Search Results (493)

Obesity and periodontitis are chronic diseases that share inflammatory and metabolic pathways. The RBFOX1 gene was selected as an exploratory candidate gene because it encodes an RNA-binding splicing regulator, has been implicated in obesity-related phenotypes, and has been reported in candidate-gene analyses of periodontitis/metabolic traits. This study investigated the association between obesity, periodontal disease severity, and RBFOX1 rs6500744 polymorphism. This case–control study enrolled 106 adults: 53 with obesity (BMI ≥ 30 kg/m²) and 53 normoweight controls. Clinical and radiographic periodontal assessments determined disease severity, complexity, staging, and grading. Genotyping of the RBFOX1 rs6500744 polymorphism (CC, CT, TT) was performed using the TaqMan^® SNP Genotyping Assay and the 7500 Fast Dx Real-Time PCR system. Multivariable models adjusted for age, sex, smoking status, and clinically confirmed type 2 diabetes. Participants with obesity showed higher levels of periodontal disease than normoweight controls, indicated by greater pocket depths, attachment loss, and bone loss. Advanced stage (Stage III/IV; p = 5.35 × 10⁻⁶) and Grade C periodontitis (p = 2.08 × 10⁻⁷) were significantly more frequent in the obese group. The rs6500744 T allele was more common among individuals with obesity (46.2% vs. 30.2%; OR 1.99, p = 0.023). Periodontal damage appeared to increase progressively from CC to CT to TT genotype, but genotype-stratified estimates, particularly for TT homozygotes, were interpreted cautiously because of the small subgroup size and multiple testing. Both obesity and the number of T alleles were associated with increased periodontal severity in adjusted statistical models. VIFs were low, residual diagnostics did not indicate major assumption violations, smoking-stratified sensitivity analyses were directionally consistent, and the obesity × T-allele interaction was not statistically significant. Obesity is associated with more severe and extensive periodontal disease in this exploratory case–control cohort; however, residual confounding from significant smoking imbalances between groups cannot be excluded. The RBFOX1 rs6500744 T allele may mark increased susceptibility to periodontal tissue destruction, but the findings do not establish causality or clinical prognostic utility and require longitudinal validation in larger, ancestry-controlled populations. Full article

Background/Objectives: The aim of this retrospective cohort study was to identify and analyze the demographic, systemic, and clinical factors associated with the type of periodontal therapy (surgical vs. non-surgical re-treatment) to better inform multifactorial approaches in periodontal treatment planning. Methods: Electronic health records were analyzed to identify two distinct patient cohorts. The surgical cohort included patients who received one or more surgical procedures (i.e., gingival flap, osseous surgery). The non-surgical re-treatment cohort included patients who received scaling and root planing on more than one occasion and had no history of surgical treatment. Bivariate analyses (t-tests and Chi-square tests) were used to compare cohort characteristics, and a multivariable binary logistic regression model was developed to identify independent predictors of receiving surgical treatment. Results: A total of 3794 patients were included in the final analysis. The non-surgical re-treatment cohort presented with significantly more severe periodontal disease at baseline, including a higher number of bleeding sites and deep pockets (p < 0.001). The logistic regression analysis revealed that a higher number of bleeding sites (OR = 0.984) and deep pockets (OR = 0.987) were significantly associated with a decreased likelihood of receiving surgical treatment. Patients with high blood pressure (OR = 0.620) or arthritis (OR = 0.611) also had significantly lower odds of receiving surgery. Conversely, White patients had significantly higher odds (OR = 1.366) of receiving surgical therapy compared to non-White patients. Conclusions: Within the limitations of this study, the selection between surgical and non-surgical periodontal therapy is a multifactorial decision. Initial disease severity, specific systemic conditions, and patient race were significant predictors of the treatment provided. These findings highlight the necessity of adopting a multifactorial risk assessment framework in periodontology—one that integrates systemic and demographic risk factors alongside clinical parameters to tailor equitable, patient-specific care. Full article

