Relationship between Chronic Periodontitis and Erectile Dysfunction: A Narrative Review

Objective. To conduct a descriptive literature review on research studies investigating the association between chronic periodontitis (CP) and erectile dysfunction (ED). Methods. Cohort studies, case-control studies, cross-sectional studies, randomized control trials, and animal studies up to July 2015 that studied the relationship between CP and ED were reviewed and reported. Data sources included PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. The themes “periodontal disease” and “erectile dysfunction” and the role of periodontal therapy were identified and discussed throughout the narrative review. Results. After reviewing the literature, it was found that an association between CP and vasculogenic ED likely exists. Inflammation resulting from CP promotes endothelial dysfunction by increasing the systemic levels of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Periodontal therapy attempts to decrease the release of TNF-α and could act to restore endothelial function, particularly in the penile vasculature. Conclusion. Although the literature reported a positive association between CP and ED, the studies were few and possess several methodological limitations. Large-scale cohort studies and confounder analysis are recommended. Dentists and physicians should collaborate to manage patients with either CP or ED because of their potential association not only with each other but also with other serious systemic comorbidities.

Malignant Transformation Rate in Patients Presenting Oral Epithelial Dysplasia: Systematic Review and Meta-Analysis

Objective. To perform a systematic review and meta-analysis on studies that assess malignant transformation rates (MTR) of oral epithelial dysplasia. Materials and Methods. This review was planned and conducted in accordance with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. PubMed, EMBASE, Google Scholar, and Cochrane databases were screened to identify observational studies. Quality assessments were completed by two reviewers independently using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Pooled-malignant transformation rate (MTR) in person years, subgroup, sensitivity, and publication bias analysis were calculated using STATA 13.0 and Comprehensive Meta-Analysis software. Results. Sixteen observational cohort studies were identified with a total of 3708 participants from Asia, North America, and Europe. Analysis showed a MTR of 10.5% (pooled-MTR: 10.5, 95% CI: 3.7 to 17.3; fixed effect model, I2=0.0%; Q-value = 2.389; p>0.05) among patients with histologically confirmed oral epithelia dysplasia undergoing long-term follow-up. Higher MTR in person year were seen among the sever dysplastic cases (pooled-MTR: 14.4%, 95% CI: 5.3% to 23.5%), studies published in Europe (pooled-MTR: 12.6%, 95% CI: 8.0% to 24.3%), and retrospective studies (pooled-MTR: 11.0%, 95% CI: 2.2% to 19.9%). Conclusion. These studies show that oral epithelial dysplasia has a significant high rate of transformation to cancer.

Malocclusion Characteristics as Risk Factors for Temporomandibular Disorders: Lessons Learned from a Meta-Analysis

The objective of this meta-analysis was to evaluate the association of various malocclusion characteristics with temporomandibular disorders (TMDs). Two reviewers identified articles through database searches of MEDLINE (Ovid) and LILACS and hand searches of major orthodontic journals and selected references. Random-effects models were used to calculate weighted pooled odds ratio (OR) estimates of malocclusion exposures. Six articles qualified for inclusion in the final quantitative analysis. Our study found that static occlusal factors had no significant association with TMD. Of the dynamic occlusal factors assessed, only the absence of canine guidance, laterotrusive interferences, and retruded contact position to maximal intercuspation slide length ≥2 mm demonstrated significant ORs. These results should be viewed with caution, as reporting biases were difficult to assess, and heterogeneity estimates may have been underestimated due to the limited number of studies within each comparison. TMD is a term that encompasses a broad group of dysfunctions, and meta-analyses should only synthesize studies with similar diagnostic criteria. At the present, there is a paucity of studies available that could be properly synthesized to answer the research question posed. Individual studies have too much variability among their methods, and researchers need to clearly define and state their TMD factor definition.

