Purpose of ReviewThe aim was to assess recent evidence that diabetes, metabolic syndrome (MetS) and obesity impact the progression of periodontitis.Recent FindingsElectronic searches using Embase, Medline, and Web of Science were carried out for epidemiological studies on humans, published between 2014 and 2016. A small number of prospective studies and systematic reviews were identified that in general provide further support for the hypothesis that diabetes, metabolic syndrome and obesity can adversely affect the periodontal condition.SummaryConfounding remains the most challenging issue in the interpretation of the associations found between diabetes, MetS, obesity and periodontal disease. Recent research applying a Mendelian randomisation approach concluded that the association between obesity and periodontitis is confounded and questioned a role for obesity in causation. Further studies are warranted to assess the issue of causality.

Objectives:To investigate periodontitis as a risk factor for incident type 2 diabetes mellitus (T2DM) in a group of men aged 58-72 years. Accepted ArticleThis article is protected by copyright. All rights reserved. Methods:1331 dentate, diabetes-free males in Northern Ireland underwent a detailed periodontal examination during [2001][2002][2003]. Follow-up was by bi-annual questionnaire and for those reporting diabetes their general medical practitioner was contacted to validate diabetes type, treatment and diagnosis date. Cox's proportional hazard models were used to estimate the effect of periodontitis on incident diabetes. Multivariable analysis included adjustment for various known confounders. Results:The mean age of the men was 63.7 (SD 3.0) years. There were 80 cases (6.0%) of incident T2DM. Follow-up was for a median period of 7.8 years ). After adjusting for confounding variables, the hazard ratio (HR) for incident T2DM in men with moderate / severe periodontitis versus those with no / mild periodontitis was 1.69 (95% CI 1.06-2.69), p=0.03. Conclusion:There was evidence in this homogenous group of dentate men, that those with moderate to severe periodontitis had a significantly increased risk of incident T2DM. Clinical Relevance Scientific rational for the study:Evidence supporting the role of chronic periodontitis as a putative risk factor for the development of type 2 diabetes mellitus (T2DM) is currently limited. Principal findings: Accepted ArticleThis article is protected by copyright. All rights reserved.This study showed that in a group of 58-72 year-old Caucasian dentate men in Northern Ireland, baseline moderate to severe periodontitis was an independent risk predictor for the development of T2DM. This relationship was independent of known confounders. Practical implications:Dentists should be aware of the potential systemic health implications of patients presenting with moderate to severe periodontitis. Patients who present with obvious risk factors for T2DM and signs of periodontitis should be informed about their risk for developing T2DM.

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In these 60-70-year-old dentate men, the presence of P. gingivalis in subgingival plaque was significantly associated with a raised level of C-reactive protein.

Background Periodontitis is a major cause of tooth loss globally. Risk factors include age, smoking, and diabetes. Intake of specific nutrients has been associated with periodontitis risk but there has been little research into the influence of overall diet, potentially more relevant when formulating dietary recommendations. Objectives We aimed to investigate potential associations between diet and periodontitis using novel statistical techniques for dietary pattern analysis. Methods Two 24-h dietary recalls and periodontal examination data from the cross-sectional US NHANES, 2009–2014 (n = 10,010), were used. Dietary patterns were extracted using treelet transformation, a data-driven hierarchical clustering and dimension reduction technique. Associations between each pattern [treelet component (TC)] and extent of periodontitis [proportion of sites with clinical attachment loss (CAL) ≥ 3 mm] were estimated using robust logistic quantile regression, adjusting for age, sex, ethnicity, education level, smoking, BMI, and diabetes. Results Eight TCs explained 21% of the variation in diet, 1 of which (TC1) was associated with CAL extent. High TC1 scores represented a diet rich in salad, fruit, vegetables, poultry and seafood, and plain water or tea to drink. There was a substantial negative gradient in CAL extent from the lowest to the highest decile of TC1 (median proportion of sites with CAL ≥ 3 mm: decile 1 = 19.1%, decile 10 = 8.1%; OR, decile 10 compared with decile 1: 0.67; 95% CI: 0.46, 0.99). Conclusions Most dietary patterns identified were not associated with periodontitis extent. One pattern, however, rich in salad, fruit, and vegetables and with plain water or tea to drink, was associated with lower CAL extent. Treelet transformation may be a useful approach for calculating dietary patterns in nutrition research.