Background and Clinical Significance: Tannerella forsythia is a Gram-negative, anaerobic bacterium primarily associated with severe periodontal disease. Extraoral infections are extremely rare, and the presence of Tannerella forsythia in synovial fluid has not been reported previously. Case Presentation: We report a case of a 60-year-old female with grade IV primary osteoarthritis referred for dental evaluation. Clinical and radiographic examination revealed stage IV generalized periodontitis. Subgingival plaque samples were collected after non-surgical periodontal therapy and analyzed using a semi-quantitative real-time PCR targeting the 16S rRNA gene. During planned knee surgery, synovial fluid was obtained and processed using the same molecular protocol. PCR analysis of samples from the deepest periodontal pockets and synovial fluid confirmed the presence of Tannerella forsythia, demonstrating its potential dissemination from oral to joint tissues. The postoperative course was uneventful, with no signs of joint infection. Conclusions: To the best of our knowledge, this is the first reported detection of Tannerella forsythia in the synovial fluid of a patient with osteoarthritis, supporting the possibility of oral–joint microbial translocation. This finding should be interpreted with caution, as the detection of bacterial DNA does not indicate viability or causative involvement. More research is necessary to clarify the mechanisms underlying this association. Full article

Objectives: This systematic review and meta-analysis aimed to evaluate the role of diode and Nd:YAG lasers as adjuncts to scaling and root planing (SRP) in the non-surgical treatment of moderate-to-severe periodontitis. Methods: The protocol was registered in PROSPERO (CRD420250603025) and conducted following PRISMA guidelines. A comprehensive search in Scopus, PubMed, and Cochrane CENTRAL (up to October 2024) identified randomized controlled trials (RCTs), prospective, and retrospective controlled clinical studies comparing SRP alone versus SRP plus adjunctive laser therapy. The primary outcome was probing pocket depth (PPD); secondary outcomes were bleeding on probing (BoP) and the clinical attachment level (CAL). Risk of bias was assessed using Cochrane RoB 2.0 tool for RCTs and Newcastle–Ottawa Scale for non-RCTs. Meta-analysis was undertaken when at least three studies presenting the same outcome at the same follow-up were found. Results: Nine studies with follow-ups from 3 to 120 months were included, representing a total of 423 participants. Both groups showed PPD reduction at all time points, with pooled analyses revealing no statistically significant differences (mean difference −0.12 to −0.35 mm; p > 0.05), although point estimates often favored laser-treated sites, particularly when baseline PPD ≥ 6 mm. Subgroup analysis showed significantly greater PPD reduction in laser-treated sites compared to SRP alone at 12 months in deep pockets (p = 0.001). These findings should be interpreted with caution, given their exploratory nature, limited sample size, and high heterogeneity. Similar patterns were observed for CAL and BoP, with substantial heterogeneity (I² > 70% at several time points). No adverse events were reported. Conclusions: Within the limitations of the available evidence, adjunctive diode and Nd:YAG laser therapy does not demonstrate consistent statistically significant differences compared to SRP alone in non-surgical periodontal treatment. While a potential adjunctive effect may be observed under specific clinical conditions, particularly in deeper pockets, current evidence is insufficient to support its superiority. Full article

Maxillary canine impaction is a common clinical condition often requiring a combined surgical–orthodontic approach; however, the effect of different surgical strategies on periodontal outcomes remains unclear. This systematic review aimed to evaluate periodontal outcomes following treatment of impacted maxillary canines, with particular focus on the influence of surgical technique (open vs. closed) and impaction site (palatal vs. buccal). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to January 2026 in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO. Randomized controlled trials, controlled clinical studies, observational studies, case series, and case reports reporting periodontal parameters were included. Primary outcomes comprised probing pocket depth, keratinized tissue width, gingival thickness, plaque and bleeding indices, and gingival recession. Twenty-seven studies were included. Overall, treated canines were associated with periodontal conditions comparable to normally erupted teeth, with probing depths generally within physiological limits and minimal gingival recession. Buccally impacted canines tended to show slightly reduced keratinized tissue compared with palatal impactions, although without clear clinical relevance. No consistent superiority of open or closed techniques was identified. Surgical–orthodontic treatment is generally associated with favorable periodontal outcomes, and treatment selection should be individualized according to anatomical and orthodontic factors. Full article

