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Introduction: We investigated the relationship between periodontal treatment and pre-clinical Alzheimer's disease (AD)., Methods: In this quasi-experimental design, 177 periodontally treated patients from the "Greifswald Approach to Individualized Medicine" cohort, which used the same protocols as the population-based Study of Health in Pomerania TREND (SHIP-TREND), and 409 untreated subjects from SHIP-TREND were analyzed. Subjects were younger than 60 years at the magnetic resonance imaging examination, with a median observation period of 7.3 years. Imaging markers for brain atrophy in late-onset AD and brain aging were used as the outcomes., Results: Robust to sensitivity analyses, periodontal treatment had a favorable effect on AD-related brain atrophy (-0.41; 95% confidence interval: -0.70 to -0.12; P = .0051), which corresponds to a shift from the 50th to the 37th percentile of the outcome distribution. For brain aging, the treatment effect was uncertain., Conclusion: Periodontitis is related to pre-clinical AD in our population., (© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: Increasing age is associated with systemic diseases as well as with periodontal diseases. We wondered whether a biological age score constructed exclusively from systemic biomarkers would reflect periodontal risk factors at baseline and tooth loss as well as periodontal outcome during 10 years follow-up., Methods: From the Study of Health in Pomerania (SHIP) 2256 participants (1072 male, 1184 female) were studied for the relationship of the systemic biomarkers glycated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL), fibrinogen, white blood cell count, blood pressure, and waist circumference to their age. Construction of a biological age (BA) score allowed its comparison with the participants' actual chronological age (CA) and their predisposition to periodontal disease., Results: Though nearly identical in CA, participants appearing younger than their true age had a significantly reduced burden of periodontal risk factors. If BA > CA, then risk factors were more frequent including smoking, oral hygiene, dental visits, education, and income. After 10 years, in participants with identical CA, tooth loss followed their BA calculated at baseline, that is, with BA > CA fewer teeth were preserved. Similarly, periodontal measures varied according to BA; sex differences were obvious. Most significant were BA-related differences in inflammatory and anthropometry parameters., Conclusions: The results support the assumption that risk profiles aggregated in BA constitute a characteristic susceptibility pattern unique to each individual, common to both systemic and periodontal diseases. Although BA was constructed exclusively from systemic measures at baseline, BA reflects the oral conditions at follow-up., (© 2020 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Aim: We aimed to investigate associations between malocclusions and periodontal disease by comparing it to that of smoking in subjects recruited from the population-based cross-sectional study "Study of Health in Pomerania.", Materials and Methods: Sagittal intermaxillary relationship, variables of malocclusion and socio-demographic parameters of 1,202 dentate subjects, 20-39 years of age, were selected. Probing depth (PD) and attachment loss (AL) were assessed at four sites by tooth in a half-mouth design. Analyses were performed with multilevel models on subject, jaw and tooth level., Results: Distal occlusion determined in the canine region, ectopic position of canines, anterior spacing, deep anterior overbite and increased sagittal overjet were associated with AL (p-value <0.05). Associations between malocclusions and PD: deep anterior overbite with gingival contact (odds ratio [OR] = 1.40, 95% CI: 1.08-1.82; p-value = 0.0101) and anterior crossbite (OR = 1.75, 95% CI: 1.29-2.38; p-value = 0.0003). Regarding crowding, only severe anterior crowding was compatible with a moderate to large association with PD (OR = 1.93, 95% CI: 0.89-4.20). Compared to smoking, the overall effect of malocclusions was about one half for AL and one-third for PD., Conclusion: Malocclusions or morphologic parameters were associated with periodontal disease., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This report provides a comprehensive overview of the adverse effects of hyperglycemia on the periodontium. It combines data from literature reviews of original data from two large, population-based epidemiologic studies with comprehensive periodontal health assessment. Emphasis is placed on the exploration of hitherto sparsely reported effects of prediabetes and poorly controlled (uncontrolled) diabetes, in contrast to the umbrella term "diabetes." This stems from the realization that it is not simply having a diagnosis of diabetes that may adversely affect periodontal health. Rather, it is the level (severity) of hyperglycemia that is the determining factor, not the case definition of the diagnosis of diabetes or the type of diabetes in question. Importantly, based on existing evidence this paper also attempts to estimate the improvements in periodontal probing depth and clinical attachment level that can be expected upon successful nonsurgical periodontal treatment in people with chronic periodontitis, with and without diabetes, respectively. This exploration includes the implentation of new systematic reviews and meta-analyses that allow comparison of such intervention outcomes between hyperglycemic and normoglycemic subjects. Based on both existing literature and original analyses of population-based studies, we try to answer questions such as: Is there a glycated hemoglobin concentration threshold for periodontitis risk? Does short-term periodontal probing depth reduction and clinical attachment level gain after scaling and root planing depend on glycemic control in type 2 diabetes? Are short-term scaling and root planing outcomes in people with hyperglycemia/diabetes inferior to those in people without diabetes? Do periodontitis patients with diabetes benefit more from the use of adjuvant antibiotics with nonsurgical periodontal treatment than people without diabetes? Does hyperglycemia lead to greater tooth loss in patients in long-term post-periodontal treatment maintenance programs? Throughout this review, we compare our new findings with previous data and report whether the results of these new analyses corroborate, or are in discord with, similar scientific reports in the literature. We also explore the potential role of dental health-care professionals in helping patients control the risk factors that are identical for periodontitis and diabetes. Finally, we suggest various topics that still need exploration in future research., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

