Risk factors and active matrix metalloproteinase-8 (aMMP-8) diagnostics for initial periodontitis in adolescents

Periodontitis (gum disease) is a chronic multifactorial infectious and inflammatory disease that causes the destruction of the supporting tissues of the teeth but can also cause chronic low-grade inflammation. Thus, periodontitis has also adverse systemic effects and is associated with several underlying health conditions, including diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, hypertension, and cancer. It should be also noted that periodontitis is a globally major oral disease whose incidence increases significantly between the ages of 20 and 40. These points underscore the importance of identifying at-risk patients as early as possible for well-timed and effective prevention and treatment. Unfortunately, identifying initial periodontitis is a challenge in primary care. Often these patients are identified after the periodontal disease has already initiated, progressed and caused visible clinical signs and radiographical findings. Patients themselves usually have not been aware of the disease and its development, which is why the prevention and treatment of periodontitis are usually mostly reactive. With this background this thesis study investigated new, effective ways to improve the diagnosis of initial periodontitis. It focuses on the risk factors of initial periodontitis in adolescents (study I) and the use of the active matrix metalloproteinase-8 (aMMP-8) mouthrinse point-of-care (PoC) test in the diagnosis of initial periodontitis to identify at-risk adolescents (study II-IV). This study utilized two samples (birth cohorts) of 15–17-year-old Finnish adolescents from the city of Kotka that were collected in 2004-2005 (N = 501) and 2014-2015 (N = 47). The results in this thesis study support the findings of previous studies that the main risk factor for initial periodontitis is the bacterial biofilm and its interaction with the immune defenses of the host, which first causes gingivitis and eventually dysbiosis of the biofilm and leads to the onset of attachment loss. Elevated aMMP-8 concentration in oral fluids, smoking, male gender and accumulation of bacterial biofilm together with elevated levels of gingival bleeding seem to be the factors that are predisposing adolescents the most to initial periodontitis. Furthermore, aMMP-8 concentration in mouthrinse seems to be more useful biomarker than full-mouth bleeding on probing to identify the onset of periodontitis. The obtained results support that the aMMP-8 mouthrinse PoC test may improve the identification and prevention of initial periodontitis. Finally, the results in this thesis offer several interesting research questions for the future follow-up studies on initial periodontitis in adolescents.Parodontiitti eli hampaan kiinnityskudossairaus on krooninen monitekijäinen infektio- ja tulehdussairaus, joka aiheuttaa hampaiden tukikudosten tuhoa. Sillä on myös haitallisia systeemisiä vaikutuksia. Kroonisena matala-asteisena tulehdustilana parodontiitti on yhdistetty useisiin kroonisiin sairauksiin, mukaan lukien diabetes, sydän- ja verisuonitaudit, keuhkoahtaumatauti, verenpainetauti ja syöpä. Parodontiitti on maailmanlaajuisesti merkittävä suun sairaus, jonka ilmaantuvuus lisääntyy merkittävästi 20–40-ikävuoden välillä. Nämä seikat korostavat nuorten riskipotilaiden tunnistamisen tärkeyttä mahdollisimman varhaisessa vaiheessa, jotta parodontiitin ennaltaehkäisy ja hoito olisi oikein ajoitettua ja tehokasta. Siten voitaisiin vähentää parodontiitin aiheuttamia terveydellisiä ja taloudellisia rasitteita niin yksilöille, yhteisöille kuin yhteiskunnallekin. Alkavan parodontiitin tunnistaminen on haastavaa perusterveydenhuollossa. Usein parodontiittipotilaat tunnistetaan ja löydetään vasta sen jälkeen, kun parodontiumissa kiinnityskudossairaus on jo alkanut, edennyt ja aiheuttanut selkeästi havaittavat kliiniset ja röntgenologiset löydökset. Potilaat itse eivät ole yleensä tietoisia sairaudestaan ja sen kehittymisestä, minkä vuoksi parodontiitin ehkäisy ja hoito ovat yleensä lähinnä reaktiivisia. Tätä taustaa vasten tässä väitöskirjassa tutkittiin uusia tapoja tehostaa nuorten alkavan parodontiitin diagnosointia keskittyen nuorten alkavan parodontiitin riskitekijöihin (tutkimus I) ja aktiivisen matriksin metalloproteinaasi-8 (aMMP-8)-suuhuuhdevieritestin käyttöön alkavan parodontiitin diagnostiikassa riskinuorten tunnistamiseksi (tutkimukset II-IV). Aineistona käytettiin kahta suomalaisista 15–17-vuotiaista kotkalaisnuorista koostuvaa syntymäkohorttia, jotka on kerätty vuosina 2004-2005 (N = 501) ja 2014-2015 (N = 47). Väitöstutkimuksen tulokset tukevat aiempia tutkimuslöydöksiä, että alkavan parodontiitin pääriskitekijänä toimii bakteeribiofilmi ja sen vuorovaikutus kehon immuunipuolustuksen kanssa, mikä aiheuttaa ensin ientulehduksen ja lopulta biofilmin dysbioosin johtaen hampaiden kiinnityskudostuhon alkamiseen. Suunesteen kohonnut aMMP-8-konsentraatio, tupakointi, miessukupuoli ja bakteeribiofilmin kerääntyminen yhdessä lisääntyneen ienverenvuodon kanssa näyttäisivät altistavan eniten alkavalle parodontiitille. Lisäksi suuhuuhteen aMMP-8-konsentraatio näyttäisi olevan hyödyllisempi biomerkkiaine kuin ienverenvuoto alkavan parodontiitin tunnistamiseksi. Saadut tulokset tukevat aMMP-8-suuhuuhdevieritestin käyttöä nuorten alkavan parodontiitin tunnistamisen ja ennaltaehkäisyn kohdentamisen tehostamisessa. Väitöstutkimuksen tulokset tarjoavat useita mielenkiintoisia tutkimuskysymyksiä tuleville nuorten alkavaa parodontiittia koskeville jatkotutkimuksille