Grade C molar-incisor pattern periodontitis (C-MIP) is a rapidly progressive form of periodontal disease affecting young individuals that is often linked to a highly virulent genotype of Aggregatibacter actinomycetemcomitans (Aa). Although Aa is present in the healthy oral microbiome, its transition into subgingival tissue correlates with the conversion from healthy to diseased status within the periodontal pocket. These changes may be due to immune evasion strategies attributed to Aa exotoxins. We previously demonstrated that a host cell protein, cellugyrin, plays a critical role in exotoxin internalization and subsequent cytotoxicity. Herein, we assess the contribution of cellugyrin to Aa phagocytosis and intracellular trafficking in human macrophages. Confocal imaging demonstrated that Aa co-localizes with cellugyrin. Importantly, cellugyrin-deficient macrophages exhibited a significant reduction in phagocytosed Aa. Furthermore, we analyzed the role of retrograde trafficking in Aa survival. Retro-2-mediated inhibition of this trafficking pathway resulted in increased intracellular Aa, likely due to increased survival. Collectively, our findings suggest that cellugyrin is involved in Aa phagocytosis and that retrograde trafficking may play a role in subsequent host cell clearance of Aa. Full article

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Background and Objectives: The objective of this study was to investigate the relationship between clinical periodontal status and COVID-19 severity, including intensive care unit (ICU) admission and in-hospital mortality, in a cohort of hospitalized patients. Materials and Methods: This single-center, cross-sectional study included 44 patients with polymerase chain reaction-confirmed COVID-19 hospitalized at Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey, between August and December 2021. Of these, 32 (72.7%) were admitted to the ICU and 12 (27.3%) to the inpatient service. All participants underwent a full-mouth clinical periodontal examination to assess probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and plaque index (PI). Clinical data, demographics, comorbidities, and validated disease severity scores (GCS, APACHE II and SOFA) were extracted from electronic medical records, and a univariate logistic regression analysis was performed to identify factors associated with in-hospital mortality. Results: Patients admitted to the ICU (n = 32) were significantly older, had a higher prevalence of comorbidities, and showed higher CAL (p = 0.049) and PI (p < 0.001) values than those treated in the inpatient service. Deceased patients (n = 15) had a significantly higher PI than survivors (p = 0.024). In the univariate logistic regression analysis, APACHE II was the only variable significantly associated with in-hospital mortality (OR = 0.867, p = 0.003), however none of the periodontal parameters, including CAL and PI, showed a statistically significant association with mortality. Conclusions: Poorer periodontal findings, particularly higher CAL and PI values, were more frequently observed in patients requiring ICU care. However, periodontal parameters were not significantly associated with in-hospital mortality in univariate analysis. Given the cross-sectional design, small sample size, and lack of multivariable adjustment, these findings should be interpreted as unadjusted associations rather than evidence of an independent or causal relationship. Full article

