Search Results (174)

Objectives: This study aimed to assess the knowledge, attitudes, and self-confidence of physicians and dentists in Croatia regarding the relationship between oral and systemic health, focusing on periodontal disease and oral manifestations of systemic diseases. Methods: A cross-sectional, web-based survey was conducted among physicians and dentists in Croatian primary healthcare. The questionnaire addressed six thematic domains, including demographic information, knowledge, self-assessment, and clinical practice. Descriptive and comparative statistical analyses were performed. Results: A total of 529 respondents were included (291 physicians and 238 dentists). The mean knowledge score for the association between periodontitis and systemic diseases was 6.8 ± 3.6 out of 15, indicating limited knowledge. For oral manifestations of systemic diseases, the mean score was 10.0 ± 3.8 out of 16, reflecting moderate proficiency. Dentists scored higher than physicians in both domains, though not significantly (p > 0.05). Routine oral mucosal examinations were reported by 89.5% of dentists and 43.0% of physicians (p ≤ 0.001). Only 21.3% of physicians correctly identified the link between periodontitis and adverse pregnancy outcomes, compared to 58.8% of dentists. The primary barriers to effective clinical management were a lack of experience (52.7%) and inadequate education. While 68.3% of dentists felt adequately educated on oral–systemic links, only 22.7% of physicians reported the same. Conclusions: Significant gaps in knowledge and confidence were observed, particularly among physicians. These findings underscore the need to integrate oral–systemic health topics into medical education and to promote interprofessional collaboration to improve patient outcomes. Full article

Background: Genetic polymorphisms in the cyclooxygenase-2 (COX-2) gene may contribute to individual susceptibility to periodontal disease. A meta-analysis assessed the association between three COX-2 single-nucleotide polymorphisms (SNPs) namely, −765 G/C (rs20417), −1195 G/A (rs689466), and 8473 T/C (rs5275), and the risk of CP. Methods: Following the PRISMA 2020 guidelines, we conducted a comprehensive search of five electronic databases and additional sources. The eligible studies were observational (case–control or cohort) with genotypic data comparing individuals with periodontal disease and periodontally healthy controls. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS), and the certainty of evidence was evaluated via the GRADE framework. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under dominant genetic models. Results: Seven studies (n = 1467 participants) met the inclusion criteria. No eligible studies evaluated the 8473 T/C SNP. The meta-analysis of the −765 G/C variant revealed a significant association with periodontal disease (OR = 1.61; 95% CI: 1.12–2.32, p = 0.03; I² = 0%). For the −1195 G/A variant, the pooled OR was 1.86 (95% CI: 1.00–3.43, p = 0.05; I² = 35%), suggesting a borderline significant association. The certainty of evidence was graded as moderate for −765 G/C and low for −1195 G/A. Conclusions: The COX-2 −765 G/C polymorphism is significantly associated with increased CP risk, while the −1195 G/A variant shows a potential, though less certain, link. Larger, high-quality studies using standardized classifications are needed to confirm these associations. Full article

