The impact of periodontal disease on hospital admission and mortality during COVID-19 pandemic

Introduction: COVID-19 has had a huge impact on society and healthcare and it has been suggested that people with periodontal disease are at risk of having worse outcomes from the disease. The aim of this study was to quantify the impact of periodontal disease on hospital admission and mortality during the COVID-19 pandemic. Materials and Methods: The study extracted UK Biobank participants who had taken a COVID-19 test between March and June 2020 (n = 13,253), of which 1,616 were COVID-19 positive (12%) and 11,637 were COVID-19 negative (88%). Self-reported oral health indicators of painful or bleeding gums and loose teeth were used as surrogates for periodontal disease, participants who did not report any of the aforementioned indicators were used as controls. Multivariable logistic regressions were used to obtain crude and adjusted odds ratios of COVID-19 infection, subsequent hospital admission and mortality adjusted for demographics, BMI, biomarkers, lifestyle and co-morbidities. Results: Painful gums, bleeding gums and loose teeth were reported in 2.7, 11.2 and 3.3% of participants with COVID-19 infection, respectively. Risk of COVID-19 infection in participants with painful or bleeding gums and loose teeth compared to controls was not increased (odds ratio [OR]: 1.10, 95% CI: 0.72–1.69; OR: 1.15, 95% CI: 0.84–1.59). COVID-19 positive participants with painful or bleeding gums had a higher risk of mortality (OR: 1.71, 95% CI: 1.05–2.72) but not hospital admission (OR: 0.90, 95% CI: 0.59–1.37). Participants with loose teeth did not show higher risk of hospital admission or mortality compared to the control group (OR = 1.55, 95% CI: 0.87–2.77; OR: 1.85; 95% CI: 0.92–2.72). Conclusion: There was insufficient evidence to link periodontal disease with an increased risk of COVID-19 infection. However, amongst the COVID-19 positive, there was significantly higher mortality for participants with periodontal disease. Utilization of linked dental and hospital patient records would improve the understanding of the impact of periodontal disease on COVID-19 related outcomes

Risk of incident cardiovascular disease in people with periodontal disease: a systematic review and meta-analysis

Objectives Cardiovascular disease (CVD) is a major cause of mortality; periodontal disease (PD) affects up to 50% of the world's population. Observational evidence has demonstrated association between CVD and PD. Absent from the literature is a systematic review and meta‐analysis of longitudinal cohort studies quantifying CVD risk in PD populations compared to non‐PD populations. To examine the risk of incident CVD in people with PD in randomised controlled trials and longitudinal cohort studies. Material and Methods We searched Medline, EMBASE and Cochrane databases up to 9th Oct 2019 using keywords and MeSH headings using the following concepts: PD, CVD, longitudinal and RCT study design. CVD outcomes included but were not restricted to any CVD, myocardial infarction, coronary heart disease (CHD) and stroke. Diagnosis method and severity of PD were measured either clinically or by self‐report. Studies comparing incident CVD in PD and non‐PD populations were included. Meta‐analysis and meta‐regression was performed to determine risk of CVD in PD populations and examine the effects of PD diagnosis method, PD severity, gender and study region. Results Thirty‐two longitudinal cohort studies were included after full text screening; 30 were eligible for meta‐analysis. The risk of CVD was significantly higher in PD compared to non‐PD (relative risk [RR]: 1.20, 95% CI: 1.14–1.26). CVD risk did not differ between clinical or self‐reported PD diagnosis (RR = 0.97, 95% CI: 0.87–1.07,). CVD risk was higher in men (RR: 1.16, 95% CI: 1.08–1.25) and severe PD (RR: 1.25, 95% CI: 1.15–1.35). Among all types of CVD, the risk of stroke was highest (RR = 1.24; 95% CI:1.12–1.38), the risk of CHD was also increased (RR = 1.14; 95% CI:1.08–1.21). Conclusion This study demonstrated modest but consistently increased risk of CVD in PD populations. Higher CVD risk in men and people with severe PD suggests population‐targeted interventions could be beneficial

Oral diseases are associated with cognitive function in adults over 60 years old

Objective To investigate the bidirectional association between oral diseases and cognitive function comprehensively. Subjects and Methods This cross sectional study utilized data from the National Health and Nutrition Examination Survey. Oral diseases include periodontitis, dental caries, and tooth loss (end point of oral disease resulting in tooth extraction). Cognitive function included three domains: memory, processing speed, and executive function. A global cognitive score was then derived from sum of the three cognitive domains. Oral cognition associations were examined using various statistical models: (1) Regress oral disease on cognitive function; (2) Regress cognitive function on oral disease; and (3) Structural equation modelling treating cognition and oral disease as latent variables. Results There were 2508 participants aged 60+ who had both oral and cognitive information. Associations between various oral disease and global cognitive score were observed (Odds ratio ORcog->periodontitis 0.95, 95% Confidence Interval [0.92, 0.99]; βcog->caries −0.13, [−0.23, −0.04]; βcog->tooth loss −0.03 [−0.04, −0.01]; βtooth loss->cog −0.04 [−0.06, −0.02]; βcaries->cog −0.03 [−0.06, −0.01]; βperiodontitis->cog −0.39 [−0.69, −0.10]). Significant correlation was also found between these oral disease and cognitive function using structural equation model (r −0.22, [−0.34, −0.10]). Conclusions This study found robust bidirectional associations between oral disease and cognitive function using various modelling approaches among the aging population

JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis

Distinct developmental origins manifest in the specialized encoding of movement by adult neurons of the external globus pallidus

SummaryTranscriptional codes initiated during brain development are ultimately realized in adulthood as distinct cell types performing specialized roles in behavior. Focusing on the mouse external globus pallidus (GPe), we demonstrate that the potential contributions of two GABAergic GPe cell types to voluntary action are fated from early life to be distinct. Prototypic GPe neurons derive from the medial ganglionic eminence of the embryonic subpallium and express the transcription factor Nkx2-1. These neurons fire at high rates during alert rest, and encode movements through heterogeneous firing rate changes, with many neurons decreasing their activity. In contrast, arkypallidal GPe neurons originate from lateral/caudal ganglionic eminences, express the transcription factor FoxP2, fire at low rates during rest, and encode movements with robust increases in firing. We conclude that developmental diversity positions prototypic and arkypallidal neurons to fulfil distinct roles in behavior via their disparate regulation of GABA release onto different basal ganglia targets