Objective: The purpose of this systematic review is to evaluate the available scientific literature on the effectiveness of combining sodium hypochlorite and cross-linked hyaluronic acid (xHyA) as an adjunct to non-surgical periodontal treatment. Materials and Methods: Five electronic databases were searched. The study was traced using the PRISMA criteria and publications from ProQuest, Google Scholar, Springer Nature, Scopus, and PubMed. The randomized study was examined using the Cochrane Risk of Bias 2 (RoB) tool and two case series studies were reviewed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results: The systematic review included four studies (two RCT and two case series). Across the included studies, the adjunctive use of sodium hypochlorite/amino acid gel and cross-linked hyaluronic acid (xHyA) following subgingival instrumentation was associated with improvements in clinical periodontal parameters. Probing pocket depth (PPD) reduction ranged from 1.5 to 5.8 mm, clinical attachment level (CAL) gain ranged from 1.5 to 5.3 mm, and bleeding on probing (BOP) reduction ranged from 57.5% to 65.6%. The improvements were generally more pronounced in deeper periodontal pockets. Minor variations in intervention protocols were observed among studies. Conclusions: The adjunctive use of sodium hypochlorite and cross-linked hyaluronic acid in non-surgical periodontal therapy may be associated with improvements in clinical periodontal parameters, including PPD, CAL, and BOP, particularly in deep pockets. However, the available evidence is limited and heterogeneous, with small sample sizes and short follow-up durations. Therefore, these findings should be interpreted with caution, and further well-designed long-term studies are required. Full article

Candida species can shift from commensal organisms to opportunistic pathogens. Both Candida albicans and non-albicans Candida (NAC) species colonize oral biofilms and periodontal pockets, where they may contribute to inflammation and the progression of periodontal disease. This study aimed to determine the prevalence and antifungal susceptibility profiles of Candida species in individuals with different stages of periodontal disease. A cross-sectional study was conducted in 100 participants whose periodontal status was clinically evaluated. Saliva samples were cultured on chromogenic agar for yeast isolation, species identification was confirmed by MALDI-TOF MS, and antifungal susceptibility to fluconazole, clotrimazole, nystatin, and amphotericin B was assessed. Candida spp. was detected in 35% of participants, where C. albicans was the most prevalent species, followed by Nakaseomyces glabratus (formerly Candida glabrata), Candida parapsilosis, Candida dubliniensis, and Candida tropicalis. Species distribution varied according to periodontal status, with N. glabratus predominating in early periodontitis and C. albicans appeared more frequently in higher severe stages of periodontitis. Susceptibility testing showed resistance of C. albicans to clotrimazole (63.6%) and nystatin (22.7%), whereas amphotericin B and fluconazole remained effective. NAC species, particularly N. glabratus, exhibited resistance to nystatin and variable resistance to clotrimazole but remained susceptible to amphotericin B. These findings underscore the importance of early detection and personalized antifungal strategies for managing periodontal disease complicated by Candida colonization. Full article

Background/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion–constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6–13.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5–12.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann–Whitney U and Wilcoxon tests (p < 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p < 0.01), accompanied by increases in overjet and Wits appraisal (p < 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p < 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p < 0.05), whereas plaque index remained stable (p > 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy. Full article

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures. Full article

Background: Vitamin D has been increasingly investigated for its pleiotropic immunomodulatory and antimicrobial effects, which may influence periodontal inflammation and healing. This systematic review aimed to evaluate the impact of serum vitamin D levels and vitamin D supplementation as an adjunct to non-surgical periodontal therapy (NSPT) on clinical and microbiological outcomes in patients with periodontitis. Methods: An electronic search was conducted in MEDLINE and other major databases up to September 2025. Randomized controlled trials assessing the relationship between vitamin D status or supplementation and periodontal outcomes following NSPT were included. Data were synthesized qualitatively, focusing on changes in serum 25(OH)D levels and periodontal parameters, including probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and gingival inflammation. Results: Four studies met the inclusion criteria. In patients with sufficient baseline vitamin D levels, supplementation provided limited additional clinical benefits beyond NSPT alone. Conversely, in vitamin D-deficient patients, supplementation regimens capable of restoring serum 25(OH)D levels above 30 ng/mL were consistently associated with greater reductions in PPD, improved CAL, and decreased plaque and bleeding indices. Microbiological analyses also revealed a reduction in red complex periodontal pathogens in supplemented groups. Conclusions: Vitamin D supplementation enhances the clinical effectiveness of NSPT primarily in patients with documented vitamin D deficiency. Its adjunctive benefits appear to be mediated by immunomodulatory and antimicrobial mechanisms that complement mechanical debridement. While current evidence supports targeted supplementation in deficient individuals, long-term randomized trials are required to establish standardized protocols and confirm sustained clinical benefits. Full article

