High incidence of periodontitis in patients with ascitic decompensated cirrhosis

BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether the common periodontitis pathogens,Porphyromonas gingivalis(P.gingivalis)and Actinobacillus actinomycetemcomitans(A.actinomycetemcomitans),can be detected not only in the oral mucosa but also in ascites and stool.AIM To investigate the significance of periodontitis,P.gingivalis,and A.actinomycetemcomitans in cirrhosis patients with ascitic decompensation.METHODS This prospective study was conducted at the University Hospital Hamburg Eppendorf,a tertiary center in Northern Germany.A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis,as well as patient outcomes.PCR was used to test gingival samples,ascites,and stool for the presence of P.gingivalis and A.actinomycetemcomitans.Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.RESULTS Periodontitis was diagnosed in 22 out of 27(82%)ascite patients,which is significantly more common than in a control cohort of 100 unselected patients(59%,P=0.04).P.gingivalis was detected in the gingiva of six patients,and one of them also had P.gingivalis in their stool.However,P.gingivalis was not found in the ascites of any patient.Five out of six patients with P.gingivalis had periodontitis(83%).A.actinomycetemcomitans was not detected in any sample.Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis,and survival(Kaplan-Meier analysis)was longer in patients with periodontitis(P=0.02).Transplantfree survival was also more common in patients with periodontitis compared to those without(63%vs 0%,P=0.02).CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis.However,there was no evidence of the translocation of P.gingivalis or A.actinomycetemcomitans into ascites.The survival of cirrhotic patients with periodontitis was not reduced.

Gingival-derived mesenchymal stem cells:An endless resource for regenerative dentistry

The gingiva, the masticatory portion of the oral mucosa, is excised and discarded frequently during routine dental treatments and following tooth extraction, dental crown lengthening, gingivectomy and periodontal surgeries. Subsequent to excision, healing eventually happens in a short time period after gingival surgery. Clinically, the gingival tissue can be collected very easily and, in the laboratory, it is also very easy to isolate gingival-derived mesenchymal stem cells (GMSCs) from this discarded gingival tissue. GMSCs, a stem cell population within the lamina propria of the gingival tissue, can be isolated from attached and free gingiva, inflamed gingival tissu-es, and from hyperplastic gingiva. Comparatively, they constitute more attractive alternatives to other dental-derived mesenchymal stem cells due to the availability and accessibility of gingival tissues. They have unique immunomodulatory functions and well-documented self-renewal and multipotent differentiation properties. They display positive signals for Stro-1, Oct-4 and SSEA-4 pluripotency-associated markers, with some co-expre-ssing Oct4/Stro-1 or Oct-4/SSEA-4. They should be considered as the best stem cell source for cell-based therapies and regenerative dentistry. The clinical use of GMSCs for regenerative dentistry represents an attrac-tive therapeutic modality. However, numerous biological and technical challenges need to be addressed prior to considering transplantation approaches of GMSCs as clinically realistic therapies for humans.

Camrelizumab(SHR-1210) leading to reactive capillary hemangioma in the gingiva: A case report

BACKGROUND Oncologic immunotherapy is attracting attention as an effective strategy for cancer treatment. Currently, there are two kinds of inhibitors: Anti-PD-1 antibodies and anti-PD-L1 antibodies. These inhibitors have shown significant implications in improving the outcomes of certain cancer types in recent years.However, along with its effectiveness, adverse events cannot be ignored. As an anti-PD-1 antibody, camrelizumab(SHR-1210) has some side effects in tumor immunotherapy. The most common adverse event is reactive capillary hemangioma. While it is widely reported to occur in the skin, gingival reactive capillary hemangioma is rarely reported.CASE SUMMARY A 54-year-old man complained of gingival overgrowth on the anterior aspect of the maxilla and mandible for more than 6 mo. He had been placed on SHR-1210 for lung cancer for 7 mo. A gingival mass extending from canine to canine was noted on the lingual surfaces of the mandible. Gingival enlargement was noted in the front teeth. A clinical diagnosis of gingival reactive capillary hemangioma and chronic periodontitis was made. The treatment involved a complex local treatment(repeated local applications of an antibiotic paste, scaling and root planning, and surgery). The excised tissue was sent for histopathological examination, which confirmed the diagnosis of capillary hemangioma. After the operation, most of the gingival enlargement was reduced. At the 2-mo follow-up,it was noted that the gingival overgrowth was immediately reduced after the replacement of the anti-PD-1 agent with an anti-PD-L1 agent.CONCLUSION As the prescription for SHR-1210 has increased considerably in recent years, the occurrence of its possible side effects, including gingival reactive capillary hemangioma, has increased. It is recommended that regular oral examinations be performed before and during the treatment of tumors with SHR-1210.

Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin:A case report

BACKGROUND Keratinized gingival insufficiency is a disease attributed to long-term tooth loss,can severely jeopardizes the long-term health of implants.A simple and effective augmentation surgery method should be urgently developed.CASE SUMMARY A healthy female patient,45-year-old,requested implant restoration of the her left mandibular first molar and second molar.Before considering a stage II,as suggested from the probing depth measurements,the widths of the mesial,medial,and distal buccal keratinized gingiva of second molar(tooth#37)were measured and found to be 0.5 mm,0.5 mm,and 0 mm,respectively.This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation.Accordingly,modified apically repositioned flap(ARF)surgery combined with xenogeneic collagen matrix(XCM)and platelet-rich fibrin(PRF)was employed to increase the width of gingival tissue.After 1 mo of healing,the widths of mesial,medial,and distal buccal keratinized gingiva reached 4 mm,4 mm,and 3 mm,respectively,and the thickness of the augmented mucosa was 4.5 mm.Subsequently,through the second-stage operation,the patient obtained an ideal soft tissue shape around the implant.CONCLUSION For cases with keratinized gingiva widths around implants less than 2mm􀀀the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF.Moreover,this surgery significantly alleviated patients’pain and ameliorated oral functional comfort.

Intragingival injection of Porphyromonas gingivalis-derived lipopolysaccharide induces a transient increase in gingival tumour necrosis factor-a, but not interleukin-6,in anaesthetised rats

This study used in vivo microdialysis to examine the effects of intragingival application of lipopolysaccharide（LPS） derived from Porphyromonas gingivalis（Pg-LPS） on gingival tumour necrosis factor（TNF）-a and interleukin（IL）-6 levels in rats. A microdialysis probe with an injection needle attached to the surface of the dialysis membrane was implanted into the gingiva of the upper incisor. For comparison, the effects of LPS derived from Escherichia coli（Ec-LPS） on IL-6 and TNF-a levels were also analysed. Pg-LPS（1 mg/1 m L） or Ec-LPS（1 or 6 mg/1 m L） was applied by microsyringe, with gingival dialysates collected every hour. Enzyme-linked immunosorbent assay（ELISA） revealed that gingival dialysates contained approximately 389 pg？m L21 of IL-6 basally; basal TNF-a levels were lower than the detection limit of the ELISA. Pg-LPS failed to alter IL-6 levels but markedly increased TNF-a levels, which remained elevated for 2 h after treatment. Neither IL-6 nor TNF-a were affected by Ec-LPS. Reverse transcriptase-polymerase chain reaction（RT-PCR） analysis revealed that the gingiva expresses Toll-like receptor（TLR） 2 and TLR4 m RNA. Immunohistochemical examination showed that TLR2 and TLR4 are expressed by gingival epithelial cells. The present study provides in vivo evidence that locally applied Pg-LPS, but not Ec-LPS, into the gingiva transiently increases gingival TNF-a without affecting IL-6. The present results suggest that TLR2 but not TLR4 expressed on gingival epithelial cells may mediate the Pg-LPS-induced increase in gingival TNF-a in rats.

Gingival unit transfer using in the Miller Ⅲ recession defect treatment

The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer(GUT) technique performed on Miller Ⅲ recession was presented and a similar recession case treated with free gingival graft(FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller Ⅲ defects.

