Diseño de una escala de salud oral de potencialidad infecciosa

La combinación de diferentes variables para conformar escalas de salud oral no ha sido una práctica muy habitual en la literatura odontológica. La idea de representar el estado de salud oral con un único valor numérico cobró un especial interés con el desarrollo de la “Medicina Periodontal”, que intenta establecer correlaciones entre los procesos infecciosos/inflamatorios de la cavidad oral y el desarrollo de determinadas enfermedades sistémicas. En este trabajo proponemos una nueva escala de salud oral global, que permitirá concretar en una única variable la potencialidad infecciosa de la cavidad oral, cuya expresión clínica son las infecciones locales y focales. La escala incorpora variables dentales y periodontales, organizadas en índices objetivos y contrastados, que reflejan en cierta medida la presencia de las principales entidades infecciosas de la cavidad oral, la caries y la enfermedad periodontal. Para simplificar la escala, se propone su aplicación mediante sistemas parciales de exploración oral. Se demuestra que la escala proporciona una información más fidedigna del estado de salud oral que la estimación subjetiva derivada de la visualización de un set de fotografías intraorales. Por último, se estableció la correlación de los diferentes grados de la escala con la presencia y la concentración de diversas especies bacterianas en la flora salival

Relationship between dental and periodontal health status and the salivary microbiome: bacterial diversity, co-occurrence networks and predictive models

The present study used 16S rRNA gene amplicon sequencing to assess the impact on salivary microbiome of different grades of dental and periodontal disease and the combination of both (hereinafter referred to as oral disease), in terms of bacterial diversity, co-occurrence network patterns and predictive models. Our scale of overall oral health was used to produce a convenience sample of 81 patients from 270 who were initially recruited. Saliva samples were collected from each participant. Sequencing was performed in Illumina MiSeq with 2 × 300 bp reads, while the raw reads were processed according to the Mothur pipeline. The statistical analysis of the 16S rDNA sequencing data at the species level was conducted using the phyloseq, DESeq2, Microbiome, SpiecEasi, igraph, MixOmics packages. The simultaneous presence of dental and periodontal pathology has a potentiating effect on the richness and diversity of the salivary microbiota. The structure of the bacterial community in oral health differs from that present in dental, periodontal or oral disease, especially in high grades. Supragingival dental parameters influence the microbiota’s abundance more than subgingival periodontal parameters, with the former making a greater contribution to the impact that oral health has on the salivary microbiome. The possible keystone OTUs are different in the oral health and disease, and even these vary between dental and periodontal disease: half of them belongs to the core microbiome and are independent of the abundance parameters. The salivary microbiome, involving a considerable number of OTUs, shows an excellent discriminatory potential for distinguishing different grades of dental, periodontal or oral disease; considering the number of predictive OTUs, the best model is that which predicts the combined dental and periodontal statusThis investigation was supported by the Instituto de Salud Carlos III (General Division of Evaluation and Research Promotion, Madrid, Spain) and co-financed by FEDER (“A way of making Europe”) under grant ISCIII/PI17/01722, and the CESPU under grants MVOS2016 and MVOS-PT-IINFACTS-2019S