Background: The non-communicable diseases dental caries and periodontal diseases pose an enormous burden on mankind. The dental biofilm is a major biological determinant common to the development of both diseases, and they share common risk factors and social determinants, important for their prevention and control. The remit of this working group was to review the current state of knowledge on epidemiology, socio-behavioural aspects as well as plaque control with regard to dental caries and periodontal diseases., Methods: Discussions were informed by three systematic reviews on (i) the global burden of dental caries and periodontitis; (ii) socio-behavioural aspects in the prevention and control of dental caries and periodontal diseases at an individual and population level; and (iii) mechanical and chemical plaque control in the simultaneous management of gingivitis and dental caries. This consensus report is based on the outcomes of these systematic reviews and on expert opinion of the participants., Results: Key findings included the following: (i) prevalence and experience of dental caries has decreased in many regions in all age groups over the last three decades; however, not all societal groups have benefitted equally from this decline; (ii) although some studies have indicated a possible decline in periodontitis prevalence, there is insufficient evidence to conclude that prevalence has changed over recent decades; (iii) because of global population growth and increased tooth retention, the number of people affected by dental caries and periodontitis has grown substantially, increasing the total burden of these diseases globally (by 37% for untreated caries and by 67% for severe periodontitis) as estimated between 1990 and 2013, with high global economic impact; (iv) there is robust evidence for an association of low socio-economic status with a higher risk of having dental caries/caries experience and also with higher prevalence of periodontitis; (v) the most important behavioural factor, affecting both dental caries and periodontal diseases, is routinely performed oral hygiene with fluoride; (vi) population-based interventions address behavioural factors to control dental caries and periodontitis through legislation (antismoking, reduced sugar content in foods and drinks), restrictions (taxes on sugar and tobacco) guidelines and campaigns; however, their efficacy remains to be evaluated; (vii) psychological approaches aimed at changing behaviour may improve the effectiveness of oral health education; (viii) different preventive strategies have proven to be effective during the course of life; (ix) management of both dental caries and gingivitis relies heavily on efficient self-performed oral hygiene, that is toothbrushing with a fluoride-containing toothpaste and interdental cleaning; (x) professional tooth cleaning, oral hygiene instruction and motivation, dietary advice and fluoride application are effective in managing dental caries and gingivitis., Conclusion: The prevention and control of dental caries and periodontal diseases and the prevention of ultimate tooth loss is a lifelong commitment employing population- and individual-based interventions., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aims: In spite of the remarkable success of current preventive efforts, periodontitis remains one of the most prevalent diseases of mankind. The objective of this workshop was to review critical scientific evidence and develop recommendations to improve: (i) plaque control at the individual and population level (oral hygiene), (ii) control of risk factors, and (iii) delivery of preventive professional interventions., Methods: Discussions were informed by four systematic reviews covering aspects of professional mechanical plaque control, behavioural change interventions to improve self-performed oral hygiene and to control risk factors, and assessment of the risk profile of the individual patient. Recommendations were developed and graded using a modification of the GRADE system using evidence from the systematic reviews and expert opinion., Results: Key messages included: (i) an appropriate periodontal diagnosis is needed before submission of individuals to professional preventive measures and determines the selection of the type of preventive care; (ii) preventive measures are not sufficient for treatment of periodontitis; (iii) repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; (iv) behavioural interventions to improve individual oral hygiene need to set specific Goals, incorporate Planning and Self monitoring (GPS approach); (v) brief interventions for risk factor control are key components of primary and secondary periodontal prevention; (vi) the Ask, Advise, Refer (AAR) approach is the minimum standard to be used in dental settings for all subjects consuming tobacco; (vii) validated periodontal risk assessment tools stratify patients in terms of risk of disease progression and tooth loss., Conclusions: Consensus was reached on specific recommendations for the public, individual dental patients and oral health care professionals with regard to best action to improve efficacy of primary and secondary preventive measures. Some have implications for public health officials, payers and educators., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Oral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014., Methods/design: DMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents' registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan., Discussion: The DMS studies first performed in 1989, 1992 and repeated in 1997 and 2005 are the only cross-sectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest., Trial Registration: German Health Services Research Data Bank VfD&#95;DMSV&#95;13&#95;002152.

Aim: There is a growing interest in comparing periodontal conditions between countries. This study compared periodontal disease conditions in three elderly populations- one from Japan and two from Germany., Materials and Methods: We compared periodontal data of 70-year-old subjects from the Niigata Study with 65-74-year-old subjects from the Study of Health in Pomerania (SHIP) and from West Germany (DMS III). A total of 489, 399 and 549 dentate subjects were analysed, respectively. Recording protocols were standardized. Linear or logistic models were used to compare Niigata Study with SHIP., Results: Elderly German subjects in SHIP and DMS III had significantly more severe periodontal conditions and fewer remaining teeth compared to those in Niigata Study, though differences were less pronounced for DMS III. German subjects showed a significantly different pattern of various periodontal risk factors compared to Japanese subjects. Even after adjustment for putative periodontal risk factors, SHIP subjects still presented significantly higher adjusted values for most periodontal parameters compared to Niigata Study subjects (p < 0.05)., Conclusions: Periodontitis was more prevalent in SHIP compared with Niigata Study, even after comprehensive risk factor adjustment. Only to a very small extent, differences between studies could be explained by the risk factors explored., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To explore associations between diabetes etiology (type 1 diabetes mellitus [T1DM] vs. T2DM) and glycemic control in the prediction of 5-year periodontal status change., Research Design and Methods: The Study of Health in Pomerania (SHIP) is a population-based stratified sample of German men and women. Healthy participants and those determined to have T2DM arose from the SHIP cohort, and T1DM participants were recruited from diabetes clinics in the catchment area that gave rise to SHIP. Dentate participants (n = 2,626; 53% women; 20-81 years of age) were included. Diabetes was determined via physician diagnosis and/or HbA(1c) ≥6.5% (uncontrolled diabetes >7.0%). Examiners blinded to diabetes status performed random half-mouth periodontal examinations, assessing probing depth (PD) and attachment loss (AL) (four sites/tooth) at baseline and follow-up. Participants were categorized into six groups as follows: 1) diabetes free (n = 2,280), 2) incident T2DM (n = 79), 3) controlled T2DM (n = 80), 4) uncontrolled T2DM (n = 72), 5) controlled T1DM (n = 43), and 6) uncontrolled T1DM (n = 72). In multivariable regressions, mean PD change (ΔMPD), mean AL change (ΔMAL), or incident tooth-loss values were regressed across the aforementioned diabetes categories., Results: Mean (SD) ΔMPD and ΔMAL values among all participants were -0.08 ± 0.5 mm and 0.08 ± 1.03 mm, respectively, and 34% lost one or more teeth. Relative to diabetes-free participants, those with uncontrolled T2DM experienced greater ΔMPD ± SE (P < 0.05), whereas participants with either uncontrolled T1DM or uncontrolled T2DM realized greater ΔMAL (P < 0.05). Uncontrolled T1DM and T2DM were both associated with an increased risk of future tooth loss (P < 0.05)., Conclusions: Diabetes control, but not etiology, was associated with future tooth loss and accelerated AL progression.

Aim: To assess the suitability of different definitions of caries and periodontitis for inclusion in tooth loss prediction models., Materials and Methods: The Study of Health in Pomerania (SHIP) is a population-based cohort study conducted in 1997-2001 (SHIP-0) and 2002-2006 (SHIP-1). This sample comprised 2,780 subjects aged 20-81 years with complete information on dental and periodontal status [DMFS status, clinical attachment loss (CAL) and probing depth (PD)]. Analyses on five-year tooth loss were limited to half-mouth data., Results: The predictive value of tested definitions was markedly age- and gender-dependent: in 20-39-aged men, the number of decayed or filled surfaces best predicted the number of lost teeth, whereas in young women CAL≥4 mm performed best. In older subjects, periodontal definitions were superior to caries definitions: mean CAL performed best in 40-59-year olds, whereas AL- or PD-related definitions predicted best in 60-81-year olds. On tooth level, mean CAL was the superior definition to assess 5-year incident tooth loss in all strata except for young men., Conclusions: Caries parameters best predicted incident tooth loss in men aged 20-39 years; in the intermediate and oldest age group and in young women, mean AL was most informative. Therefore, prediction models need to be developed for different age and gender groups., (© 2012 John Wiley & Sons A/S.)

Aim: To assess the extent of remission and progression of periodontal diseases among adults in a Northeast German Region., Materials and Methods: The Study of Health in Pomerania (SHIP) is a population-based cohort study with baseline examinations conducted in 1997-2001 and 5-year-follow-up in 2002-2006. The study comprised 2558 subjects aged 20-81 years. Periodontal status was assessed by probing depth (PD) and attachment level (AL), measured at four surfaces per tooth, half-mouth. An event was defined as AL progression or remission of ≥3 mm on ≥2 sites., Results: Average change in mean AL (mean PD) was 0.10 mm (-0.05 mm) during follow-up, equalling 0.02 mm/year (-0.01 mm/year). Adjusted for gender and follow-up time, change in mean AL was significantly higher in 20-29- and 60-69-year-old patients compared with 50-59-year-old patients (p < 0.05). 6.5 (7.5) events of progression (remission) in AL per 100 person-years were observed. In multivariate models, risk factors for progression comprised current smoking, middle or low education, being single or divorced and diabetes (p < 0.05). Enhanced progressive attachment loss seen in 20-29- and 60-81-year-old patients was explained through unfavourable risk factors distributions., Conclusions: Periodontal progression was moderate. Periodontal prophylaxis and motivation to reduce risk factors should especially be addressed to patients having unfavourable risk factor distributions., (© 2012 John Wiley & Sons A/S.)

Platelet factor 4 (PF4) and heparin (H) form PF4/H complexes, the target of the immune reaction in heparin-induced thrombocytopenia (HIT). HIT seems to be a secondary immune response as anti-PF4/H-IgG antibodies occur as early as day 4 of heparin treatment. This study investigated whether prevalent infections such as periodontitis may induce the PF4/H immune response as: (1) natural anti-PF4/H Abs are present in the normal population; (2) PF4 bound to bacteria exposes the same antigen(s) as PF4/H complexes; and (3) sepsis induces PF4/H Abs in mice. We found PF4 bound to periodontal pathogens (Aggregatibacter actinomycetemcomitans; Porphyromonas gingivalis) enabling subsequent binding of human anti-PF4/H Abs. The association of natural PF4/H Abs and periodontitis was assessed in a case-control study, enrolling individuals with natural anti-PF4/H Abs (n = 40 matched pairs), and in the cross-sectional population-based Study of Health in Pomerania (SHIP; n = 3500). Both studies showed a robust association between periodontitis and presence of anti-PF4/H Abs independent of inflammation markers (case-control study: lowest vs highest tertile, odds ratio, 7.12 [95% confidence interval, 1.73-46.13; P = .005]; SHIP study, p(trend) ≤ 0.001). Thus, preimmunization to PF4/bacteria complexes by prevalent infections, for example, periodontitis, likely explains the presence of natural anti-PF4/heparin Abs and the early occurrence of anti-PF4/H-IgG in HIT.

Aim: We assessed the prevalence and extent of periodontitis in Germany. Furthermore, region- and gender-specific differences in periodontal disease prevalence were evaluated., Material and Methods: The fourth German Dental Health Survey is a national cross-sectional survey conducted in 2005. Nine hundred and twenty-five adults (35-44 years) and 1040 seniors (65-74 years) were examined. The survey comprised social- and health-related interviews and dental examinations. Probing depth (PD) and clinical attachment loss (CAL) were assessed at three sites at 12 index teeth., Results: Prevalence of CAL> or =3 mm was found in 95.0% in adults and 99.2% in seniors with 68.7% and 91.4% of teeth being affected, respectively. PD> or =4 mm was prevalent in 76.9% and 87.7% in both age groups, respectively. According to the CDC definition considering mesiobuccal and distolingual sites, prevalence of periodontitis was 70.9% and 87.4% in both age cohorts, with one-fourth and one-half presenting severe forms, respectively. Periodontal prevalence was significantly higher in male subjects and East German subjects., Conclusions: Periodontitis was highly prevalent in German adults. To reduce periodontal burden, treatment of periodontal diseases and continuous maintenance should become an integral part in dental practice. Furthermore, health recommendations should be implemented at the community, professional, and individual level.

Background: Substantial variation exists in reported associations between periodontal infections and cardiovascular disease. Imprecise periodontal exposure definitions are possible contributors to this variability. We studied appropriate exposure definitions for studying associations between clinical periodontal disease (PD) and systemic disease., Methods: Data originate from men and women aged 20-79 enrolled in the Study of Health in Pomerania (SHIP) from 1997-2001. Age and sex-adjusted correlation analysis identified PD definitions with the highest cross-sectional associations with three subclinical markers of systemic disease: plasma fibrinogen (n = 3481), serum hemoglobin A1c (HbA1c) (n = 3480), and common carotid artery intima-media thickness (c-IMT) (n = 1745, age > or = 45)., Results: In men and women, percent of sites with attachment loss (AL) > or =6 mm and tooth loss both revealed the highest correlation with HbA1c (rho = 0.11; several other definitions related similarly), while the strongest fibrinogen correlation was observed with percent of sites with pocket depth > or =3 mm (rho = 0.19). Findings for c-IMT among men were strongest for percent of sites with AL > or =6 mm (rho = 0.14; several other definitions related similarly) while among women, percent of sites with pocket depth > or =5 or 6 mm had the highest observed correlation (rho = 0.13)., Conclusions: A range of near optimal definitions varied according to gender and whether the systemic disease marker reflected an acute or chronic situation. Pocket depth was more strongly correlated with the acute marker fibrinogen while attachment and tooth loss tended to be more strongly correlated with the chronic markers, HbA1c, and c-IMT. These findings can be useful in designing future studies investigating the association between PD and systemic disease.

Background: Persistent organic pollutants (POPs), which are endocrine disruptors that accumulate in adipose tissue, can increase the risk of periodontal disease through the disturbance of the immune system., Objective: We examined associations of background exposure to POPs with periodontal disease in the general population., Design: Cross-sectional associations of concentrations of serum POPs with the prevalence of periodontal disease were investigated in 1,234 adults > or = 20 years of age in the National Health and Nutrition Examination Survey 1999-2002., Results: Among several POPs, organochlorine (OC) pesticides were most strongly associated with periodontal disease. Adjusted odds ratios across quintiles of OC pesticides were 1.0, 1.3, 1.7, 2.4, and 2.7 (p for trend < 0.01) for the presence in any site of clinical attachment loss > or = 4 mm and 1.0, 1.7, 2.6, 3.4, and 3.7 (p for trend < 0.01) for the presence of pocket depth > or = 4 mm. Polychlorinated biphenyls and polychlorinated dibenzo-p-dioxins also showed significant positive associations with one or both definitions of periodontal disease. Results did not materially change when continuous variables of clinical attachment loss or pocket depth were used as outcomes. Although participants with periodontal disease had higher white blood cell and neutrophil counts, neutrophil counts were inversely related to OC pesticides (p for trend < 0.01). These inverse associations did not change after excluding subjects with C-reactive protein >/= 3 mg/L., Conclusion: POPs, especially OC pesticides, were positively associated with periodontal disease, possibly through immunomodulation due to OC pesticides.

Background: Patients with halitosis contact primary care practitioners, dentists, and gastroenterologists alike., Objectives: It is unclear whether gastroesophageal reflux disease (GERD) is a risk factor for halitosis. DESIGN AND PATIENTS/PARTICIPANTS: We studied this possible relationship in the general population using the cross-sectional Study of Health in Pomerania (SHIP). Employing structured interviews, self-reported halitosis was assessed among 417 edentulous (toothless) subjects aged 40 to 81 years and among 2,588 dentate subjects aged 20 to 59 years. The presence of heartburn or acid regurgitation (GERD-related symptoms) at 4 levels (absent, mild, moderate, severe) was taken as exposure and used for logistic regression. Analyses were adjusted for relevant confounders, such as age, sex, depressive symptoms, history of chronic gastritis, history of gastric or duodenal ulcer, smoking, school education, and dental status., Measurements and Main Results: We found a strong positive association between GERD-related symptoms and halitosis (odds ratio 12.94, 95% confidence interval (CI) 2.66-63.09, P = 0.002 for severe compared to no GERD-related symptoms) in denture-wearing subjects and a moderate, positive association between GERD-related symptoms and halitosis (odds ratio 2.24, 95% CI 1.27-3.92, P = 0.005) in dentate subjects with a clear dose-effect relationship., Conclusions: The present study provides clear evidence for an association between GERD and halitosis. As there are effective treatments for GERD, these results suggest treatment options, such as proton pump inhibitors, for halitosis. These should be studied in randomized controlled trials.