Background: Periodontitis is a multifactorial disease leading to the loss of clinical attachment and alveolar bone. The diagnosis of periodontitis involves a clinical examination and radiographic evaluation, including panoramic images. Panoramic radiographs are cost-effective methods widely used in periodontitis classification. The remaining bone height (RBH) is a parameter used to assess the alveolar bone level. Large language models are widely utilized in the medical sciences. ChatGPT, the leading conversational model, has recently been extended to process visual data. The aim of this study was to assess the effectiveness of the ChatGPT models 4.5, o1, o3 and o4-mini-high in RBH measurement and tooth counts in relation to dental professionals’ evaluations. Methods: The analysis was based on 10 panoramic images, from which 252, 251, 246 and 271 approximal sites were qualified for the RBH measurement (using the models 4.5, o1, o3 and o4-mini-high, respectively). Three examiners were asked to independently evaluate the RBH in approximal sites, while the tooth count was achieved by consensus. Subsequently, the results were compared with the ChatGPT outputs. Results: ChatGPT 4.5, ChatGPT o3 and ChatGPT o4-mini-high achieved substantial agreement with clinicians in the assessment of tooth counts (κ = 0.65, κ = 0.66, κ = 0.69, respectively), while ChatGPT o1 achieved moderate agreement (κ = 0.52). In the context of RBH values, the ChatGPT models consistently exhibited a positive mean bias compared with the clinicians. ChatGPT 4.5 was reported to provide the lowest bias (+12 percentage points (pp) for the distal surfaces, width of the 95% CI for limits of agreement (LoAs) ~60 pp; +11 pp for the mesial surfaces, LoA width ~54 pp). Conclusions: ChatGPT 4.5 and ChatGPT o3 show potential in the assessment of tooth counts on a panoramic radiograph; however, their present level of accuracy is insufficient for clinical use. In the current stage of development, the ChatGPT models substantially overestimated the RBH values; therefore, they are not applicable for classifying periodontal disease. Full article

Background: The interdental papilla plays a critical role in maintaining both the esthetic and functional integrity of the periodontium. Although the relationship between the papilla presence and the contact point–bone crest distance is well established, the impact of vertical bone defect morphology—common in periodontitis—remains largely unexplored. Aim: To assess the relationship between the loss of interdental papilla height and three site-specific factors—vertical bone defect morphology, probing depth, and papilla base width—in patients with periodontitis. Materials and Methods: Ten periodontitis patients contributing 28 interdental papillae adjacent to vertical bone defects were included. The recorded parameters included probing depth, papilla base width, and loss of papilla height. Intraoperative measurements of defect depth, mesiodistal width, and buccolingual width were also obtained. Patient-level variables, such as age, sex, oral hygiene, and gingival phenotype, were not controlled or included in the analysis, due to the small number of participants and the study’s focus on defect-level characteristics. Spearman’s rank correlation was used due to non-normal data distribution. Results: A moderate positive association was observed between the probing depth and loss of papilla height (ρ = 0.353), approaching but not reaching statistical significance (p = 0.066). Weak, non-significant associations were found with the remaining parameters (p > 0.05). Conclusions: Although no statistically significant associations were found, observed trends may indicate site-specific influences on the loss of papilla height. These preliminary findings highlight the need for further research with larger, well-characterized cohorts to better understand the factors affecting papilla stability in periodontitis. Full article

Background/Objectives: The colour changes related to inflammation have yet to be quantified despite the fact that the intensification of gingival colour is one of the cardinal signs of gingival inflammation. We aimed to (1) assess the effect of periodontal treatment on gingival colour according to biotype and initial degree of inflammatory severity and (2) identify the relationship between the plaque index and gingival colour and compare the colour of moderately or severely inflamed gums to the colour of gums with mild inflammation. Methods: Forty-three participants with visual signs of inflammation were included in the study. CIELAB colour coordinates were measured using a spectrophotometer at the distal papilla, free gingival margin, middle zone of the attached gingiva, and mucogingival line proximate to the maxillary central incisor pre-treatment and four weeks post treatment with periodontal debridement. Each participant’s gingival biotype, plaque and gingival indices, age, and gender were also recorded. Results: The biotype and plaque index were both found to influence the colour of inflamed gums, albeit only the a* coordinate in two of the zones examined (the distal papilla and free gingival margin). Statistically significant differences were also found between the a* coordinates of participants with and without plaque at the distal papilla and the free gingival margin. The severity of inflammation also influenced the L* coordinates of gingival colour (p < 0.001) in all participants in all four zones examined. Periodontal treatment only affected the L* coordinate of gingival colour at the distal papilla and the free gingival margin. Conclusions: When gingival inflammation occurs, participants with thin biotype and plaque have redder gums, and moderately or severely inflamed gingiva have a visually perceptible darker colour. Periodontal treatment significantly increases the lightness of the distal papilla and the free gingival margin. Further, periodontal treatment creates a perceptible colour change in all zones under study, which is not dependent on either the patient’s biotype or initial severity of inflammation. Clinical Significance. Digital spectrophotometric analysis provides a valuable technological enhancement to quantify gingival colour and record changes in gingival colour during the course of periodontal treatment. Regardless of the initial severity of gingival inflammation, a perceptible increase in the L* coordinate (gums become visibly lighter) can be expected after periodontal treatment. Regardless of the initial severity of inflammation, a perceptible increase in the L* coordinate can be expected (gums become visibly lighter) after treatment. Full article

Background: Periodontitis is linked to sleep-disordered breathing (SDB), including snoring, with 50–75% of cases involving mouth breathing (MB). Standard treatment includes scaling and root planing (SRP). Oral appliance therapy (OAT) is used to treat snoring and SDB. OAT plus a mouth shield (OAT+) worn during sleep may reduce MB to enhance periodontal health. This study evaluated whether OAT+, as an adjunct to SRP, improves periodontal health by reducing periodontal pathogens and facilitating upper airway patency. Methods: Fourteen participants with mild–moderate periodontitis were randomized to receive SRP on one side of the mouth at baseline (T0). Pocket depth (PD), bleeding on probing (BOP), and plaque index (PI) were recorded, and bacterial DNA from periodontal pockets were analyzed via PCR at baseline (T0) and 12 weeks (T3). At 4 weeks (T1), all participants received a self-titrated myTAP^® OA, followed by a mouth shield at 8 weeks (T2). Sleep metrics, including respiratory disturbance index (RDI), were recorded using the NOX T3 at T0–T3. Results: BOP and deep PD levels exhibited slight improvements from the baseline for both SRP and non-SRP (OAT+ only) treated sites but did not achieve significance. BOP decreased significantly more from the baseline in the SRP than in the non-SRP group at T3 (p = 0.028); P. gingivalis’ presence declined on both sides (p = 0.0135). Other periodontal and bacterial parameters showed no significant differences between or within groups. Snoring (p = 0.011), MB (p = 0.025), and RDI (p = 0.019) significantly decreased with OAT+ at T3. Conclusions: In mild–moderate periodontitis patients who snore, OAT+ reduces snoring, MB, and obstructive events, serving as an adjunct to SRP with no negative clinical effects over the short term. The combined therapy yielded similar results to OAT+ alone, likely due to minimization of MB. Its capacity to improve the oral environment is worthy of further investigation. Full article

E-cigarettes, a form of electronic nicotine delivery system (ENDS), have gained significant popularity, particularly among adolescents who often view vaping as a “cool” lifestyle choice. This growing trend has spurred extensive research on the effects of ENDS on both oral and systemic health. By synthesizing data from systematic reviews and meta-analyses, this umbrella review offers a comprehensive evaluation of the impact of e-cigarettes on oral biofilm accumulation and microbiota composition. A systematic search was conducted up to 12 March 2025, across PubMed/MEDLINE, Google Scholar, Cochrane Library, and Scopus for studies published between 2015 and 2025. Ten studies met the eligibility criteria. The quality of the selected papers, as assessed using the AMSTAR 2 tool, ranged from moderate to high. The findings of this review suggest that e-cigarette use may contribute to dysbiosis in the oral microbiota and foster biofilm accumulation, thereby increasing the risk of oral diseases such as periodontitis, peri-implantitis, oral candidiasis, and caries. The findings also highlight the need for further research into the long-term effects of e-cigarette use on oral health. This review is registered with PROSPERO (CRD420251025639). Full article