Background: The Mediterranean diet (MD) represents a nutritionally balanced eating pattern characterized by high consumption of fruits, vegetables, legumes, nuts, whole grains, olive oil, fish, and extra-virgin olive oil as the principal fat source and limited intake of red meat and refined sugars. Emerging evidence indicates that the MD’s anti-inflammatory and antioxidant properties extend beyond systemic health, potentially reducing the risk and severity of periodontitis. This narrative review aimed to synthesize current evidence on the relationship between adherence to the MD and periodontal health outcomes. Methods: A comprehensive electronic literature search was conducted in PubMed without restrictions on publication date. Fourteen studies, ranging from 2019 to 2025, were included, encompassing human, clinical, experimental, and review designs that examined MD adherence and its effects on periodontal parameters. Eligible studies included cross-sectional, cohort, randomized controlled trials; systematic reviews; and animal models assessing clinical periodontal indices, inflammatory biomarkers, or microbial composition. Extracted data included study design, population characteristics, dietary assessment methods, and primary periodontal findings. Results: Most studies demonstrated that greater adherence to the MD was associated with improved periodontal parameters, including reduced probing pocket depth, clinical attachment loss, and bleeding on probing. Interventional trials showed significant reductions in systemic inflammatory markers such as IL-1β, TNF-α, and CRP, along with decreased counts of periodontopathogenic bacteria. Experimental studies further revealed the protective role of oleic acid and polyphenols in regulating macrophage activity, suppressing osteoclastogenesis, and enhancing IL-10 expression via epigenetic modulation. However, heterogeneity in dietary scoring systems, sample characteristics, and follow-up duration limited direct comparison, and not all associations reached statistical significance. Conclusions: Current evidence supports a beneficial association between MD adherence and periodontal health, mediated through anti-inflammatory, antioxidant, and microbiome-stabilizing mechanisms. Further standardized longitudinal and interventional studies are needed to confirm causality and refine nutritional strategies for periodontal disease prevention and management. Full article

Background: Researchers are now focusing on new and less invasive therapies to improve the domiciliary maintenance phase of periodontitis. Ozonated olive oil as an alternative to common local antiseptics and the assumption of probiotics to maintain a eubiotic oral microbiome show promising results. However, the literature is still limited on this topic. This RCT aims to investigate the clinical benefits of combining ozonated olive oil products (mouthwash and toothpaste) with probiotics on oral health status in patients with stage I and II periodontitis following the active phase of therapy. Methods: The study followed a triple-blind RCT design. Patients with stage I and II periodontitis were enrolled and randomly assigned to three groups: group A (placebo), group B (effective ozonated olive oil mouthwash and toothpaste), and group C (combined protocol with effective ozonated olive oil and probiotics). Clinical assessment was performed at the first visit and after 30 days, considering Full-Mouth Plaque Score (FMPS), Full-Mouth Bleeding Score (FMBS), and Probing Pocket Depth (PPD). Results: The FMPS percentages showed a significative reduction (p = 0.0002) of 24%, 33%, and 62% observed in group A, group B, and group C, respectively. Also, the FMBS percentages were significantly decreased (p < 0.0001): −15%, −20%, and −49% observed in group A, group B, and group C, respectively. The mean PPD showed significant differences (p < 0.0001): −0.10 mm, −0.40 mm, and −1.10 mm observed in group A, group B, and group C, respectively. Overall, group C showed the best improvement among the considered clinical indexes. Conclusions: The findings of this clinical trial support the use of a combined regime of the antimicrobial and anti-inflammatory effects of ozonated olive oil and the modulation of the oral microbiome of probiotic supplements as an adjunctive domiciliary strategy for patients affected by stage I and II periodontitis. Full article