RESUMEN

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

Asunto(s)

Costos de la Atención en Salud , Medicaid , Atención Odontológica , Humanos , New York , Evaluación de Resultado en la Atención de Salud , Estados Unidos

RESUMEN

Undiagnosed diabetes and prediabetes present a serious public health challenge. We previously reported that data available in the dental setting can serve as a tool for early dysglycemia identification in a primarily Hispanic, urban population. In the present study, we sought to determine how the identification approach can be recalibrated to detect diabetes or prediabetes in a White, rural cohort and whether an integrated dental-medical electronic health record (iEHR) offers further value to the process. We analyzed iEHR data from the Marshfield Clinic, a health system providing care in rural Wisconsin, for dental patients who were ≥21 y of age, reported that they had never been told they had diabetes, had an initial periodontal examination of at least 2 quadrants, and had a glycemic assessment within 3 mo of that examination. We then assessed the performance of multiple predictive models for prediabetes/diabetes. The study outcome, glycemic status, was gleaned from the medical module of the iEHR based on American Diabetes Association blood test cutoffs. The sample size was 4,560 individuals. Multivariate logistic regression revealed that the best performance was achieved by a model that took advantage of the iEHR. Predictors included age, sex, race, ethnicity, number of missing teeth, percentage of teeth with at least 1 pocket ≥5 mm from the dental EHR, and overweight/obesity, hypertension, hyperlipidemia, and smoking status from the medical EHR. The model achieved an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.69-0.72), yielding a sensitivity of 0.70 and a specificity of 0.62. Across a range of populations, informed by certain patient characteristics, dental care team members can play a role in helping to identify dental patients with undiagnosed diabetes or prediabetes. The accuracy of the prediction increases when dental findings are combined with information from the medical EHR. Knowledge Transfer Statement: Prediabetes and diabetes often go undiagnosed for many years. Early identification and care can lead to improved glycemic outcomes and prevent wide-ranging morbidity, including adverse oral health consequences, in affected individuals. Information available in the dental office can be used by clinicians to identify those who remain undiagnosed or are at risk; the accuracy of this prediction increases when combined with information from the medical electronic health record.

RESUMEN

OBJECTIVES: This study presents the global burden of major oral diseases with an exegetical commentary on their current profiles, the critical issues in oral healthcare and future perspectives. METHODS: A narrative overview of current literature was undertaken to synthesise the contexts with critical elaboration and commentary. RESULTS: Oral disease is one of the most common public health issues worldwide with significant socio-economic impacts, and yet it is frequently neglected in public health policy. The oral data extracted from the Global Burden of Disease Study in 2010 (Murray et al, 2012) show that caries, periodontal disease, edentulism, oral cancer and cleft lip/palate collectively accounted for 18 814 000 disability-adjusted life-years; and the global burden of periodontal disease, oral cancer and caries increased markedly by an average of 45.6% from 1990 to 2010 in parallel with the major non-communicable diseases like diabetes by 69.0%. Oral diseases and non-communicable diseases are closely interlinked through sharing common risk factors (e.g. excess sugar consumption and tobacco use) and underlying infection/inflammatory pathways. CONCLUSIONS: Oral disease remains a major public health burden worldwide. It is of great importance to integrate oral health into global health agenda via the common risk factor approach. The long-term sustainable strategy for global oral health should focus on health promotion and disease prevention through effective multidisciplinary teamwork.

Asunto(s)

Enfermedades de la Boca , Costo de Enfermedad , Humanos , Factores Socioeconómicos

RESUMEN

A change in the American Diabetes Association guidelines added hemoglobin A1c (HbA1c) to the assays for diabetes diagnosis, but evidence suggests that glucose vs. HbA1c criteria may identify different segments of the affected population. We previously demonstrated that oral findings offer an opportunity for the detection of undiagnosed abnormal fasting plasma glucose (FPG) among dental patients who present with diabetes risk factors. In this new cross-sectional study, we sought to extend these observations. The first goal, using data from 591 new participants, was to assess our previously identified hyperglycemia detection models when HbA1c is used for case definition. The second goal, using data from our total cohort of 1,097 participants, was to evaluate the models' performance regardless of whether an FPG or an HbA1c is used for diagnosis. The presence of ≥ 26% teeth with deep pockets or ≥ 4 missing teeth correctly identified 72% of pre-diabetes or diabetes cases in the HbA1c sample and 75% in the total population. The addition of a point-of-care HbA1c ≥ 5.7% increased correct identification to 87% and 90%, respectively. These results demonstrate the validity of our prediction models regardless of the test used for diabetes or pre-diabetes diagnosis in the clinical setting and underscore the contribution dentists can make.

Asunto(s)

Diabetes Mellitus Tipo 2/diagnóstico , Hiperglucemia/diagnóstico , Estado Prediabético/diagnóstico , Pérdida de Diente/complicaciones , Adulto , Glucemia/análisis , Distribución de Chi-Cuadrado , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/análisis , Humanos , Hiperglucemia/complicaciones , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estado Prediabético/complicaciones , Valor Predictivo de las Pruebas , Curva ROC , Factores de Riesgo , Sensibilidad y Especificidad

RESUMEN

Many diabetic patients remain undiagnosed, and oral findings may offer an unrealized opportunity for the identification of affected individuals unaware of their condition. We recruited 601 individuals who presented for care at a dental clinic, were ≥40 years old, if non-Hispanic white, and ≥30 years old, if Hispanic or non-white, and had never been told they have pre-diabetes or diabetes. Those with at least one self-reported diabetes risk factor (N=535) received a periodontal examination and a point-of-care hemoglobin A1c (HbA1c) test. A fasting plasma glucose (FPG) test was used as the study outcome, signifying potential diabetes or pre-diabetes. Performance characteristics of simple models of dysglycemia (FPG≥100 mg/dL) identification were evaluated and optimal cut-offs identified. A model including only two dental variables had an estimated area under the receiver operating characteristic curve (AUC) of 0.65. The addition of a point-of-care HbA1c test improved the AUC to 0.79 (p<0.001). The presence of ≥26% deep pockets or ≥4 missing teeth correctly identified 73% of true cases; the addition of an HbA1c≥5.7% increased correct identification to 92%. Analysis of our data suggests that oral healthcare professionals have the opportunity to identify unrecognized diabetes and pre-diabetes in dental patients and refer them to a physician for further evaluation and care.

Asunto(s)

Diabetes Mellitus Tipo 2/diagnóstico , Bolsa Periodontal/etiología , Pautas de la Práctica en Odontología , Estado Prediabético/diagnóstico , Adulto , Área Bajo la Curva , Glucemia/análisis , Distribución de Chi-Cuadrado , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/análisis , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Estado Prediabético/sangre , Estudios Prospectivos , Autoinforme , Sensibilidad y Especificidad , Pérdida de Diente/etiología

RESUMEN

BACKGROUND AND OBJECTIVE: The relationship between diabetes and periodontal diseases is well established. Our aim in this study was to explore the diabetes-related parameters that are associated with accelerated periodontal destruction in diabetic youth. MATERIAL AND METHODS: Three-hundred and fifty 6-18-year-old children with diabetes received a periodontal examination. Data on important diabetes-related variables were collected. Analyses were performed using logistic regression, with gingival/periodontal disease as the dependent variable, for the whole cohort and separately for two subgroups (6-11 and 12-18 years of age). RESULTS: Regression analyses, adjusting for age, gender, ethnicity, frequency of prior dental visits, dental plaque, and dental examiner, revealed a strong positive association between mean hemoglobin A1c over the 2 years prior to inclusion in the study and periodontitis (odds ratio = 1.31, p = 0.030). This association approached significance in the younger subgroup (odds ratio = 1.56, p = 0.052, n = 183). There was no significant relationship between diabetes duration or body mass index-for-age and measures of gingival/periodontal disease in this cohort. CONCLUSION: These findings suggest that accelerated periodontal destruction in young people with diabetes is related to the level of metabolic control. Good metabolic control may be important in addressing periodontal complications in young patients with diabetes, similarly to what is well established for other systemic complications of this disease.

Asunto(s)

Complicaciones de la Diabetes , Hemoglobina Glucada/análisis , Enfermedades Periodontales/etiología , Adolescente , Factores de Edad , Índice de Masa Corporal , Niño , Placa Dental/complicaciones , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Pérdida de la Inserción Periodontal/etiología , Factores de Tiempo

RESUMEN

Periodontal data typically consist of observations made at multiple sites within each patient. Observations within a patient tend to be positively correlated; hence, standard statistical techniques that assume independence are invalid. Regression techniques for correlated data have been proposed; communicating results from these models, however, is difficult, due to their inherent complexity. Simpler statistical approaches have also been proposed, but many of these methods can be applied only when covariates are specific to the subject, and do not vary from site to site within a subject. In this paper, we present two methods for the analysis of multiple 2x2 tables containing site-specific periodontal data. The methods presented are modifications of the well-known Mantel-Haenszel methods. We illustrate these methods using a subset of data from a clinical trial examining the effects of scaling and root planing on levels of interleukin-1 beta.

Asunto(s)

Interleucina-1/análisis , Modelos Estadísticos , Bolsa Periodontal , Distribución de Chi-Cuadrado , Análisis por Conglomerados , Intervalos de Confianza , Factores de Confusión Epidemiológicos , Raspado Dental , Líquido del Surco Gingival/inmunología , Humanos , Oportunidad Relativa , Bolsa Periodontal/inmunología , Bolsa Periodontal/patología , Bolsa Periodontal/terapia

RESUMEN

The aim of this report is to provide early data from an ongoing study examining (i) the relationship between periodontal infections and pre-term low birth weight (PLBW) in a cohort of young, minority, pregnant and post-partum women; and (ii) the effect of periodontal interventions on pregnancy outcome. During the first 2 yr of the study, 213 women were enrolled and examined clinically for dental plaque, calculus, bleeding on probing, and probing depth. Birth outcome data were available for 164 women, including one group (n = 74) subjected to oral prophylaxis during pregnancy, and a second group (n=90) who received no prenatal periodontal treatment. Subgingival plaque samples were available from 145 subjects (4 samples/subject) and were analyzed by checkerboard DNA hybridization with respect to 12 bacterial species. The prevalence of PLBW was 16.5% (27 cases) in this cohort. No differences in clinical periodontal status were observed between PLBW cases and women with normal birth outcome. However, PLBW mothers had significantly higher levels of Bacteroides forsythus and Campylobacter rectus, and consistently elevated counts for the other species examined. PLBW occurred in 18.9% of the women who did not receive periodontal intervention (17 cases), and in 13.5% (10 cases) of those who received such therapy.

Asunto(s)

Recién Nacido de Bajo Peso , Trabajo de Parto Prematuro/etiología , Enfermedades Periodontales/complicaciones , Complicaciones Infecciosas del Embarazo/microbiología , Adolescente , Adulto , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Bacteroides/aislamiento & purificación , Campylobacter/aislamiento & purificación , Distribución de Chi-Cuadrado , Niño , ADN Bacteriano/análisis , Placa Dental/microbiología , Profilaxis Dental , Femenino , Humanos , Recién Nacido , Grupos Minoritarios , Ciudad de Nueva York , Hibridación de Ácido Nucleico/métodos , Trabajo de Parto Prematuro/microbiología , Enfermedades Periodontales/microbiología , Enfermedades Periodontales/prevención & control , Pobreza , Embarazo

RESUMEN

In hyperglycemic states found in diabetics, a nonenzymatic glycation and oxidation of proteins and lipids occurs. As a result, advanced glycation end products (AGEs), particularly N epsilon-(carboxymethyl)lysine, accumulate in the plasma and tissues of diabetic subjects. This accumulation has been linked to the development of pathogenic complications of diabetes. Many of the effects of AGEs are receptor-dependent and involve a multi-ligand member of the immunoglobulin superfamily of cell surface molecules. The best characterized of these is the receptor for advanced glycation end products (RAGE), which is expressed by multiple cell types including endothelium and mononuclear phagocytes. Based on data from a variety of sources, including studies of RAGE-deficient mice, it appears that RAGE plays a central role in oral infection, exaggerated inflammatory host responses, and destruction of alveolar bone in diabetes. It is possible that antagonists of RAGE might have a valuable adjunctive therapeutic role for the management of periodontal disease found in diabetics.

Asunto(s)

Diabetes Mellitus/metabolismo , Productos Finales de Glicación Avanzada/metabolismo , Proteínas de la Membrana/metabolismo , Enfermedades Periodontales/metabolismo , Receptores Inmunológicos/metabolismo , Pérdida de Hueso Alveolar/metabolismo , Animales , Diabetes Mellitus/sangre , Modelos Animales de Enfermedad , Endotelio Vascular/metabolismo , Productos Finales de Glicación Avanzada/antagonistas & inhibidores , Productos Finales de Glicación Avanzada/sangre , Hiperglucemia/metabolismo , Inmunoglobulinas/metabolismo , Ligandos , Lisina/análogos & derivados , Lisina/sangre , Lisina/metabolismo , Proteínas de la Membrana/antagonistas & inhibidores , Proteínas de la Membrana/sangre , Ratones , Ratones Endogámicos C57BL , Ratones Endogámicos , Enfermedades Periodontales/sangre , Periodontitis/metabolismo , Fagocitos/metabolismo , Receptor para Productos Finales de Glicación Avanzada , Receptores Inmunológicos/antagonistas & inhibidores , Receptores Inmunológicos/sangre

Asunto(s)

Complicaciones de la Diabetes , Enfermedades Periodontales/complicaciones , Animales , Glucemia/análisis , Diabetes Mellitus/sangre , Diabetes Mellitus/fisiopatología , Productos Finales de Glicación Avanzada/fisiología , Humanos , Hiperglucemia/fisiopatología , Hiperlipidemias/fisiopatología , Proteínas de la Membrana/fisiología , Enfermedades Periodontales/microbiología , Enfermedades Periodontales/fisiopatología , Periodontitis/fisiopatología , Porphyromonas gingivalis/fisiología , Receptor para Productos Finales de Glicación Avanzada , Receptores Inmunológicos/fisiología

RESUMEN

BACKGROUND: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline. METHODS: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months. RESULTS: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups. CONCLUSIONS: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Asunto(s)

Antibacterianos/uso terapéutico , Minociclina/uso terapéutico , Periodontitis/tratamiento farmacológico , Administración Tópica , Adulto , Factores de Edad , Anciano , Análisis de Varianza , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Cápsulas , Terapia Combinada , Intervalos de Confianza , Raspado Dental , Femenino , Estudios de Seguimiento , Hemorragia Gingival/tratamiento farmacológico , Hemorragia Gingival/terapia , Humanos , Masculino , Microesferas , Persona de Mediana Edad , Minociclina/administración & dosificación , Minociclina/efectos adversos , Oportunidad Relativa , Pérdida de la Inserción Periodontal/tratamiento farmacológico , Pérdida de la Inserción Periodontal/terapia , Bolsa Periodontal/tratamiento farmacológico , Bolsa Periodontal/terapia , Periodontitis/terapia , Vehículos Farmacéuticos , Seguridad , Factores Sexuales , Fumar , Resultado del Tratamiento

RESUMEN

As noted in both this and the previous review, our understanding of the etiology, diagnosis, and treatment of the periodontal diseases is continuously evolving. Periodontology in the year 2001 is different than what it was 20 years ago, and the specialty will be different 20 years in the future. Assessment of patients will be more specific, and the development of risk profiles will allow identification of individuals who require greater or lesser amounts of care. Therapy can then be directed to the specific needs of each patient. Surgical periodontics will be focused on regeneration, not resection. Lastly, as patients continue care on a maintenance schedule, their status will be assessed by sensitive tests that will predict the onset of an active phase of disease so that appropriate interceptive treatment can be provided.