Clinical presentation and management of drug-induced gingival overgrowth: A case series

BACKGROUND We report three patients with drug-induced gingiva overgrowth(DIGO)caused by nifedipine,a calcium channel blocker,who were treated and followed up for 1–3 years.We discussed their symptoms,treatment process,treatment prognosis,and follow-up results.CASE SUMMARY All the patients had a history of nifedipine treatment to control hypertension.Besides nifedipine,Patient 1 was prescribed immunosuppressant cyclosporine A to control nephritis,which is also implicated in GO.Thus,we assumed that a synergistic effect between the drugs contributed to the severity of Patient 1’s condition.This condition has been reported to be more pronounced in patients with periodontitis.In the course of treatment,Patients 1 and 2 did not stop or change drugs.After initial periodontal treatment,periodontal surgery,and later periodontal support and better plaque control,their gingival hyperplasia was well managed and controlled.Under the guidance of a physician,Patient 3 replaced her calcium-channel blocker drug with losartan potassium and hydrochlorothiazide tablets.She received initial treatment without surgery,obtaining a good curative effect.CONCLUSION Patients’compliance,self-plaque control,and professional periodontal therapy have a vital role in treating and preventing the recurrence of DIGO.

Interleukin-1α and tumor necrosis factor-α expression on the compressed side of gingiva during orthodontic tooth movement

Objectives: The aim of this study was to investigate the effect of orthodontic loading on the expression of interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α) in compressed gingiva. Materials and Methods: Twenty-four male Wistar rats were used with four rats as controls at day 0. In ten rats, corticotomy was performed on either left or right side and the re-maining side was served as control, and killed at 7 and 14 days. In the remaining ten rats, maxillary right and left first molars were moved orthodontically with a constant force of 20 g;appliance and appliance in conjunction with cortictomy (appliance-corticotomy) were sequentially alternated between left and right sides and euthanized at 7 and 14 days. Real time polymerase chain reactions of compressed gingiva excised from the euthanized rats was performed to measure mRNA expressions of IL-1α and TNF-α. Results: There were no significant differences in the expression of IL-1α between all the groups. On the other hand, TNF-α from the pressure side in the ap- pliance group and the appliance in conjunction with corticotomy group showed significant increase on the 7th day compared to that of either control or corticotomy group. Conclusions: Orthodontic loading induced the elevation of TNF-α in compressed

Nomograms for Predicting Cancer-Specific Survival of Patients with Gingiva Squamous Cell Carcinoma:A Population-Based Study

The use of the traditional American Joint Committee on Cancer(AJCC)staging system alone has limitations in predicting the survival of gingiva squamous cell carcinoma(GSCC)patients.We aimed to establish a comprehensive prognostic nomogram with a prognostic value similar to the AJCC system.Methods:Patients were identified from SEER database.Variables were selected by a backward stepwise selection method in a Cox regression model.A nomogram was used to predict cancer-specific survival rates for 3,5 and 10 years in patients with GSCC.Several basic features of model validation were used to evaluate the performance of the survival model:consistency index(C-index),receiver operating characteristic(ROC)curve,calibration chart,net weight classification improvement(NRI),comprehensive discriminant improvement(IDI)and decision curve analysis(DCA).Results:Multivariate analyses revealed that age,race,marital status,insurance,AJCC stage,pathology grade and surgery were risk factors for survival.In particular,the C-index,the area under the ROC curve(AUC)and the calibration plots showed good performance of the nomogram.Compared to the AJCC system,NRI and IDI showed that the nomogram has improved performance.Finally,the nomogram's 3-year and 5-year and 10-year DCA curves yield net benefits higher than traditional AJCC,whether training set or a validation set.Conclusion:We developed and validated the first GSCC prognosis nomogram,which has a better prognostic value than the separate AJCC staging system.Overall,the nomogram of this study is a valuable tool for clinical practice to consult patients and understand their risk for the next 3,5 and 10 years.

THE CLINICAL STUDY OF THE NORMAL WIDTH OF THE ATTACHED GINGIVA IN PERMANENT DENTITION

The widths of attached gingiva of all tooth in 300 individuals (aged 12-63 years) without clinical evidence of gingival inflammation were measured for this study. The measurement show that the widest zone on buccolabial aspect was in the incisor with a height of 9.5ram, the narrowest was in the first premolar. The width of lingual mandibular attached gingiva was increased from incisor to molar area. The width of attached gingiva did not relate to sex and age. There was no difference in width of attached gingiva between left and right tooth. Our result is about the same with those of most previous studies.

Expression of PCNA in oral gingival epithelium of aggressive and, chronic periodontitis—A pilot study

Periodontal disease leads to loss of tissue homeostasis of tooth supporting structures. The mechanism of fibrous tissue degradation by various enzymes in chronic periodontitis and aggressive periodontitis was well documented but there is paucity of information regarding epithelial response. The aim of the present study was to evaluation of epithelial cell proliferation in Chronic Periodontitis, Aggressive Periodontitis and normal patients using Proliferating Cell Nuclear Antigen (PCNA). The study consists of 30 individuals who attended the Periodontia clinic of Vishnu Dental College. They were divided equally into 3 groups: chronic periodontitis (10) aggressive periodontitis (10) and normal individuals requiring gingival excision for crown lengthening (10). Excised gingival tissues were routinely processed and subjected to Immuno-histochemical evaluation using Proliferating Cell Nuclear Antigen (PCNA). The mean proliferation index was almost equal in Aggressive periodontitis patients (36.55) and normal individuals (37.02) but it was high in Aggressive Periodontitis patients when compared to chronic periodontitis group (18.86). Observations of this study indicate the possibility of subclinical inflammation in clinically normal gingiva and difference in the types of microorganism associated with chronic periodontitis and aggressive periodontitis.

TNF-α、IL-6、IL-1β Effect of omeprazole combined with amoxicillin on cytokines in gingival crevicular fluid of patients with periodontal disease

Objective:To investigate the TNF-α、IL-6、IL-1βeffect of omeprazole combined with amoxicillin on cytokines in gingival crevicular fluid of patients with periodontal disease.Methods:102 patients with periodontal disease who were treated in our hospital from June 2016 to March 2018 were selected.Randomly divided into two groups,the control group was treated with omeprazole alone,and the research group was treated with omeprazole combined with amoxicillin.The levels of inflammatory cytokines(TNF-α、IL-6、IL-1β),therapeutic effects and adverse reactions to drugs were compared between the two groups.Results:the levels of inflammatory factors(TNF-α、IL-6、IL-1β)in the study group were lower than those in the control group(P<0.05).The therapeutic effect(82.4%)of the control group was lower than that of the study group(96.1%)(P<0.05).The incidence of adverse reactions to drugs in the study group(3.8%)was lower than that in the control group(21.5%)(P<0.05).Conclusion:joint take omeprazole amoxicillin treatment of periodontal disease patients achieved ideal therapeutic efficacy.

A Blackish Gingiva Revealing a Metastatic Melanoma of the Oral Mucosa

Background and Objective: Malignant melanoma is the most aggressive skin cancer because it has very strong metastatic power. Endobuccal localization is very rare. Its discovery is often made in the late stage, which leads to a consistently pessimistic diagnostic. We report a case of palatal melanoma at the metastatic stage. Case Report: A 43-year-old woman presented left lateral cervical swelling associated with dyspnea for 5 months. She had regularly taken chewing tobacco for 4 years and had developed blackish gums. The endobuccal examination showed a blackish non-haemorrhagic swelling of 5 cm of the long axis, located at the level of the palatal vault, associated with pigmentation in teeth 21, 22, and 23. The anatomopathological examination confirmed the melanoma. The spreading assessment revealed pleural and hepatic metastasis. The proposed treatment was palliative treatment. The patient died 2 months later. Conclusion: Melanoma of the oral mucosa is a very aggressive tumor. The scarcities of dental care among the Malagasy people exacerbate the delay in diagnosis. Its management is still challenging in Madagascar.