Background/Objectives: Patients with head and neck cancer frequently develop oral complications such as oral mucositis, infections, necrosis, and periodontal disease among others as a consequence of antineoplastic therapy. It is mainly radiotherapy that promotes oral dysbiosis, favouring the overgrowth of opportunistic microorganisms. Identifying effective adjunctive strategies to prevent or mitigate these adverse effects is crucial. Recent studies have suggested that probiotics could be used to restore microbial homeostasis and modulate inflammatory responses in the oral cavity. This systematic review and meta-analysis assessed the efficacy of probiotics in alleviating oral complications associated with antineoplastic treatments in this patient population. Methods: A comprehensive search was conducted in PubMed, LILACS, Scopus and the Cochrane Central Register of Controlled Trials, following the PRISMA 2020 guidelines. Only randomised controlled trials (RCTs) were included. Results: Nine eligible RCTs were analysed using a random-effects meta-analysis. Probiotic use was significantly associated with a reduced incidence of severe (grade 3–4) oral mucositis (RR = 0.58; 95% CI: 0.41–0.81). Moderate benefits were also observed in modulating the oral microbiota and reducing levels of pathogenic bacteria and Candida spp. However, no significant improvements were noted in periodontal parameters or plaque indices. Conclusions: Probiotics show promise in the management of oral mucositis, but further well-designed trials are needed to evaluate their broader impact on oral health during cancer therapy. This review is not registered on PROSPERO. Full article

Aim: This systematic review and meta-analysis evaluated the adjunctive use of hyaluronic acid (HA) in non-surgical periodontal therapy to improve clinical outcomes in patients with moderate-to-severe chronic periodontitis. The aim was to assess its effectiveness in reducing probing pocket depth (PPD), improving clinical attachment level (CAL), and decreasing bleeding on probing (BOP). Methods: Four electronic databases were searched (PubMed, Cochrane Library, Scopus, Web of Science, Grey Literature) for randomized controlled trials (RCTs) published until January 2025 and involving otherwise healthy patients treated with scaling and root planing (SRP) plus HA after at least 12 weeks of follow-up. Risk of bias was assessed using RoB 2.0; data were collected on clinical assessment, microbiological, and biochemical analysis and then analyzed using a fixed-effects or random-effects model considering the high heterogeneity of the included studies, which calls for caution when interpreting the results. Results: Fourteen of the 21 RCTs reviewed underwent a meta-analysis. Compared with SRP alone, the addition of adjunctive HA ≥ 0.8% led to an improvement in PPD, but the reduction in BOP was less consistent. Biochemical markers indicated less inflammation, oxidative stress, and selective antimicrobial activity. Although studies on 0.2% HA are still limited, improvements have been observed in clinical parameters, along with better biochemical and microbiological outcomes in the experimental group compared to the control group. Conclusions: Despite moderate heterogeneity and methodological limitations, the evidence supports the use of HA combined with SRP in periodontal treatment. Full article

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care and oral health promotion in nursing homes of older adults. Methods: Seven databases were searched without date restrictions from 15 September to 21 November 2024. A manual search was also performed in the reference lists of the included articles. This research included studies evaluating older adults aged ≥80 years, regardless of sex, who received domiciliary dental care associated or not with oral health promotion, evaluating periodontal condition, dental caries, and the dental and denture plaque index. Regarding data collection and analysis, a risk of bias assessment was performed using RoB 2.0 and RoB 1.0, according to the study design. The level of evidence was assessed using the GRADE tool. Results: Of the 2415 studies found, 5 met the eligibility criteria. After quality assessment, one randomized clinical trial presented a moderate risk of bias, and one presented a low risk. Also, two non-randomized studies presented a high risk and one a low risk. The certainty of evidence was classified as low for all outcomes assessed. One study demonstrated a reduction in the caries level of participants. Regarding periodontal and gingival conditions, although the occurrence of deep pockets (greater than 3.5 mm) decreased over time, there was no significant difference between the control and intervention groups. The level of dental and denture plaque showed a slight reduction. Conclusion: There is limited evidence that domiciliary dental care in nursing homes for older adults can lead to a reduction in caries levels and that oral health programs can reduce dental and denture plaque in evaluations conducted over periods of up to two years. Although the results show a limited magnitude, this does not diminish the importance of promoting domiciliary oral health care. Full article