Asunto(s)

Enfermedades Periodontales/terapia , Antibacterianos/uso terapéutico , Raspado Dental , Predicción , Líquido del Surco Gingival/química , Gingivitis/clasificación , Bacterias Gramnegativas/clasificación , Regeneración Tisular Guiada Periodontal , Humanos , Mediadores de Inflamación/análisis , Pérdida de la Inserción Periodontal/clasificación , Pérdida de la Inserción Periodontal/diagnóstico , Pérdida de la Inserción Periodontal/cirugía , Pérdida de la Inserción Periodontal/terapia , Enfermedades Periodontales/clasificación , Enfermedades Periodontales/diagnóstico , Enfermedades Periodontales/cirugía , Bolsa Periodontal/clasificación , Bolsa Periodontal/diagnóstico , Bolsa Periodontal/cirugía , Bolsa Periodontal/terapia , Periodontitis/clasificación , Periodontitis/diagnóstico , Periodontitis/cirugía , Periodontitis/terapia , Aplanamiento de la Raíz

Asunto(s)

Enfermedades Periodontales/terapia , Adulto , Complicaciones de la Diabetes , Progresión de la Enfermedad , Susceptibilidad a Enfermedades , Predicción , Bacterias Gramnegativas/fisiología , Estado de Salud , Humanos , Enfermedades Periodontales/etiología , Enfermedades Periodontales/fisiopatología , Factores de Riesgo , Fumar/efectos adversos

RESUMEN

BACKGROUND: This review examines salivary constituents as potential diagnostic tests for periodontal disease. Saliva is a fluid that is readily available and contains locally-produced microbial and host response mediators, as well as systemic (serum) markers that may prove to be an aid in the diagnosis of periodontal disease. METHODS: A medline search was conducted and the relevant literature concerning the applications of saliva for periodontal diagnosis was reviewed. RESULTS: Based on the literature, salivary markers that have been studied as potential diagnostic tests for periodontal disease include proteins of host origin (i.e., enzymes, immunoglobulins), phenotypic markers, host cells, hormones (cortisol), bacteria and bacterial products, ions and volatile compounds. CONCLUSIONS: A number of markers show promise as sensitive measures of disease and the effectiveness of therapy. At this time, host-derived enzymes and other inflammatory mediators orginating from the gingival crevice appear to hold the greatest promise as salivary diagnostic tests for periodontal disease. Longer-term longitudinal studies, however, are required to establish the relationship between specific markers and progression of periodontal disease. Furthermore, analysis of saliva may offer a cost-effective approach to assessment of periodontal disease in large populations.

Asunto(s)

Enfermedades Periodontales/diagnóstico , Saliva/química , Bacterias/aislamiento & purificación , Pruebas Enzimáticas Clínicas , Humanos , Hidrocortisona/análisis , Isotipos de Inmunoglobulinas/análisis , Mediadores de Inflamación/análisis , Saliva/enzimología , Saliva/inmunología , Saliva/microbiología , Proteínas y Péptidos Salivales/análisis

RESUMEN

Diabetes is associated with increased prevalence, severity, and progression of periodontal disease. To test the hypothesis that activation of RAGE (Receptor for Advanced Glycation End products) contributes to the pathogenesis of diabetes-associated periodontitis, we treated diabetic mice, infected with the human periodontal pathogen Porphyromonas gingivalis, with soluble RAGE (sRAGE). sRAGE is the extracellular domain of the receptor, which binds ligand and blocks interaction with, and activation of, cell-surface RAGE. Blockade of RAGE diminished alveolar bone loss in a dose-dependent manner. Moreover, we noted decreased generation of the proinflammatory cytokines TNF-alpha and IL-6 in gingival tissue, as well as decreased levels of matrix metalloproteinases. Gingival AGEs were also reduced in mice treated with sRAGE, paralleling the observed suppression in alveolar bone loss. These findings link RAGE and exaggerated inflammatory responses to the pathogenesis of destructive periodontal disease in diabetes.

