The Role of Osteoporosis as a Systemic Risk Factor for Periodontal Disease

Periodontal disease is an infectious and inflammatory disease with a high incidence in the global population and an extremely complex etiopathogenesis. Osteoporosis is one of the systemic diseases that can affect the integrity of periodontal tissues. Osteoporosis, as a skeletal disease, causes a reduction in bone mass and microarchitectural changes in the bone. Discussions about the connection between the two diseases affecting the bone began in 1960, but, contrary to the high number of studies, discoveries are still being made regarding the pathophysiological mechanisms that link the two diseases. The chapter proposes a systematized description of data on the influence of osteoporotic disease on the periodontal structures, therapeutic methods to address the patient with periodontal disease and osteoporosis and data on the potential influence of conventional and adjunctive periodontal treatment on systemic parameters in patients with osteoporosis

Cytokines’ Involvement in Periodontal Changes

The bacterial challenge on the periodontal tissues triggers an inflammatory reaction, driven by pro-inflammatory cytokines, that eventually leads to the periodontal structures’ damage. The pathogenic mechanisms of this inflammatory reaction are complex and are influenced by the type of host-immune response and certain local and systemic factors. These factors can influence periodontal inflammation, through the action of the various pro-inflammatory cytokines. Periodontal disease and certain systemic conditions can have a mutual association, as the pathogenic mechanisms of these diseases can involve similar molecular and cellular elements. The concept of ‘periodontal medicine’ comprises these pathogenic connections, focusing on the key role that periodontal health has on the general homeostasis and well-being

Advances in Locally Delivered Antimicrobials for Periodontitis Treatment

Periodontal disease represents an inflammatory disease of the tissues supporting the maintenance and functionality of the teeth on the dental arches. The main cause of periodontitis consists in periodontal dysbiosis, which will trigger an inflammatory response, progressively leading to periodontal tissue breakdown. Scaling and root planing represent the gold standard in treating periodontal diseases but, as it was already established, these measures are unable to completely eliminate the subgingival bacterial plaque. Therefore, new adjunctive therapies have emerged, involving systemic and local delivery of various antimicrobial products. This chapter aims to provide current knowledge on the local application of different periodontal supplementary therapies. The chapter focuses on local forms of antimicrobials, such as irrigations, gels or controlled release systems but also on laser/LED-assisted periodontal pocket photodynamic antibacterial therapy (PDT), along with various photosensitizers. Moreover, we present data from current guidelines regarding the recommendations for the main locally delivered antimicrobials

The Complex Relationship of Periodontal Disease and Rheumatoid Arthritis

The relationship between periodontitis and systemic diseases is an important part of clinical periodontal research, which has been growing steadily. Even though the etiologies of periodontal disease and rheumatoid arthritis (RA) differ, these pathologies have many common features, both being multifactorial diseases characterized by localized chronic inflammatory reactions, which are fuelled by an analogous set of cytokines (among many, the most prominent being Tumour Necrosis Factor (TNF), Interleukin (IL) 6 and 17), leading to high systemic circulating concentrations of inflammatory markers such as C-reactive protein (CRP). It was not until the discovery of peptidylarginine deiminase (PAD) mediated citrullination of proteins by Porphyromonas gingivalis that the link between the two diseases was purely speculative. This citrullination initiates a series of events which culminate in the production of anti-citrullinated protein antibodies (ACPA) and, finally, in the clinical manifestation of rheumatoid arthritis. Another common denominator is the bone destruction caused by proinflammatory cytokines secreted by T 17 helper cells (TH17) which is the pathological hallmark of both diseases. Other notable common areas are shared risk factors such as environmental and genetic risk factors. Regarding treatment, neither pathologies have a definitive cure, however, several strategies are employed, some of which are common, such as diet and lifestyle changes, and immunomodulating medication applied locally or systemically

The Effect of Acknowledged and Novel Anti-Rheumatic Therapies on Periodontal Tissues—A Narrative Review