Periodontitis is a common inflammatory disease that not only damages periodontal tissues but also induces systemic effects, including cardiac dysfunction. Mesenchymal stem cells (MSCs) offer regenerative potential due to their ability to differentiate, modulate immune responses, and secrete anti-inflammatory factors. However, the relative efficacy of local versus systemic MSC administration remains unclear. This study evaluated the therapeutic effects of adipose-derived MSCs (AD-MSCs) in a rat model of experimental periodontitis, comparing local and systemic administration. AD-MSCs were characterized based on morphology, surface marker expression, and differentiation potential. Ligature-induced periodontitis was established over 60 days, after which AD-MSCs (1 × 10⁶ cells) were administered either supraperiosteally (local group) or intravenously (systemic group). Periodontal regeneration was assessed through clinical, radiographic, and histopathological analyses, while cardiac function was evaluated using echocardiography and histopathological examinations. Results demonstrated that local AD-MSC administration provided superior therapeutic benefits compared to systemic delivery. Locally administered cells significantly enhanced bone regeneration, reduced inflammation, and improved periodontal tissue architecture. In contrast, systemic administration offered moderate benefits but was less effective in restoring periodontal integrity. Similarly, in the heart, local treatment resulted in greater improvements in systolic function, as indicated by enhanced ejection fraction and fractional shortening, along with reduced myocardial fibrosis. Although systemic administration also provided cardioprotective effects, diastolic dysfunction persisted in both treatment groups. In conclusion, local AD-MSC administration proved more effective in regenerating periodontal tissues and mitigating cardiac dysfunction, highlighting its potential as an optimized therapeutic strategy for periodontitis and its systemic complications. Full article

Background: Periodontitis is a prevalent inflammatory condition that destroys periodontal tissues. Scaling and root planing (SRP) is the gold standard for non-surgical treatment; however, its efficacy may be limited in cases with complex dental issues. This umbrella review aims to evaluate the effectiveness of hyaluronic acid (HA) as an adjunct to scaling and root planing (SRP) in enhancing clinical outcomes for periodontitis management. Methods: A comprehensive review of five systematic reviews, including meta-analyses where available, was conducted to synthesize evidence on the adjunctive use of HA with SRP. The studies were evaluated using the AMSTAR-2 quality assessment tool to determine methodological rigor. Data on clinical parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were extracted and analyzed. Results: The findings indicate that HA supplementation leads to moderate improvements in PD, CAL, BOP, GI, and PI compared to SRP alone. Notable reductions in PD and gains in CAL were observed, with some meta-analyses showing statistically significant benefits. However, the heterogeneity in HA concentrations (0.2–1.4%), application methods, treatment frequencies, and follow-up durations (1 week to 12 months) limits definitive conclusions. Additionally, HA did not significantly affect the reduction in P. gingivalis prevalence. Conclusions: The use of HA in conjunction with SRP shows promise in enhancing the efficacy of non-surgical periodontal therapy. However, the heterogeneity in the quality and methodologies of the studies indicates the necessity for high-quality, standardized randomized controlled trials to establish clear clinical guidelines for the application of HA in the treatment of periodontitis. Full article