Asunto(s)

Pérdida de Hueso Alveolar/prevención & control , Infecciones por Bacteroidaceae/etiología , Diabetes Mellitus Experimental/complicaciones , Productos Finales de Glicación Avanzada/metabolismo , Periodontitis/etiología , Receptores Inmunológicos/fisiología , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/inmunología , Pérdida de Hueso Alveolar/metabolismo , Animales , Infecciones por Bacteroidaceae/complicaciones , Infecciones por Bacteroidaceae/inmunología , Infecciones por Bacteroidaceae/metabolismo , Modelos Animales de Enfermedad , Productos Finales de Glicación Avanzada/administración & dosificación , Humanos , Interleucina-6/metabolismo , Masculino , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 3 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , Ratones , Ratones Endogámicos C57BL , Periodontitis/complicaciones , Periodontitis/inmunología , Periodontitis/metabolismo , Porphyromonas gingivalis/inmunología , Porphyromonas gingivalis/patogenicidad , Receptor para Productos Finales de Glicación Avanzada , Receptores Inmunológicos/antagonistas & inhibidores , Receptores Inmunológicos/inmunología , Factor de Necrosis Tumoral alfa/metabolismo

Asunto(s)

Complicaciones de la Diabetes , Diabetes Mellitus/metabolismo , Productos Finales de Glicación Avanzada/metabolismo , Periodontitis/etiología , Animales , Diabetes Mellitus/prevención & control , Productos Finales de Glicación Avanzada/antagonistas & inhibidores , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/metabolismo , Inmunoterapia , Ratones , Ratones Endogámicos NOD , Estrés Oxidativo , Periodontitis/metabolismo , Receptores Inmunológicos/metabolismo

RESUMEN

Recent evidence suggests that periodontal disease may play an etiologic role in the pathogenesis of several systemic illnesses, such as cardiovascular disease and preterm birth. This article reviews proposed mechanisms for such associations and outlines studies currently underway aimed at clarifying this issue. Results from this line of research may fundamentally change the way we approach our periodontitis patients.

Asunto(s)

Periodontitis/complicaciones , Enfermedades Cardiovasculares/etiología , Trastornos Cerebrovasculares/etiología , Diabetes Mellitus/etiología , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Investigación

RESUMEN

BACKGROUND: In previous studies, we demonstrated that increased levels of immunoglobulin A (IgA) in gingival crevicular fluid (GCF) may be "protective", while increased levels of the polymorphonuclear lysosomal enzyme, beta-glucuronidase, in GCF were associated with increased risk of disease activity. In this study, we examined the effect of scaling and root planing (SRP) on the levels of beta-glucuronidase, IgG, and IgA in GCF over a 24-week period and compared these to clinical attachment loss (CAL). METHODS: Twenty-nine patients with periodontal disease were examined for attachment level, probing depth, plaque, and bleeding on probing at 6 sites per tooth. GCF was collected from the mesial aspect of all teeth excluding third molars and analyzed for beta-glucuronidase, IgG, and IgA. After baseline data were collected, each patient received SRP, and GCF was collected again at 2, 4, 6, 8, 12, and 24 weeks post-SRP while clinical data were obtained at 4, 8, 12, and 24 weeks. In addition, we analyzed whether the magnitude of the IgA response to SRP would affect the rate of periodontal disease progression by examining GCF IgA levels at 2 time intervals: 2 to 4 weeks post-SRP and 6 to 12 weeks post-SRP. RESULTS: Seventeen patients (58.6%) exhibited at least 1 site losing > or =2.5 mm of CAL during the 24-week study. Beta-glucuronidase in GCF was significantly decreased at 2 weeks following SRP and then demonstrated a gradual increase throughout the study period. Levels of IgA in GCF significantly increased following SRP, reaching a peak at 6 weeks and then gradually decreasing throughout the study. Furthermore, we found an inverse relationship between GCF IgA levels at 6 to 12 weeks post-SRP and the occurrence of CAL. CONCLUSIONS: These results support the hypothesis that maintenance of high levels of IgA in GCF may be "protective" against periodontal attachment loss. Furthermore, levels of beta-glucuronidase appear to be a more sensitive indicator of gingival inflammation than clinical measures.