Oral Hygiene Status, Periodontal Status, and Periodontal Treatment Needs among Institutionalized Intellectually Disabled Subjects in Kolhapur District, Maharashtra, India

The aim of the study was to determine influence of intellectually disability (ID) on oral hygiene status (OHS), periodontal status (PS), and periodontal treatment needs (PTNs) and investigate the association of these clinical parameters with various sociodemographic and clinical variables among multicentric institutionalized ID subjects aged 5–55 years in Kolhapur district, Maharashtra, India. This descriptive cross-sectional study was conducted by both questionnaire and clinical examination. OHS, PS, and PTNs of these subjects were assessed by recording Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index of Treatment Needs, respectively. Analysis of variance and multiple logistic and stepwise linear regression analysis were used for statistical analysis. Of the 576 subjects examined, the mean age of the subjects was 17.50 ± 7.4 years. Subjects with profound level of ID had the highest mean OHI-S, PS, and PTNs scores of 4.47 ± 1.04, 2.84 ± 0.78, and 2.25 ± 0.44, respectively, as compared with other ID groups (P<0.0001). The present study signified that ID subjects had poor OHS and PS with the highest PTNs and were influenced by age (P<0.0001), degree of ID (P<0.0001), SES, location, institution type, and parent’s level education. The present study underlines a considerable need for prevention and treatment of periodontal disease among ID subjects in India.

Clinical Relevance of the Advanced Microbiologic and Biochemical Investigations in Periodontal Diagnosis: A Critical Analysis

New approaches to periodontal diagnosis, including advanced microbiologic, biochemical, and genetic tests, have been shown to provide the clinician with the information not available by traditional means. The purpose of a diagnostic test is to confirm, exclude, classify, or monitor disease to guide treatment. Their clinical value depends on whether the information they provide leads to improved patient outcomes. This can be assessed by randomized trials, which compare patient outcomes from the new diagnostic test versus the old test strategy. Being nonmandatory for marketing approval, such trials are not always feasible because of large sample sizes requirements. So, many diagnostic tests enter the practice without being critically analysed for any additional benefits. Effective diagnosis is just as essential as the selection of effective treatments for the success of periodontal therapy. So, the current paper aims to focus on the practical utility of this rapidly emerging plethora of periodontal diagnostic tools, emphasizing the critical issues surrounding the clinical application of microbiologic and biochemical investigations, employed for periodontal diagnosis.

Enamel Carious Lesion Development in Response to Sucrose and Fluoride Concentrations and to Time of Biofilm Formation: An Artificial-Mouth Study

The aim of this study was to evaluate both sucrose and fluoride concentrations and time of biofilm formation on enamel carious lesions induced by an in vitro artificial-mouth caries model. For Study 1, biofilms formed by streptococci and lactobacilli were grown on the surface of human enamel slabs and exposed to artificial saliva containing 0.50 or 0.75 ppmF (22.5 h/d) and broth containing 3 or 5% sucrose (30 min; 3x/d) over 5 d. In Study 2, biofilms were grown in the presence of 0.75 ppmF and 3% sucrose over 3 and 9 days. Counts of viable cells on biofilms, lesion depth (LD), and the integrated mineral loss (IML) on enamel specimens were assessed at the end of the tested conditions. Counts of total viable cells and L. casei were affected by sucrose and fluoride concentrations as well as by time of biofilm formation. Enamel carious lesions were shallower and IML was lower in the presence of 0.75 ppmF than in the presence of 0.50 ppmF (P<0.005). No significant effect of sucrose concentrations was found with respect to LD and IML (P>0.25). Additionally, deeper lesions and higher IML were found after 9 d of biofilm formation (P<0.005). Distinct sucrose concentrations did not affect enamel carious lesion development. The severity of enamel demineralization was reduced by the presence of the higher fluoride concentration. Additionally, an increase in the time of biofilm formation produced greater demineralization. Our results also suggest that the present model is suitable for studying aspects related to caries lesion development.

Correlation of Anxiety Levels between Temporomandibular Disorder Patients and Normal Subjects

Background. Temporomandibular disorders (TMDs) are among the common musculoskeletal conditions affecting the individual. Anxiety plays an important role in the pathogenesis of TMD. Modern lifestyle and work environment bring to focus the role of anxiety in everyday life which is changing the demographics of diseases like TMD. This study compared the anxiety scores between TMD patients and normal subjects. Material and Methods. 505 individuals were included in the study who were divided into group 1 with 255 individuals presenting with signs and symptoms of TMD and group 2 with 250 normal individuals as controls. Hospital anxiety depression scale was used to calculate the anxiety scores. Fischer’s t test was used to compare the anxiety scores between the two groups. Results. 80% of individuals in group 2 and 44% in group 1 individuals had normal anxiety scores. 45% of the individuals in group 1 and 19% in group 2 had borderline anxiety scores. 11% of group 1 individuals and <1% of group 2 individuals demonstrated high anxiety scores. These results were statistically significant. Conclusion. Individuals with TMD exhibited higher levels of anxiety scores whereas significant number of control subjects exhibited normal anxiety scores.