The spatial transcriptomic landscape of human gingiva in health and periodontitis

The gingiva is a key oral barrier that protects oral tissues from various stimuli.A loss of gingival tissue homeostasis causes periodontitis,one of the most prevalent inflammatory diseases in humans.The human gingiva exists as a complex cell network comprising specialized structures.To understand the tissue-specific pathophysiology of the gingiva,we applied a recently developed spatial enhanced resolution omics-sequencing(Stereo-seq)technique to obtain a spatial transcriptome(ST)atlas of the gingiva in healthy individuals and periodontitis patients.By utilizing Stereo-seq,we identified the major cell types present in the gingiva,which included epithelial cells,fibroblasts,endothelial cells,and immune cells,as well as subgroups of epithelial cells and immune cells.We further observed that inflammation-related signalling pathways,such as the JAK-STAT and NF-κB signalling pathways,were significantly upregulated in the endothelial cells of the gingiva of periodontitis patients compared with those of healthy individuals.Additionally,we characterized the spatial distribution of periodontitis risk genes in the gingiva and found that the expression of IFI16 was significantly increased in endothelial cells of inflamed gingiva.In conclusion,our Stereo-seq findings may facilitate the development of innovative therapeutic strategies for periodontitis by mapping periodontitis-relevant genes and pathways and effector cells.

Determining the Checkpoint of Transition from Thin to Thick Periodontal Phenotypes in the Maxillary and Mandibular Anterior Regions of South Indian Population

Aim:The aim of this study was to compare and investigate the tissue thickness at the maxillary and mandibular central incisors utilizing the probe visibility method and traditional way of measuring gingival thickness(GT)by endodontic files.Methodology:In 200 selected patients,the GT was measured at both the maxillary and mandibular anterior using an endodontic file after local infiltration at the mid-distance from the gingival margin to the mucogingival junction.The checkpoint of transition from thin to thick periodontal phenotype was determined by probe visibility method in the following age groups:Group A:21-30 years;Group B:31-40 years;Group C:41-50 years;and Group D:51-60 years.Results:GT varied from 0.3 to 1.9 mm.Gingival translucency was observed up to the thickness of 0.7 mm.At 0.8 mm of GT,there was no probe visibility.Conclusion:According to the present research,the gingiva appears transparent up to a thickness of around 0.7 mm.The checkpoint of transition between thin and thick periodontal phenotypes at both the maxillary and mandibular anterior was associated with a GT of 0.8 mm.

An investigation of immunocompetence substances in normal gingival and periodontitis tissue

To investigate the effects of nitric oxide (NO), endothelin (ET), substance P (SP) and calcitonin gene-related peptide (CGRP) immunocompetence substances and their relationship to chronic periodontitis Methods Immunohistochemical aod histochemical staining methods were used to detect the expression of the NO synthase (NOS), ET, SP and CGRP levels in 20 patients with chronic periodontitis and 20 healthy subjects as control Results Quantitative analysis by Quantimat 970 showed that NOS and ET in periodontitis tissue increased significantly ( P <0 01), particularly the content of ET in comparison with healthy subjects The intergroup expression of SP and CGRP showed no remarkable changes Conclusion Our results demonstrate that the level of NOS and ET were significantly increased in periodontitic tissue, which may diminish the blood supply and influence the periodontal tissue causing tissue damage Our study suggests that immunocompetence substances NO and ET are closely associated with periodontitis and may play an important role in the disease

Single-nucleus transcriptomics uncovers a geroprotective role of YAP in primate gingival aging

Aging has a profound impact on the gingiva and significantly increases its susceptibility to periodontitis,a worldwide prevalent inflammatory disease.However,a systematic characterization and comprehensive understanding of the regulatory mechanism underlying gingival aging is still lacking.Here,we systematically dissected the phenotypic characteristics of gingiva during aging in primates and constructed the first single-nucleus transcriptomic landscape of gingival aging,by which a panel of cell type-specific signatures were elucidated.Epithelial cells were identified as the most affected cell types by aging in the gingiva.Further analyses pinpointed the crucial role of YAP in epithelial self-renew and homeostasis,which declined during aging in epithelial cells,especially in basal cells.The decline of YAP activity during aging was confrmed in the human gingival tissues,and downregulation of YAP in human primary gingival keratinocytes recapitulated the major phenotypic defects observed in the aged primate gingiva while overexpression of YAP showed rejuvenation effects.Our work provides an in-depth understanding of gingival aging and serves as a rich resource for developing novel strategies to combat aging-associated gingival diseases,with the ultimate goal of advancing periodontal health and promoting healthy aging.