Aim: To assess the diagnostic utility of an oral rinse active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Materials & Methods:The aMMP-8 index test was undertaken in 408 consecutive adults, followed by a full-mouth periodontal examination. The reference standard was the 2017 World Workshop classification of periodontal diseases. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were assessed.Results: 68.6% of the participants were diagnosed with periodontitis, including Stages I (15.9%), II (15.9%), III (29.7%) and IV (7.1%). A positive aMMP-8 POCT was associated with periodontitis after adjusting for age, gender, tobacco smoking and systemic diseases, while it was unable to differentiate among the stages/grades of periodontitis and between gingivitis/periodontal health. This test showed a sensitivity of 33.2% and a specificity of 93.0% for detecting periodontitis (threshold level >10 ng/ml). The levels of aMMP-8 adjusted by the number of teeth present (aMMP-8/NTP) performed better for periodontitis (sensitivity: 67.1%; specificity: 68.8%). Notably, aMMP-8/NTP were strongly predictive for Stage IV periodontitis (threshold level =0.4312 ng/ml) (sensitivity: 89.7%; specificity: 73.6%; and AUROC: 0.856). The test performance greatly improved in combination with age and smoking, with a sensitivity of 82.5%, a specificity of 84.4%, and an AUROC of 0.883. Conclusion:This aMMP-8 POCT is able to detect periodontitis with better specificity than sensitivity across the spectrum of its severity. This test may be useful for periodontal screening in conjunction with subject characteristics and/or other sensitive screening tools. Further validation studies are needed. K E Y W O R D Sdiagnosis, gingivitis, matrix metalloproteinase-8, periodontal health, periodontitis, point-ofcare test, screening, sensitivity and specificity Clinical RelevanceScientific rationale for the study: The traditional periodontal diagnostic approach relies on clinical parameters that are difficult to measure, lack precision to detect incipient periodontitis and can only reflect the previous tissue destruction. Point-of-care biomarker tests based on oral fluidsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Aim: To clinically validate a self-reported questionnaire for periodontal disease and assess its accuracy for differentiating periodontal health and different stages of periodontitis.Methods: A Chinese (Cantonese) version of a self-reported questionnaire was prepared by translating and validating the original English questions proposed by the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). The utility of the CDC/AAP questionnaire and its individual questions was assessed against a full-mouth periodontal examination. Periodontal case definition was based on the 2017 World Workshop classification of periodontal diseases. Multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC) analysis were performed to assess the accuracy of the questionnaire.Results: 408 subjects enrolled in this study, including those with periodontal health (16.2%), gingivitis (15.2%), Stages I/II periodontitis (31.8%) and Stages III/IV periodontitis (36.8%). Overall, the questionnaire had poor accuracy in detecting the presence of Stages I/II periodontitis with an AUROC 0.608. While it showed moderate to high accuracy for identifying periodontal disease (gingivitis and periodontitis), periodontitis and Stages III/IV periodontitis with an AUROC of 0.837, 0.803 and 0.870, respectively. Self-reported measures in combination with age and tobacco smoking showed excellent performance for identifying Stages III/IV periodontitis with a high AUROC of 0.953, a sensitivity of 95.7%, and a specificity of 89.0%. Specific questions and combinations provided greater utility to discriminate the various periodontal case definitions. Conclusions:The self-reported CDC/AAP questionnaire may be a feasible tool for detecting periodontitis, and its combination with demographic and lifestyle factors is useful for the identification of individuals with Stages III/IV periodontitis. This questionnaire seems less helpful in screening of Stages I/II periodontitis. Further studies are needed to test the validity in larger community-based populations.

Aim: To describe periodontal and functional characteristics of subjects diagnosed with different stages of periodontitis and to associate measures of masticatory function and quality of life with periodontitis stage. Materials and Methods:This was a cross-sectional study on a convenience sample of 214 subjects with periodontitis seeking oral care in a hospital setting. They received a full-mouth intra-oral examination including dental and periodontal charting by a single calibrated examiner who also established the periodontitis stage diagnosis. Subjects were assessed using the OHIP-14, a validated masticatory dysfunction questionnaire, and a quantitative test based on the ability to mix a dual colour chewing gum. Mixing was quantified based on the variance of hue (VOH) with a colorimetric software. Descriptive, univariate, and multivariate analyses were performed.Results: Subjects with stage IV periodontitis reported greater impairment of oralhealth-related quality of life, reduced food intake or altered food type intake attributed to difficulties in chewing, objective measures of masticatory dysfunction, tooth loss, as well as more advanced periodontal breakdown compared with subjects with stages I-III of the disease. Quantitative assessment of masticatory function was associated, in a multivariate analysis, with (i) loss of functional tooth units in the premolar/molar region, presence of hypermobile teeth, and severity of periodontal attachment loss, and (ii) age, body mass index, and periodontitis stage IV and grade C diagnosis. Conclusions: Subjects with stage IV periodontitis are characterized by a specific set of signs and symptoms of advanced periodontal breakdown and functional impairment, which impact on the quality of life and masticatory function/food intake choices. Stage IV periodontitis captures a clinical entity with distinct features and treatment needs.This study is registered in ClinicalTrials.gov (NCT03928080).

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Immediate implant placement has received increasing attention due to the shortened treatment period and predictable prognosis, which has the potential to improve patient satisfaction (Kan et al., 2018;Shi et al., 2015). Placement, however, utilizes mainly the socket and the alveolar bone plate slope; bleeding from the socket interferes with proper visualization of the implant site, thus making the surgery more difficult and affecting the accuracy of implant placement (Blanco, Carral, Argibay, & Liñares, 2019).Suboptimal immediate implant position may result in restorative and esthetic challenges, and may compromise the longevity of the

Aim To report the 36‐month follow‐up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. Material and methods 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed‐up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Results No differences were observed between the randomized and the follow‐up population. Average baseline recession was 2.6 ± 1.0 mm. 3‐year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from −0.02 to 0.65 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6‐ and 36‐month follow‐up (difference 0.06 mm, 95% CI −0.17 to 0.29 mm). Conclusion CMX was not non‐inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision‐making.

Aim: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. Materials and Methods:A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous.Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants.Linear and multinomial logistic regression models were used to examine the corresponding associations.Results: Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (β edentulous = À0.39, 95% confidence interval [CI], À0.48, À0.30; β 1-9 teeth = À0.46, 95% CI, À0.55, À0.37; β 10-19 teeth = À0.36, 95% CI, À0.46, À0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89).Conclusions: Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective Jie Shen and Shujiao Qian contributed equally to this study.Maurizio Tonetti and Changzheng Yuan are co-senior authors.

Aim To assess the accuracy of self‐reported gingival bleeding on brushing (GBoB) for differentiating between periodontal health and disease and explore the optimal haemoglobin concentration that enables visual detection of GBoB. Materials and methods Self‐assessment of GBoB was conducted in supervised sessions for 408 consecutive adults. The haemoglobin levels in saliva/toothpaste slurry (TPS) were analysed, followed by a full‐mouth periodontal examination. Periodontal diagnoses were made based on the 2017 classification of periodontal diseases. Gingival inflammation was defined as presence of at least 10% of sites with bleeding on probing (BOP). Logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were applied to assess the accuracy of GBoB. Results Overall, 37.1% of the subjects claimed self‐reported GBoB, and they had higher values of BOP (median: 25.0%; interquartile range (IQR): 16.0%–37.5%) than those without GBoB (median: 13.5%; IQR: 8.0%–24.8%, p < .001). The concentration/total amount of haemoglobin in TPS was positively correlated with the number of bleeding sites (r = .409/r = .520, p < .001). Haemoglobin concentration of 90.58 μg/ml or 0.51 μl blood volume enabled visual detection of GBoB with an AUROC of 0.848. Self‐reported GBoB exhibited significantly increased values of diagnostic odds ratios (3–8) for varying degrees of gingival inflammation and periodontal disease (gingivitis and periodontitis). It showed low to moderate accuracy for discriminating periodontitis and gingivitis from periodontal health, with a sensitivity of 37.1% and 61.3% and a specificity of 84.8% and 84.4%, respectively. Absence of self‐reported GBoB and low levels of haemoglobin had 93%–98% predictive values for periodontal health. Conclusions Despite its low sensitivity for the discrimination of periodontitis, self‐reported GBoB is a promising sentinel sign for periodontal health and disease, and gingival inflammation in particular. It is visually detectable after minor blood loss. After validation in an independent population, identification of GBoB may promote earlier detection and better prevention and treatment of periodontal disease, thereby eventually reducing the global burden of the disease.