Impact of an Oral Health Education Workshop on Parents’ Oral Health Knowledge, Attitude, and Perceived Behavioral Control among African Immigrants

Purpose. To evaluate the impact of an educational workshop on parental knowledge, attitude, and perceived behavioral control regarding their child’s oral health. Materials and Methods. A one-time oral health education workshop including audio/visual and hands-on components was conducted by a trained dentist and bilingual community workers in community locations. Participants were African parents of children who had lived in Canada for less than ten years. The impact of the workshop was evaluated by a questionnaire developed based on the theory of planned behavior. Results. A total of 105 parents participated in this study. Participants were mainly mothers (mean age 35.03±5.4 years) who came to Canada as refugee (77.1%) and had below high school education (70%). Paired t-test showed a significant difference in participants’ knowledge of caries, preventive measures, and benefits of regular dental visits after the workshop (P value<0.05). A significant improvement was also found in parental attitudes toward preventive measures and their perceived behavioral control (P<0.05). Parents’ intention to take their child to a dentist within six months significantly altered after the workshop (P value<0.05). Conclusions. A one-time hands-on training was effective in improving parental knowledge, attitude, perceived behavioral control, and intention with respect to their child’s oral health and preventive dental visits in African immigrants.

Reliability of Pederson Scale in Surgical Extraction of Impacted Lower Third Molars: Proposal of New Scale

The aim of this study was to evaluate the clinical reliability of the Pederson index in preoperative assessment of the difficulty of surgical removal of impacted mandibular third molars. Pederson index was found to be unreliable predictor of true difficulty with low sensitivity and specificity. A new index (Kharma scale), which takes into consideration the anatomical form of tooth roots, is proposed and evaluated both pre- and postoperatively. The results of the evaluation indicate that the new estimating index is more reliable and accurate measure than Pederson scale.

Salivary Melatonin and the Severity of Attachment Loss: A Case-Control Study

Background. Melatonin (MT: N-acetyl-5-methoxytryptamine) is a neuroendocrine hormone secreted mainly by the pineal gland in the brain. MT is produced with a circadian rhythm characterized by elevated blood levels during the night. In healthy individuals, maximal secretion of MT occurs between midnight and 2:00 am, whereas the minimal production occurs during the day. MT can be determined by repeated measurement of plasma or salivary MT or urine sulfatoxy-melatonin. Melatonin has powerful antioxidant effects, has an immunomodulatory role, stimulates the synthesis of type I collagen fibers, and promotes bone formation. Melatonin is also secreted in the saliva, although its role in the mouth is not known well. The purpose of this study was to examine the correlation between salivary melatonin level and periodontal diseases. Methods. Fifty subjects by mean age of 40.44±6.38 years were equally divided into 5 groups: 10 healthy subjects, 10 subjects with gingivitis, 10 subjects with localized moderate chronic periodontitis, 10 subjects with generalized moderate chronic periodontitis, and 10 subjects with generalized severe chronic periodontitis. Saliva samples were collected from all the subjects and melatonin levels were determined using an enzyme-linked immunosorbent assay. Two-way and one-way ANOVA and Tukey test were used to analyze relationships among variables. Results. Healthy subjects had significantly higher salivary melatonin level (5.29±0.50 pg/mL) compared to patients with gingivitis (4.35±0.30 pg/mL) (P<0.001). The difference between salivary melatonin level in patients with gingivitis and periodontitis was significant (P<0.001). Level of melatonin in patients with generalized severe chronic periodontitis (3.39±0.10 pg/mL) was significantly lower than that in other groups (P<0.01). Conclusions. This study determined that salivary melatonin level in patients with periodontal diseases is lower than that in healthy subjects. Consequently we conclude that there is a negative correlation between melatonin level and the severity of disease, suggesting that melatonin might have a protective role against periodontal diseases, although further research is required to validate this hypothesis.