopausal Women: The Buffalo OsteoPerio Study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141377/1/jper1489.pd