Rheumatoid arthritis (RA) and periodontal disease (PD) are chronic complex inflammatory diseases with several common susceptibility factors, especially genetic and environmental risk factors. Although both disorders involve a perturbation of the immune–inflammatory response at multiple levels, one major difference between the two is the different locations in which they develop. RA is triggered by an exaggerated autoimmune response that targets joints, while periodontal disease occurs as a consequence of the subgingival periodontopathogenic microbiota. Current treatment models in both pathologies involve the stratification of patients to allow therapeutic individualization according to disease stage, complexity, progression, lifestyle, risk factors, and additional systemic diseases. Therapeutic guidelines for RA comprise of five main classes of drugs: non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs): biologic and non-biologic. Although various treatment options are available, a definitive treatment remains elusive, therefore research is ongoing in this area. Several alternatives are currently being tested, such as matrix metalloproteinases (MMP) inhibitors, toll-like receptors (TLR) blockers, pro-resolution mediators, anti-hypoxia inducing factors, stem cell therapy, NLRP3 inhibitors and even natural derived compounds. Although the link between PD and rheumatoid arthritis has been investigated by multiple microbiology and immunology studies, the precise influence and causality is still debated in the literature. Furthermore, the immunomodulatory effect of anti-rheumatic drugs on the periodontium is still largely unknown. In this narrative review, we explore the mechanisms of interaction and the potential influence that anti-rheumatoid medication, including novel treatment options, has on periodontal tissues and whether periodontal health status and treatment can improve the prognosis of an RA patient

METALLIC INSTRUMENTS CORROSION USED IN DENTAL OFFICE

Dental instruments are the tools that dental professionals use to achieve dental treatment. These include tools for examination, handling, restoration and removal of adjacent teeth and oral structures. Dental instruments and dental rotary instruments are made of stainless steel or titanium and its alloys. In this paper we present various corrosion types of these materials and experimental results on corrosion

EVALUATION OF GLYCEMIA AT THE LEVEL OF SULCULAR AND CAPILLARY BLOOD IN DIABETIC PATIENTS WITH PERIODONTAL DISEASES

Scope of the study: A reliable, rapid and non-invasive evaluation of the patients suffering from diabetes mellitus through investigation of glycemia from the sulcular (crev‑ icular) gingival blood. Materials and method: Laboratory investigations were made for evaluating the glycemia from the capillary (CBGL) and crevicular (SBGL) blood in 60 patients with periodontitis (30 suffering from diabetes, 30 non-diabetics), the obtained data being analyzed statisti‑ cally. Results: The mean values of glycemia (at both MSBG-sulcular and MCBG-capillary level), expressed in mg/dl, were of 168.60 and, respectively, 190.57. The MCBG level was of 269.73 for the group with diabetes and of 111.40 for the non-diabetic ones, respectively, whereas the MSBG level was of 240.217 for the first group and of 97.03 for the second one. An important correlation could be also observed between the levels of these values and the degree of periodontal affection. Conclusions: Testing of sulcular blood may represent an adequate, rapid and reliable method for the identification of patients affected with dia‑ betes, permitting to recommend a new screening protocol

Effects of Locally Delivered Minocycline Microspheres in Postmenopausal Female Patients with Periodontitis: A Clinical and Microbiological Study

The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection

The Assessment Of Root Canal Sealers Ph In The Treatment Of Periapical Inflammation Processes – An In Vitro Study

Introduction: The endodontic treatment represents the best conservative option for irreversible endodontically affected teeth maintenance on the dental arch. Besides the rigorous mechanic-chemical treatment, in aseptic conditions, the regenerative or, on the contrary, inhibitive qualities of the root canal sealer on the periradicular tissue play an important role in the long-term success of the treatment. The aim of the study The object of this study consisted in analysing the pH values of frequently used root canal sealers in the endodontic treatment, to make a series of correlations with their therapeutically indications. Materials and Methods We tested the following root canal sealers: AH-26 (De Trey), ZOE, Pulpispad (Spad, Dijon), Sealapex (Kerr), Endomethasone (Septodont), Endospad (Spad, Dijon). The materials were prepared according to the producer indications. The pH recordings were made on different time points: immediately after the preparation, after 24 hours, after a week and after two weeks. Results Our data analysis revealed a variation of the pH values of the 6 root canal sealers and differences in their pH values on different time recordings. The highest values were presented by Sealapex; in the alkaline values order, this was followed by Endomethasone and Endospad. The lowest pH values, to acid zones, were recorded from AH-26, ZOE and Pulpispad. Conclusions The presence in the root canal of an alkaline pH sealer ensures an additional opportunity for the infection control and tissue regeneration of the periradicular tissue. Due to this property, the root canal sealers that have calcium hydroxide in their composition are used more and more frequently

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities—A Narrative Review of Recent Data

The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique