Periodontal disease:A silent factor in the development and progression of diabetic retinopathy

The global increase in the prevalence of type 2 diabetes mellitus(T2DM)and its complications presents significant challenges to public health.Recently,periodontal disease(PD)was recognized as a factor that is likely to influence the progression of T2DM and its complications due to its potential to exacerbate systemic inflammation and oxidative stress.In this editorial,we comment on the article published by Thazhe Poyil et al in the very recent issue of the World Journal of Diabetes in 2024,which investigated the correlation between PD and diabetic retinopathy(DR)in T2DM patients,with emphasis on the association between periodontal swollen surface area,glycated hemoglobin(HbA1c),interleukin-6(IL-6),and lipoprotein(a).The findings by Thazhe Poyil et al are significant as they demonstrate a strong link between PD and DR in T2DM patients.This correlation highlights the importance of addressing periodontal health in diabetes management to potentially reduce the risk and severity of DR,a complication of diabetes.The integration of periodontal evaluation and treatment into diabetes care protocols may lead to improved glycemic control and better overall outcomes for T2DM patients.A few studies have established an interconnection between PD and diabetic complication,specifically DR,in T2DM patients,which we aim to highlight in this editorial.Emphasis was placed on the different mechanisms that suggest a bidirectional relationship between PD and T2DM,where the presence of periodontal inflammation negatively influenced glycemic control and contributed to the development and progression of DR through shared inflammatory and vascular mechanisms.This article highlights the importance of collaboration amongst diabetes specialists,ophthalmologists,periodontists,and public health professionals to advance the prevention,early detection,and treatment of PD and DR.This will improve the health and quality of life of T2DM patients.Moreover,the editorial highlights the need for further research on the specific molecular and immunological mechanisms that underlie the link between periodontitis and DR,with identification of common inflammatory biomarkers and signaling pathways.This is expected to facilitate effective direction of therapeutic objectives,thereby improving the management of diabetes and its complications through integrated care that incorporates oral health.

Causal relationship between inflammatory bowel disease and gingivitis or periodontal disease:A two-sample Mendelian randomized analysis

Background:Observational studies have shown that inflammatory bowel disease(IBD),such as ulcerative colitis(UC)and Crohn disease(CD),is associated with gingivitis and periodontal disease(GP).This study aims to investigate whether there is a causal relationship between IBD and GP.Methods:This study assessed the causal relationship between IBD and GP through a two-sample Mendelian randomization(MR)study.The required data were obtained through the IEU OpenGWAS project.Instrumental variable screening and the MR and sensitivity analyses were performed using the“TwoSampleMR”R package.Results:IBD,UC,and CD may have a causal effect on GP(IBD,inverse variance weighting[IVW]OR=1.05,95%CI=1.00–1.10,P=0.03;UC,IVWOR=1.05,95%CI=1.00–1.11,P=0.03;CD,weighted median OR=1.06,95%CI=1.00–1.13,P=0.04;simple mode OR=1.15,95%CI=1.02–1.31,P=0.03).Scatterplots,forest plots,and funnel plots showed a significant relationship between IBD and GP and confirmed the robustness of the model.In sensitivity testing,no horizontal pleiotropy or heterogeneity was found in this study.Conclusions:This study found a possible causal relationship between IBD(UC and CD)and GP,which deserves to be considered in clinical practice.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Maternal Periodontal Disease and Risk of Preeclampsia:A Meta-analysis

Research on the association between maternal periodontal disease and the risk of pree- clampsia has generated inconsistent results. This meta-analysis was conducted to evaluate the asso- ciation between maternal periodontal disease and the risk of preeclampsia. A literature search of PubMed and Embase was performed to identify relevant papers published before March 2013. Only observational studies that assessed maternal periodontal disease and the risk of preeclampsia were selected. Patients＇ periodontal status was examined at different time points during pregnancy or after delivery （at 14-32 weeks of gestation, within 48 h prior to or within 5 days after delivery）. Pooled odds ratios （ORs） and corresponding 95% confidence intervals （CIs） were calculated for cases and controls. Cases were defined as women with concurrent hypertension and proteinuria after 20 weeks of gestation. Eleven studies involving 1118 women with preeclampsia and 2798 women without preeclampsia were identified and analyzed. Women with periodontal disease before 32 weeks of ges- tation had a 3.69-fold higher risk of developing preeclampsia than their counterparts without perio- dontal disease （OR=3.69; 95% CI=2.58-5.27）. Periodontal disease within 48 h prior to delivery was associated with a 2.68-fold higher risk of preeclampsia （OR=2.68; 95% CI=1.39-5.18）. Pregnant women with periodontal disease within 5 days after delivery had a 2.22-fold higher risk of pree- clampsia than women without periodontal disease （OR=2.22; 95% CI= 1.16-4.27）. In conclusion, this meta-analysis suggests that maternal periodontal disease is an independent predictor ofpreeclampsia.

Periodontal disease is associated with increased coronary heart disease risk:A meta-analysis based on 38 case-control studies

AIM: To investigate whether periodontal disease(PD) is associated with increasing coronary heart disease(CHD) risk by performing a meta-analysis.METHODS: Two authors independently searched Pub Med and China National Knowledge Infrastructure up to January 10 th, 2013 for relevant case-control studies that investigated the association between PD and CHD. After quality assessment using Newcastle-Ottawa Scale and data extraction by two independent authors, the overall and subgroup meta-analyses were performed and publication bias were examined using the Comprehensive Meta-Analysis V2 software. Potential publication bias was assessed using visual inspection of the funnel plots, Egger linear regression test, and trims and fill method.RESULTS: Finally 38 relevant case-control studies were identified, involving 4950 CHD patients and 5490 controls. Eleven studies were rated low quality and 27 were high quality. Based on random-effects, a significant association was identified between PD and CHD(OR 3.79, 95%CI: 2.23-6.43, P < 0.001, I2 = 98.59%), and sensitivity analysis showed that this result was robust. Subgroup analyses according to adjusted/unadjusted ORs, source of control, methodological quality, end point, assessment of PD/CHD, and ethnicity also indicated a significant association. Publication bias was detected, and the estimated OR including the "missing" studies did not substantially differ from our estimate with adjustment for missing studies(OR 4.15, 95%CI: 2.62-6.54, P < 0.001).CONCLUSION: Based on the meta-analysis, PD is probably associated with CHD risk independently and significantly.

Periodontal disease and risk of benign prostate hyperplasia: a cross-sectional study

Background:Both periodontal disease and benign prostatic hyperplasia are age-related diseases that affect millions of people worldwide.Hence,this study aimed to investigate the association between periodontal disease and the risk of benign prostatic hyperplasia.Methods:A total of 4930 participants were selected from an available health examination that was carried out in 2017,only males were considered for further analysis.All eligible males were divided into benign prostatic hyperplasia and normal groups,the benign prostatic hyperplasia group was then divided into prostate volume≤60 g and>60 g subgroups;all their periodontal status was extracted and then into normal(CPI score of 0),periodontal disease(CPI score between 1 and 4),and periodontitis(CPI score between 3 and 4)groups.The correlation between periodontal disease and benign prostatic hyperplasia was investigated using logistic regression analyses and greedy matching case-control analysis.Subgroup analysis based on prostate volume was also performed.All analyses were conducted with SAS 9.4 software.Results:A total of 2171 males were selected for this analysis.The presence of periodontal disease significantly increased the risk of benign prostatic hyperplasia by 1.68 times(OR=1.68,95%CI:1.26–2.24),and individuals with periodontitis showed a higher risk(OR=4.18,95%CI:2.75–6.35).In addition,among matched cases and controls,this association remained robust(periodontal disease:OR=1.85,95%CI:1.30–2.64;periodontitis:OR=4.83,95%CI:2.57–9.07).Subgroup analysis revealed that periodontal disease significantly increased benign prostate hyperplasia risk as well(for prostate volume≤60 g:OR=1.64,95%CI:1.22–2.20;for volume>60 g:OR=2.17,95%CI:1.04–4.53),and there was a higher risk in the group with a prostate volume greater than 60 g.Conclusions:Periodontal disease is significantly and positively associated with an increased risk of benign prostatic hyperplasia.Further validation studies should be performed to explore the relationship between periodontal treatment and benign prostate hyperplasia.

The Clinical Effects of Allantoin Powder for Gargle on Periodontal Diseases and Aphthous Ulcer

A newly developed mouthrinse, Allantoin Powder for Gargle, was clinically investigated. The compound of this agent is mainly allantoin, which is believed easy to penetrate into gingival sulcus and periodontal pockets as well as other places (such as tongue, soft palate, etc.) where it is inconvenient to use medication, 219 patients with various diseases of oral cavity were investigated in the double blind randomlized placebo controlled study. It was observed that apparent efficient rates of the experimental mouthrinse on periodontitis and marginal gingivitis were 81.25% and 56.86% respectively; and the efficient rate of it on aphthous ulcer was 68.57%. The data show that this agent has effective as an adjuctive on the treatments of periodontal diseases and aphthous ulcer.

Assessment of Knowledge of the Relationship between Periodontal Disease and Systemic Disease among Dental Students and Its Impact on Oral Hygiene Practices

Background: Dental students play a role in both oral and general health education in their communities, so it is important that they have good knowledge to enable them offer good counsel. Knowing the relationship between periodontal disease and systemic conditions will put them in better stead when giving oral health education. The aim of this study was to assess the level of knowledge among dental students of the relationship between periodontal diseases and systemic conditions, and to determine whether there was a correlation between this knowledge and their oral hygiene practices. Methods: This was a cross-sectional study among dental students of the University of Port Harcourt, Rivers State, Nigeria. Consenting participants were given a self-administered questionnaire eliciting socio-demographic information, knowledge about the relationship between periodontal diseases and systemic diseases, as well as oral hygiene practices. Each correct response on knowledge was scored as 1, while incorrect responses were scored 0, with a maximum score of 7. Participants’ knowledge was graded as poor (0 - 2), fair (3 - 5) and good (6 - 7). Data was analyzed using IBM SPSS version 21. p ≤ 0.05 was considered statistically significant. Spearman’s ranked correlation was used to assess the correlation between knowledge of the relationship between periodontal diseases and systemic diseases and oral hygiene practices. Results: There were 109 dental students (58 males, 51 females) in this study, with a mean age of 24.1 ± 3.6 years. Preclinical students were 43 (39.4%) while clinical students were 66 (60.6%). All (100%) participants knew that oral health was important to systemic health, with 89.9% knowing that periodontal disease was specifically linked to systemic disease. Only 50.5% of participants knew that there was a link between periodontal disease and diabetes mellitus. Sixty-four (58.7%) of the participants regularly cleaned in between their teeth. The most commonly used interdental cleaning aid was toothpick (45.0%). Clinical students had significantly better knowledge on the relationship between periodontal disease and systemic disease compared to pre-clinical students (p = 0.001). There was positive correlation between knowledge about periodontal disease and its link with systemic disease and better oral hygiene practices, but this was not statistically significant. Conclusion: The majority of dental students had a fair knowledge about the relationship between periodontal diseases and systemic diseases.

Racial Differences Effects on Oral Health and Periodontal Diseases Extent, Staging and Grading among the Multi-Ethnic Expatriates in Aseer Region, Saudi Arabia

Background: Given the increase in the numbers of expatriates in Saudi Arabia and the shortage of information about expatriates’ oral health and periodontal disease severity and progression. Objectives: This study aimed to evaluate the effects of the racial differences on oral health and periodontal disease extent, staging, and grading among the multi-ethnic expatriates in the Aseer region, Saudi Arabia. Materials and Methods: This cross-sectional study was carried out on 300 expatriates in Aseer region, Saudi Arabia. They were divided into three equal racial different groups (n = 100), Arabs (AR), Asians (AS), and Africans (AF). The interviews of all participants were completed then the clinical examinations of periodontal diseases extent, staging, and grading parameters were performed. Statistical analysis was done by ANOVA test, Tukey’s test, and Chi-square test. The statistical significance level was determined at p < 0.05. Results: There were statistically significant differences in the comparison between the three ethnic/racial groups in clinical parameters except in GBI, PCR, FI, TFO, and BC, where there were no statistically significant differences in the comparison between the three ethnic/racial groups. There were differences associated with age, gender, smoking, and diabetes, without statistically significant differences among the three racial groups. Conclusion: We concluded that most participants in this study had a generalized severe grade 4 plaque-induced gingivitis and localized periodontitis stage III grade B.

Risks Factors of Caries and Periodontal Diseases in the Patients, after 5 Years Use a Partial Removable Denture

Objective: The goal of the removable partial denture is to restore impaired esthetics and masticatory function by replacing missing teeth. The aim of this study was to establish a possible correla-tion between removable partial denture in acrylic resin use after 5 years and dental diseases. Materials and Methods: Partially edentulous patients presenting for removable denture treatment at the Prosthodontics service of the Affiliated Hospital of Kinshasa University, Democratic Republic of Congo were assessed in this study. Patients were randomly assigned into 2 groups: Denture and non-denture group. Caries and periodontal diseases were compared between both groups. Statistical significance was set at p < 0.05. Results: The average age in the denture and non-denture-group was 53.15 (±SD 22.05) and 31.59 (±SD 11.98) years. Out of 160 teeth were decayed, both 110 teeth (68.75%) in the denture-group and 50 teeth (31.25%) in the non-denture group. The DMFT index calculated at start time of the study was 0.2 for both groups, after five years was 7.1 for the denture-group and 2.6 for the non-denture-group. The plaque index in the denture-group had an index of 1 and that of non-denture-group was 0.5. Conclusion: The relationship has been found between patients’ wearers a RPD and dental diseases.

Effectiveness of Oral Health Education Program on Prevention of Periodontal Disease in Japanese Pregnant Women

The prevalence of periodontal disease among pregnant women increases with gestational age. Therefore, oral health education in the early stage of pregnancy should prevent periodontal disease and decrease the risk of an adverse pregnancy outcome such as preterm delivery and low birth weight. However, there has been no study on oral health care intervention for prevention of periodontal disease during pregnancy. The purpose of this study was to examine the efficiency of an oral health education program on periodontal disease among Japanese low-risk pregnant women. A total of 207 pregnant women before 20 weeks of gestation were recruited. The first 131 of them were assigned to the control group and the remaining 76 to the experimental group. The experiment participants received an oral health education program including the toothpick brushing method in their early stage of pregnancy. Improvement of the self-assessment score of periodontal symptoms was used as a binary outcome variable. A logistic regression analysis indicated that the intervention (OR = 3.83) and proficiency of the toothpick brushing method (OR = 24.93) were statistically significant predictors of the outcome in the late stage of pregnancy. The positive outcome appeared after practice of the toothpick method brushing for 20 or more weeks, and was associated with the decrease in the log-transformed proportion of the count of Candida species in salivary microbiota (p = 0.026).

Periodontal Diseases in Pregnant Women in Prenatal Consultation

Background: The relationship between pregnancy and periodontal health had well documented in the literature. Of many studies of periodontal diseases in the Democratic Republic of Congo, no study had evaluated these diseases in pregnant women during Prenatal Consultation (PC). This study aimed to describe the occurrence and clinical profile of periodontal diseases in pregnant women admitted to the PC at the General Military Hospital of BOBILA. Materials and Methods: It is a cross-sectional and analytical study of pregnant women admitted to the PC from August to December 31, 2018, at the General Reference Military Hospital of BOBILA/Kinshasa City. The data were collected through a survey combined with the stomatological interview. Sociodemographic data, clinical and periodontal indices included Oral Hygiene Index Simplified (OHI-S), Bleeding on Probing (BOP), and Periodontal Disease Index (PDI) were assessed. The statistical analyses were carried out using the SPSS version 20.0 software. The Chi-square tests, Student t-test were used to determine differences in the distribution of variables, and the odd Ratio with a confidence interval (IC) at 95% was used to estimate the degree of association. The results were significant at p < 0.05. Results: Of the 105 pregnant women received at the PC, 83 were included in this study. The age group between 20 - 29 was the most represented, with a predominance of stay-at-home mothers (75.9%) and married cases (73.4%), they had an average economic status (56.6%) and a secondary education level (63.8%). Gingival bleeding (44.6%) was the main complaint of the pregnant. Gestational age was a significant factor associated with gum bleeding (p < 0.005). Most of the pregnant had poor oral hygiene, localized gravidities (69.6%) during the third semester. Conclusion: A significant proportion of women had experienced periodontal diseases during the pregnancy period, mostly in the third trimester, and was associated with a gestational age of pregnant women.

Endothelial Nitric Oxide Synthase Gene Polymorphism and Periodontal Disease

The endothelial isoform of nitric oxide synthase (eNOS) is responsible for the physiological production of NO in endo-thelial cells and platelets. There is evidence that the G894T polymorphism of the eNOS gene is associated with this enzyme's basal activity and NO production, which could contribute to the pathogenesis of periodontal diseases (PD). Therefore, this study was designed to investigate the role of G894T polymorphism in the eNOS gene as a predisposing factor to periodontal disease. In this study we investigated the association of this polymorphism with PD in an admix-ture population (N = 119) separated into three groups: Healthy control, Moderate and Severe PD, without statistical differences among them for risk factors for PD, such as age, gender and smoking status. We observed that the GG ge-notype was associated with the progression of PD as indicated by an increase in frequency of approximately 18% in the Moderate and 26% in the Severe groups compared to the Healthy control group (p = 0.0302). This finding indicates that patients carrying the GG genotype have a greater chance of developing PD compared with those carrying the T allele, and it reinforces the notion that genetic factors contribute to the development and aggravation of PD.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease,accompanied by oral inflammation and pathological changes in the microbiome,induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease(NAFLD).A subgroup of NAFLD patients have a severely progressive form,namely nonalcoholic steatohepatitis(NASH),which is characterized by histological findings that include inflammatory cell infiltration and fibrosis.NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma.The oral microbiota may serve as an endogenous reservoir for gut microbiota,and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis.Gut dysbiosis increases the production of potential hepatotoxins,including lipopolysaccharide,ethanol,and other volatile organic compounds such as acetone,phenol and cyclopentane.Moreover,gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall,leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation.In particular,many animal studies support that oral administration of Porphyromonas gingivalis,a typical periodontopathic bacterium,induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis.NAFLD,also known as the hepatic phenotype of metabolic syndrome,is strongly associated with metabolic complications,such as obesity and diabetes.Periodontal disease also has a bidirectional relationship with metabolic syndrome,and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively.In this review,we will describe the link between periodontal disease and NAFLD with a focus on basic,epidemiological,and clinical studies,and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome.In conclusion,it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease,gut microbiota,and metabolic syndrome.Thus,the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics,prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Diagnostic value associated with the combination of saliva pepsin and microorganisms in functional heartburn and gastroesophageal reflux disease

Heartburn is a common symptom shared by both gastroesophageal reflux disease(GERD)and functional heartburn(FHB),which can make it challenging to differentiate between the two conditions.However,examining oral manifestations of GERD can be a cost-effective and readily available method to aid in this differentiation process.It may serve as a valuable tool in distinguishing GERD from FHB.

Periodontitis and chronic kidney disease:A bidirectional relationship based on inflammation and oxidative stress

Chronic kidney disease(CKD)and chronic periodontitis(CP)are prevalent conditions which significantly impact public health worldwide.Both diseases share inflammatory and oxidative stress mechanisms,an indication of a likely bidirectional relationship.This editorial explored the association between CKD and CP by highlighting common inflammatory mechanisms and recent research findings that address this interrelationship.Through reviews of recent studies,we discussed how periodontal bacteria may activate systemic immune responses that affect both periodontal and renal tissues.Additionally,meta-analysis data indicated an increased risk of CKD development in patients with CP,and vice versa.The results suggest the need for more rigorous research in the future in order to address the confounding factors and evaluate specific periodontal health interventions and their direct effects on kidney function.We emphasized the importance of comprehensive and multidisciplinary care for the improvement of the overall health of patients affected by CP and CKD.

Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions?

Periodontal disease and inflammatory bowel disease(IBD) are both chronic inflammatory diseases. Their pathogenesis is mediated by a complex interplay between a dysbiotic microbiota and the host immuneinflammatory response, and both are influenced by genetic and environmental factors. This review aimed to provide an overview of the evidence dealing with a possible pathogenic interaction between periodontal disease and IBD. There seems to be an increased prevalence of periodontal disease in patients with IBD when compared to healthy controls, probably due to changes in the oral microbiota and a higher inflammatory response. Moreover, the induction of periodontitis seems to result in gut dysbiosis and altered gut epithelial cell barrier function, which might contribute to the pathogenesis of IBD. Considering the complexity of both periodontal disease and IBD, it is very challenging to understand the possible pathways involved in their coexistence. In conclusion, this review points to a complex pathogenic interaction between periodontal disease and IBD, in which one disease might alter the composition of the microbiota and increase the inflammatory response related to the other. However, we still need more data derived from human studies to confirm results from murine models. Thus, mechanistic studies are definitely warranted to clarify this possible bidirectional association.