Periodontitis as a Risk of Hospitalization and Death by SARS-CoV-2

Non peer reviewe

Repeated Daily Use of Dual-Light Antibacterial Photodynamic Therapy in Periodontal Disease—A Case Report

Good oral hygiene at home is the foundation for optimal treatment response and long-term periodontal disease control. Antibacterial photodynamic therapy (aPDT) provides a very potent adjunctive treatment for plaque control. However, the literature regarding repeated aPDT use is sparse. aPDT has been a modality applied mainly in the dental office environment, and when applied once a year or every few months, the results have been usually disappointing. Recently, LED development has brought aPDT for repeated and practical use at home. We present the very positive results and clinical outcome of daily applied dual-light aPDT-technology treatment in conjunction with mechanical cleaning of a 78-year-old male patient with severe periodontal disease (Stage IV and Grade B)

Interaction between TCF7L2 rs7903146 Genotype, HbA1c Levels, and the Periodontal Status of Dental Patients

Publisher Copyright: © 2021 Georg Thieme Verlag. All rights reserved.Objective The aim of the study was to investigate the potential interaction between TCF7L2 rs7903146 genotype, which is implicated for type-2 diabetes mellitus genetic susceptibility, HbA1c levels, and the periodontal status of dental patients. Materials and Methods HbA1c levels, clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, and plaque index), and several parameters (such as body mass index [BMI], smoking habits, education level, and age) were recorded in 150 patients who fulfilled the criteria for screening for prediabetes/diabetes of the Centers for Disease Control and Prevention. DNA was extracted and the TCF7L2 single nucleotide polymorphism (SNP) rs7903146 was genotyped in all participants. Results Thirty-one patients out of 150 tested were found with unknown hyperglycemia (20.7%). Regarding sex, education, parent with diabetes, normal BMI, smoking, age ≥45 years and prior testing for diabetes, no differences were observed between patients displaying HbA1c 0.05). Regarding periodontal parameters and differences between subgroups (HbA1c levels ≥ 5.7 and HbA1c levels 5.7 and HbA1c 0.05). Statistical AnalysisPatient characteristics and their association with prediabetes were tested by Pearson's Chi-square test (asymptotic, two sided). Differences of periodontal parameters between subgroups were tested with the Mann-Whitney U-test. The associations of allele and genotype frequencies in the patient and control groups were analyzed using the Fisher's exact test of independence.The significance level was set at the 0.05 for all tests. Conclusion A statistically significant association between TCF7L2 rs7903146 genotype and periodontal condition or HbA1c levels was not observed in contrast to statistically significant differences of clinical parameters of periodontitis in patients with hyperglycemia.Peer reviewe

Lingonberry polyphenols : Potential SARS-CoV-2 inhibitors as nutraceutical tools?

