Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97 % gene similarity cut-off for bacterial species level identifications. A significant ‘microbial shift’ occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection.
OBJECTIVES
The association of periodontal disease in people diagnosed with rheumatoid arthritis (RA) is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease may benefit people with RA. We performed a systematic literature review (SLR) to investigate the effect of periodontal treatment on RA disease activity.
METHODS
Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. Quality assessment of included studies was performed and data were grouped and analysed according to RA disease outcome measure and a narrative synthesis performed.
RESULTS
We identified a total of 21 studies of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA Disease activity score (DAS-28) was the primary outcome for most studies. A total of 9/17 studies reported a significant intra-group DAS-28 score change. Three studies demonstrated a significant intra-group improvement in ACPA level following NSPT. Other RA biomarkers showed high levels of variability at baseline and following periodontal treatment.
CONCLUSION
There is some evidence to suggest periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer follow up durations are needed. The selection of the study population, periodontal interventions, biomarker, and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with pre-specified disease characteristics.
Lay summary
What does this mean for patients?
This review found 21 research trials which investigated the effect of gum disease treatment on rheumatoid arthritis. The key finding was that treating gum disease in people who have rheumatoid arthritis improves the ‘DAS28’ score, which is a measure of how severe the rheumatoid arthritis is. This is important, as rheumatoid arthritis is incurable and has a significant impact on quality of life. Furthermore, gum disease is more prevalent in people with rheumatoid arthritis, and if untreated can lead to pain, infection, and premature tooth loss. This review highlighted several limitations of the included trials. In addressing these limitations, the review makes important recommendations for future research on this topic to ensure further high-quality findings. Finally, this review makes a strong case that rheumatologists, dentists and people who are affected by rheumatoid arthritis should have a heightened awareness of the link between these two diseases. Screening and treating gum disease should form part of the normal care pathway for people with rheumatoid arthritis.
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