Effect of periodontal treatment on glycosylated hemoglobin levels n elderly patients with periodontal disease and type 2 diabetes

Background Periodontal disease is closely related to type 2 diabetes and is an important complication of diabetes.This study aimed to investigate the effect of periodontal treatment on levels of blood glucose （Glu） and glycosylated hemoglobin （HbA1c） among elderly patients with type 2 diabetes and periodontal disease.Methods A total of 107 elderly patients with type 2 diabetes and periodontal disease were selected and divided into two groups according to their HbA1c levels. Group A was a well-controlled diabetic group and group B was uncontrolled.Their probing depth （PD）, attachment loss （AL）, the value of Glu and HbA1c were analyzed before periodontal treatment and 4 months later.Results There was a significant difference in periodontal condition between groups A and B （P 〈0.01）. The periodontal condition for both groups was significantly （P〈0.01） improved after periodontal therapy. The effect of treatment in group A was more pronounced than group B, and the difference was significant （P 〈0.01）. After the periodontal treatment, Glu and HbA1c were reduced significantly in both groups （P 〈0.05）.Conclusions Periodontal condition is related to the control of Glu level among elderly patients with type 2 diabetes and periodontal disease. Periodontal treatment can effectively reduce the level of Glu and HbA1c as well as improve the periodontal condition in elderly type-2 diabetes patients with periodontal disease.

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease

BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be easily examined;therefore,their exploration might be a cheap,widely available,and useful tool in the differentiation of GERD and FHB.AIM To evaluate the prevalence of dental erosions(DE)and periodontal diseases(PD)in patients with heartburn and their association with GERD and FHB.METHODS A total of 116[M/F:51/65,mean age:54(17-80)years]consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.RESULTS Dental disorders were detected in 89%(103/116).Patients with PD+DE had significantly more often pathologic reflux(90.0%vs 27.8%;P<0.05),higher esophagitis scores(1.8 vs 0.9;P<0.05),and a significantly different mean impedance curve(P=0.04)than those without any dental diseases.The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD,especially if both were present(28.9%vs 2.0%;P<0.01),more severe PD(1.5 vs 1.0;P<0.01),and longer history of heartburn(15 years vs 9 years;P<0.01)than those with FHB.CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB.Among the studied parameters,the co-appearance of DE and PD seems to be the best predictor of GERD,whereas the absence of dental disorders was mostly observed in FHB.

Could there be an interplay between periodontal changes and pancreatic malignancies?

The term"periodontal disease"refers to a group of chronic inflammatory illnesses caused by specific microorganisms from subgingival biofilm,that affect the toothsupporting tissues.Recent research has also shown that periodontal infection plays a role in aggravating systemic disease states at distal sites,reinforcing the significance of the oral cavity for general health.Additionally,it has been suggested that gastroenterological malignancies may be promoted by hematogenous,enteral or lymphatic translocation of periopathogens.In the past 25 years,the global burden of pancreatic cancer(PC)has more than doubled,making it one of the major causes of cancer-related mortality.Periodontitis has been linked to at least 50%increased risk of PC and it could be considered a risk factor for this malignancy.A recent study performed on 59000 African American women with a follow up of 21 years showed that participants who had poor dental health had higher chances of PC.The findings,according to researchers,might be related to the inflammation that some oral bacteria trigger.Regarding the mortality of PC,periodontitis considerably raises the chance of dying from PC.Microbiome alterations in the gut,oral cavity and pancreatic tissues of PC patients occur when compared to healthy flora,demonstrating a link between PC and microecology.Inflammation may also contribute to PC development,although the underlying pathway is not yet known.The function of the microbiome in PC risk has drawn more focus over the last decade.Future risk of PC has been linked to the oral microbiome,specifically increased levels of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and decreased relative abundance of Leptotrichia and Fusobacteria,suggesting that it may have an impact on the inflammatory condition by expanding,altering,and regulating the commensal microbiome.Patients who received periodontal treatment had significantly decreased incidence rate ratios for PC.By analyzing patterns in the microbiome composition throughout PC development and establishing strategies to enhance the cancerassociated microbial system,we can increase the efficacy of therapy and eventually find an application for the microbial system.The development of immunogenomics and gut microgenomics in the life sciences will result in a significant advancement in our understanding of how microbial systems and immunotherapy interact,and it may also have intriguing therapeutic implications for extending the lifetime of PC patients.