HLA DR4 antigens have been considered as a risk factor in periodontal disease. The aim of this "case control" study was to verify and to provide fuller clarification of such data. "Cases" or patients had to be aged between 20 and 48 years. They presented at least 5 sites spread over several teeth with an attachment loss equal or greater than 6 mm, and 10 sites spread over several teeth with periodontal pockets equal to or greater than 5 mm. Verification with a WHO probe showed an individual CPITN score of 4. Moreover, subjects whose average CPITN score for the 6 sextants was less than 3 were excluded from the study. Among these "severe periodontitis" patients, a subgroup was distinguished composed of subjects aged 20-35 years who presented, in accordance with the cases by Katz and co-workers, 5 or more teeth showing pocket depths of 6 mm or more. The dental chartings of these subjects showed an attachment loss of more than 3 mm on certain teeth over an inter-exam period of 1-3 years. They all displayed obvious loss of bony support in the affected sites. This constituted the "rapidly progressive periodontitis" subgroup. The "controls" were all over 20 years of age, and it was clinically verified that they were free of periodontal disease. There were 48 "cases" and 55 "controls". HLA typing of patients and controls was performed using "sequence oligoprobe hybridization after polymerase chain reaction" in accordance with the 11th International Workshop. This method allowed the detection of DR4 alleles as well as DR4 subtypes. The ethno-geographic origin of the subjects, considered as a confounding variable, was neutralized by stratified analysis. Subtypes 0401, 0404, 0405 and 0408 tended to be more frequent (p=0.08) in the cases (Severe Periodontitis). Focusing on analysis of "rapidly progressive periodontitis" in subjects aged 20-35 years, a very significant Mantel-Haenszel chi2 was obtained (p=0.0058) which led to a Mantel-Haenszel standardized odds ratio (OR) equal to 17. The 95% confidence interval was 1.03<0.R.<180.10. In conclusion, this supports previous reports and gives further clarification: in particular subtypes 0401, 0404, 0405 and 0408 can be considered as a risk factor for "rapidly progressive periodontitis". It should be noted that these determinants have been implicated in rheumatoid arthritis.
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disorder that leads to joint damage, deformity, and pain. It affects approximately 1% of adults in developed countries. Periodontitis is a chronic oral infection, caused by inflammatory reactions to gram-negative anaerobic bacteria, and affecting about 35 to 50% of adults. If left untreated, periodontitis can lead to tooth loss. A significant association has been shown to exist between periodontitis and RA in observational studies. Some intervention studies have suggested that periodontal treatment can reduce serum inflammatory biomarkers such as C-reactive protein, or erythrocyte sedimentation rate. We hypothesize that periodontitis could be an aggravating factor in patients with RA, and that its treatment would improve RA outcomes. The aim of this clinical trial is to assess the effect of periodontal treatment on the biological and clinical parameters of patients with RA.Methods/designThe ESPERA (Experimental Study of Periodontitis and Rheumatoid Arthritis) study is an open-label, randomized, controlled trial. Subjects with both RA and periodontitis will be recruited at two university hospitals in southwestern France. In total, 40 subjects will be randomized into two arms (intervention and control groups), and will be followed up for 3 months. Intervention will consist of full-mouth supra-gingival and sub-gingival non-surgical scaling and root planing, followed by systemic antibiotic therapy, local antiseptics, and oral hygiene instructions. After the 3-month follow-up period, the same intervention will be applied to the subjects randomized to the control group.The primary outcome will be change of in Disease Activity Score in 28 Joints (DAS28) at the end of the follow-up period. Secondary outcomes will be the percentages of subjects with 20%, 50%, and 70% improvement in disease according to the American College of Rheumatology criteria. Health-related quality of life assessments (the Health Assessment Questionnaire and the Geriatric Oral Health Assessment Index) will also be compared between the two groups.DiscussionEvidence-based management of potential aggravating factors in subjects with active RA could be of clinical importance, yet there are few randomized controlled trials on the effect of periodontal treatment on the clinical parameters of RA. The ESPERA trial is designed to determine if non-surgical periodontal treatment could improve clinical outcomes in patients with active RA, and the quality of life of these patients.Trial registrationThe ESPERA Trial was registered in Current Controlled Trials [ISRCTN79186420] on 2012/03/20. The trial started recruiting on 2012/03/06.
One of the main problems for aged people is that of having a balanced diet, improved by correct conditioning of the alimentary bolus. Does the masticatory status influence the appearance of gastrointestinal disorders? Such a question justifies the present study. The present work concerned all the patients (211) of eight geriatric institutions, and was completed by a retrospective approach (case-control study). The main result brought by the case-control study, showed that poor oral functional characteristics represent a risk for gastrointestinal pathology (age being neutralized; odds ratio (OR): 2.62). This result indicates that the loss of teeth must be compensated by functionally effective dentures. Not only will the patients' physical and psychic health improve but also medical and public health problems will be solved.
Background: Periodontitis is a common, chronic inflammatory disease caused by gram-negative bacteria leading to destruction of tissues supporting the teeth. Epidemiological studies have consistently shown increased frequency, extent and severity of periodontitis among diabetic adults. More recently, some controlled clinical trials have also suggested that periodontal treatment could improve glycaemic control in diabetic patients. However current evidence does not provide sufficient information on which to confidently base any clinical recommendations. The main objective of this clinical trial is to assess whether periodontal treatment could lead to a decrease in glycated haemoglobin levels in metabolically unbalanced diabetic patients suffering from chronic periodontitis.
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