The VAS pain scores showed favorable anesthetic efficacy of the test gel compared to a placebo gel in reducing patients' pain on periodontal probing in a group of patients with generalized CP. It suggests that the gel may be used for patients who find the full-mouth periodontal probing experience particularly painful in view of other tested alternatives.

The aim of this study was to compare the in-vitro osteogenic differentiation potential of withinsubject mesenchymal stem cells (MSCs) derived from the dental pulp of permanent teeth (dental pulp stem cells-DPSCs), the dental pulp of deciduous teeth (pulp of human exfoliated deciduous teeth-SHEDs), and the periodontal ligament of permanent teeth (periodontal ligament stem cells-PDLSCs). A single subject was identified that required concurrent removal of both deciduous and permanent teeth for orthodontic purposes. Primary, mixed population cells from dental pulp, deciduous dental pulp, and periodontal ligament were obtained by the tissue out-growth method. Subsequently, isolation of STRO-1 +ve cells from their respective primary cell cultures was achieved by immunomagnetic separation. Cells were induced with an osteogenic cocktail of 5mM β-glycerophosphate, 100nM dexamethasone and 50 mg/mL ascorbic acid for up to 21 days. Osteogenic responses were assessed functionally by an alkaline phosphatase (ALP) activity assay and an alizarin red staining assay. Expression of the early osteogenic associated genes alkaline phosphatase gene (ALPL), runt-related transcription factor 2 (RUNX2), collagen type I alpha 1 (COL1A), and secreted phosphoprotein 1 (SPP1) were compared by qPCR at days 1, 4 and 7 of differentiation. Functional analysis revealed there were significant differences in intracellular ALP activity on days 4, 7, 10 & 14 with PDLSCs > SHEDs > DPSCs. Quantification of alizarin red staining showed significantly more mineralisation for PDLSCs by day 21. Gene expression analysis showed significant early up-regulations of the osteogenic markers ALPL and COL1A1 for PDLSCs over DPSCs and SHEDs. SHEDs showed significantly higher upregulation of ALPL over DPSCs. In conclusion, PDLSCs showed a significantly higher osteogenic differentiation potential than both DPSCs and SHEDs evidenced by functional studies and gene expression. This may be of significance for the use of dentally derived MSCs in bone tissue engineering applications.

Objective: To investigate whether there was an association between chronic periodontitis (CP) and reduced respiratory function.Methods: A group of dentate 58-to 72-year-old men in Northern Ireland had a comprehensive periodontal examination. Parallel to the periodontal examination, participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Fasting blood samples were obtained and analysed for high-sensitivity C-reactive protein (hs-CRP). Spirometry measures were performed using a wedge bellows spirometer (Vitalograph S Model). The primary outcome variable of interest was the percentage predicted forced expiratory volume in one-second (% predicted FEV 1 ). Analysis included multiple linear regression with adjustment for various confounders and a regression-based mediation analysis. Results:A total of 1,380 men were included in the analysis. The mean age was 63.7 years (SD 3.0). Multiple linear regression analysis showed that a doubling in mean clinical attachment loss (CAL) equated to a −3.33% (95% CI: −4.80, −1.86), p < 0.001 change in % predicted FEV 1 after adjustment for all other potential confounding variables. Systemic inflammation, as measured by hs-CRP, only accounted for a minor mediating pathway effect (9%). Conclusions:In this homogenous group of dentate men, CP was significantly associated with a reduced respiratory function. K E Y W O R D Schronic obstructive pulmonary disease, inflammation, periodontitis, respiratory function | 267 WINNING et al.