Asunto(s)

Líquido del Surco Gingival/química , Inmunoglobulina A/análisis , Pérdida de la Inserción Periodontal/diagnóstico , Adulto , Análisis de Varianza , Biomarcadores/análisis , Protocolos Clínicos , Raspado Dental , Glucuronidasa/análisis , Humanos , Inmunoglobulina G/análisis , Lisosomas/enzimología , Pérdida de la Inserción Periodontal/terapia , Aplanamiento de la Raíz , Factores de Tiempo

RESUMEN

BACKGROUND: A specific composite genotype of the polymorphic interleukin-1 (IL-1) gene cluster has recently been associated with severe periodontitis. One polymorphism of the composite periodontitis-associated genotype (PAG) has been functionally linked with expression of high levels of IL-1. The purpose of this study was to test whether gingival crevicular fluid (GCF) levels of IL-1beta and tumor necrosis factor-alpha (TNFalpha), and gingival tissue levels of IL-1alpha, IL-1beta, and TNFalpha correlate with PAG, and to examine the effect of conservative periodontal therapy on these levels. METHODS: Twenty-two adults with moderate to advanced periodontal disease were enrolled. Polymerase chain reaction amplification and restriction enzymes were used to identify specific polymorphisms from peripheral blood samples. GCF samples were collected at baseline and 3 weeks following conservative treatment and analyzed by ELISA for IL-1beta and TNFalpha. An interproximal gingival biopsy was collected at baseline and follow-up and analyzed for IL-1alpha, IL-1beta, and TNFalpha by ELISA. RESULTS: The genotyping identified 7 as PAG(+) and 15 as PAG(-). The 2 groups were comparable in terms of existing periodontitis and age. In shallow sites (<4 mm), total IL-1beta in GCF was 2.5 times higher for PAG(+) patients prior to treatment (P=0.03), and 2.2 times higher after treatment (P=0.04), while differences were less apparent in deeper sites. Following treatment, a reduction in IL-1beta concentration in GCF was seen for PAG(-) but not for PAG(+) patients. While not statistically significant, a trend was observed in mean tissue levels of IL-1beta which were 3.6 times higher in PAG(+) versus PAG(-) patients (P=0.09). CONCLUSIONS: These data suggest that PAG(+) patients may demonstrate phenotypic differences as indicated by elevated levels of IL-1beta in GCF.

Asunto(s)

Encía/metabolismo , Líquido del Surco Gingival/metabolismo , Interleucina-1/genética , Periodontitis/genética , Factor de Necrosis Tumoral alfa/genética , Adulto , Análisis de Varianza , Raspado Dental , Femenino , Predisposición Genética a la Enfermedad , Encía/química , Líquido del Surco Gingival/química , Humanos , Interleucina-1/análisis , Interleucina-1/biosíntesis , Masculino , Persona de Mediana Edad , Bolsa Periodontal/genética , Periodontitis/terapia , Reacción en Cadena de la Polimerasa , Polimorfismo Genético , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/biosíntesis

RESUMEN

Our understanding of the etiology and pathogenesis of periodontal diseases has grown in the recent past, and new findings have led to advances in patient management. This article summarizes important new knowledge and offers a description of traditional and novel diagnostic approaches. These include clinical and radiographic assessments of the periodontal tissues, evaluation of the microbial challenge and the host response, and certain elements of the host genotype that may confer susceptibility to destructive periodontal diseases.

Asunto(s)

Periodontitis/diagnóstico , Técnicas de Tipificación Bacteriana , Recuento de Colonia Microbiana , Instrumentos Dentales , Líquido del Surco Gingival/inmunología , Humanos , Periodoncia/instrumentación , Periodontitis/microbiología