Proposed pathway of the effect of lingonberry polyphenols on oral microbial (viral) load reduction and consequent beneficial local and systemic (respiratory tract) anti-inflammatory and antimicrobial/antiviral effects.Non peer reviewe

Effects of Fermented Lingonberry Juice Mouthwash on Salivary Parameters-A One-Year Prospective Human Intervention Study

A one-year prospective human intervention study was performed to examine the effects of fermented lingonberry juice (FLJ), used as a mouthwash for six months, on salivary parameters. A total of 25 adult participants used 10 mL of FLJ as mouthwash 30 s daily for 6 months in addition to their normal oral homecare routines. Standard oral examinations and gathering of samples were performed at the beginning of the study and after six months and one year. Resting and stimulated saliva secretion rates, resting saliva pH, and stimulated saliva buffering capacity were determined. A questionnaire of participants' subjective sensations of mouth dryness was also recorded at each timepoint. Fermented lingonberry juice mouthwash had positive effect to all five salivary parameters and were, according to the omnibus test, statistically significant during the study period. Analysis of the subjective dry mouth sensation questionnaires revealed that symptoms of xerostomia decreased due to the use of FLJ. This study revealed that the once-a-day use of FLJ mouthwash had a beneficial, increasing effect on salivary flow rates, buffering capacity, and salivary pH. FLJ thus can be safely used as an adjunctive and beneficial therapy in oral homecare, protecting teeth and oral mucosa, including periodontium, and also relieving dry mouth symptoms.Peer reviewe

Effects of Fermented Lingonberry Juice Mouthwash on Salivary Parameters—A One-Year Prospective Human Intervention Study

A one-year prospective human intervention study was performed to examine the effects of fermented lingonberry juice (FLJ), used as a mouthwash for six months, on salivary parameters. A total of 25 adult participants used 10 mL of FLJ as mouthwash 30 s daily for 6 months in addition to their normal oral homecare routines. Standard oral examinations and gathering of samples were performed at the beginning of the study and after six months and one year. Resting and stimulated saliva secretion rates, resting saliva pH, and stimulated saliva buffering capacity were determined. A questionnaire of participants’ subjective sensations of mouth dryness was also recorded at each timepoint. Fermented lingonberry juice mouthwash had positive effect to all five salivary parameters and were, according to the omnibus test, statistically significant during the study period. Analysis of the subjective dry mouth sensation questionnaires revealed that symptoms of xerostomia decreased due to the use of FLJ. This study revealed that the once-a-day use of FLJ mouthwash had a beneficial, increasing effect on salivary flow rates, buffering capacity, and salivary pH. FLJ thus can be safely used as an adjunctive and beneficial therapy in oral homecare, protecting teeth and oral mucosa, including periodontium, and also relieving dry mouth symptoms

Lingonberries—General and Oral Effects on the Microbiome and Inflammation

Lingonberry (Vaccinium vitis ideae L.) is a low-bush wild plant found in the northern hemisphere. The berries are used in traditional medicine in Finland to treat oral yeast infections. General and oral effects of lingonberries on the microbiome and inflammation are reviewed. A brief introduction to oral microbiome symbiosis and dysbiosis, innate and adaptive immunity and inflammation are included, and special features in microbe/host interactions in the oral environment are considered. In vitro anticancer, antimicrobial, antioxidant, anti-inflammatory, and in vivo mouse and human studies are included, focusing on the symbiotic effect of lingonberries on oral and general health

Host-Modulation Therapy and Chair-Side Diagnostics in the Treatment of Peri-Implantitis

Previous studies report periodontitis and peri-implantitis being able to induce systemic low-grade inflammation, which is known to be associated with increased risk for some systemic medical disease such as cardiovascular disease. In this regard, recent studies have shown that host modulation therapy (HMT) together with traditional mechanical and surgical treatment not only cease the progression of periodontitis but also reduce the systemic collagenolytic biomarkers in both oral fluids and circulation. This suggests that the corresponding adjunctive HMT-medication could be effective in the prevention and treatment of dental peri-implantitis, as well. Furthermore, low-cost, safe, and practical oral fluid active matrix metalloproteinase-8 (aMMP-8) lateral-flow immunotests have been proposed as point-of-care/chair-side diagnostic tools to detect peri-implantitis and periodontitis, and to monitor their effective resolutions, while using various therapeutic strategies, including host modulation. This study reports the potential benefits of HMT-medication in the prevention and treatment of dental peri-implantitis among five patients (four of five were current/ex-smokers). In addition, the aMMP-8 point-of-care test diagnosed 20 peri-implantitis and 20 healthy controls correctly. In conclusion, this study and previous studies support the potential effectiveness of HMT-medication(s) and point-of-care/chair-side technologies in the treatment and diagnostics/monitoring of peri-implantitis. However, more studies are needed to further confirm this.Peer reviewe