Background: Periodontal disease is a multifactorial infectious pathology that affects dental supporting tissues, impacting the health and quality of life of patients. Assessing chewing efficiency before and after periodontal therapy is crucial to better understand its impact on the quality of life of periodontal patients. Thus, the aim of this case series study was to determine whether basic periodontal therapy improves masticatory ability and efficiency in patients with mild to moderate periodontitis. Methods: A prospective, longitudinal, case series study was carried out in 42 periodontal patients treated at the University Odontology Clinic. Masticatory efficiency before and after basic periodontal treatment was assessed using both objective (HueCheck Gum test) and subjective (Quality of Masticatory Function Questionnaire: QMFQ) methods. Results: Significant improvements (p = 0.0001) were observed in periodontal variables such as hygiene index (HI), probing depth (PD), and clinical attachment level (CAL), as well as in the initial and final QMFQ total score (p = 0.045). In addition, significant differences were found in post-treatment QMFQ scores related to parafunctional habits (p = 0.046) and facial patterns, especially in meat consumption (p = 0.042) fruit and vegetable consumption (p = 0.007, p = 0.044). The initial mean HueCheck Gum test values were 0.59 ± 0.09 and the final values were 0.61 ± 0.11. These differences were not statistically significant. Conclusions: Basic periodontal treatment does not objectively improve the masticatory efficiency of patients with mild–moderate periodontitis, evaluated by means of the test of mixing two chewing gums, but it does offer subjective improvements. Full article

Background and Objectives: Among nutritional factors implicated in periodontal health, the vitamin B complex—particularly folate (vitamin B9), cobalamin (B12), thiamine (B1), and riboflavin (B2)—has gained attention for its role in immunomodulation and tissue repair. This systematic review aims to synthesize current evidence on whether adequate vitamin B complex intake or status is associated with improved periodontal outcomes. Methods: A systematic search was performed in PubMed, Scopus, and Web of Science for observational studies investigating vitamin B complex intake or status in relation to periodontal disease indicators. Articles were screened according to PRISMA guidelines, and five studies met inclusion criteria. Results: Five observational studies were included. In older adults, each standard deviation increase in serum folate was associated with an approximate 26% reduction in periodontal disease odds ratio (OR = 0.74, 95% confidence interval (CI) 0.58–0.93). Among young adult women, inadequate riboflavin (B2) and pyridoxine (B6) intake correlated with higher community periodontal index (CPI) scores (p < 0.05). In a large NHANES-based cohort, insufficient thiamine (B1) intake yielded a 33% higher likelihood of severe periodontitis (p < 0.05), while adequate riboflavin was protective (OR = 0.90). Another dose–response analysis (n = 8959) indicated up to a 30% risk reduction for moderate folate or B1 intake, but no extra benefit with excessive intake. Finally, a UK Biobank analysis (n = 9476) showed that those in the highest quartile of a “high micronutrient” dietary pattern—including vitamins B6 and folate—had a 24% lower risk of self-reported periodontal disease (OR = 0.76, 95% CI 0.65–0.90) compared to the lowest quartile. Conclusions: Across diverse populations, inadequate vitamin B complex intake—especially folate—was consistently linked to worse periodontal outcomes. Full article

Background: Lifestyle habits such as sleep, hygiene, or eating conducts are nowadays suffering from a lack of consistency, and this situation is being linked to systemic and mental health consequences. Nevertheless, not enough attention has been paid to investigate the plausible relation between lifestyle habits and oral health, and hence, this investigation aims to study the possible effects of certain lifestyle conducts on oral health in dental students. Methods: A sample of 195 dental students was gathered and basic sociodemographic data (gender, age, and nationality), hygiene habits, as well as data related to smoking, adherence to healthy habits, and daily schedule constancy were recorded. Oral health, with reference to decayed, missing, and filled teeth, was recorded using the DMFT index and bleeding upon probing (BOP). The Healthy Lifestyle Scale (EVS) was utilized to record sleep, smoking, and mealtime and diet characteristics. Descriptive analysis, Pearson correlations, a hierarchical linear regression model, and moderation analysis were performed. Results: The present evidence showed a direct relation between healthy lifestyle habits and oral health indicators. Respect to mealtime routines (MT), correct sleep hygiene habits (SR) and eating a balanced diet (BD) exert a moderator effect on caries and smoking. Smoking shows a positive correlation with the number of filled teeth and BOP. Conclusions: Findings suggest that healthy lifestyle habits are related to better oral health status. In addition, correct sleep hygiene habits, a balanced diet, and a mealtime schedule can act as a moderator factor between caries and smoking. Full article