Background: Photodynamic killing of periodontopathogenic bacteria may be an alternative to the systemic application of antibacterial drugs used in the treatment of periodontal diseases. Even though the method is still in the experimental stage, increasing bacterial resistance problems may promote the introduction of photodynamic therapy (PDT) into periodontal practice., Aim: In this review a literature survey is given of PDT as seen from a periodontal perspective., Methods: In this review, the present knowledge and experience of PDT is summarized. Literature data are presented on drawbacks of conventional antibiotics, the mechanism of PDT, bactericidal effects of PDT as well as results of clinical efforts. The future prospects of the method are discussed., Results: The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Encouraging studies using PDT in periodontitis and in peri-implantitis are known., Conclusion: Even though PDT is still in experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

The systemic response to periodontal disease was analyzed in the cross-sectional Study of Health in Pomerania (SHIP). The completed data of 2,738 subjects aged 20 to 59 years were used for logistic regression analysis with an increased plasma fibrinogen level (> or =3.25 g/L according to Clauss) as the dependent variable. Participants were divided into four groups according to the number of periodontal pockets > or =4 mm (0, 1-7, 8-14, > or =15 pocketing). An additional group comprised the 52 edentulous subjects. The adjusted odds ratio (OR) of > or =15 periodontal pockets for increased plasma fibrinogen levels was 1.88 (95% CI: 1.25-2.83). Edentulism per se was not associated with increased plasma fibrinogen levels but was contained in a two-way interaction with the number of cigarettes/day in current smokers (p = 0.031). For edentulous nonsmokers the adjusted OR was 1.10 (95% CI: 0.51-2.39). Furthermore, body mass index, the interaction between gender and body mass index, serum LDL cholesterol, medication, the interaction between LDL cholesterol and medication, aspirin, smoking, school education, chronic bronchitis, and the interaction between alcohol consumption and chronic gastritis were associated with plasma fibrinogen levels. Our results show that periodontal disease but not edentulism per se is associated with an increased plasma fibrinogen level.

Objective: The aim of this study was to describe the oral health status of older adults living in northeastern Germany., Materials and Methods: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross-sectional, population-based study. Data on 1446 subjects aged 60-79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss., Results: The prevalence of edentulousness varied from 16% in the 60-65-year-old group to 30% in the 75-79-year-old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60-65 years) to one in the oldest (75-79 years). Among subjects aged 60-69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70-79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70-79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60-69 years: 85% vs. 71% in 70-79-year-old men; women aged 60-69 years: 71% vs. 62% in 70-79-year-olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern., Conclusions: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.

The goal of the Study of Health in Pomerania (SHIP) was to estimate the prevalence of diseases, identify potential risk factors in a defined region in northeast Germany, and examine the particular living situation of this population after the reunification of East and West Germany. One of the main concerns of the SHIP design is the analysis of the relationships between dental, medical, social, and environmentally and behaviorally determined health factors. SHIP is a cross-sectional study (clinical findings and sociologic interviews). The sample was drawn in two steps: Thirty-two communities in the region were selected, and within these communities, a simple random sample was drawn from residence registries, stratified by gender and age. The final sample included 4,310 males and females, aged 20 to 79 years. This is equivalent to a participation rate of 68.8%. Data collection was completed in May 2001. The data collection and items comprised four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination included the teeth, periodontium, oral mucosa, morphology and function of the craniomandibular system, and prosthodontics. The medical examination included blood pressure measurements; electrocardiography; echocardiography; carotid, thyroid, and liver ultrasound examinations; neurologic screening; and blood and urine sampling. The computer-assisted interview consisted of questions on symptoms of disease, utilization of medical and dental services, self-assessment of general and oral health, health behavior and knowledge, and socioeconomic variables. The self-administered questionnaire comprised housing conditions, social network, work conditions, subjective well-being, and individual consequences of the German reunification.

Background/aims: The aim of this study was to analyse the residual periodontal attachment in teeth extracted by East German dentists in order to determine a possible 'forceps level'., Methods: Out of about 8000 extracted teeth collected from a dental waste disposal company, 500 teeth were randomly selected. After exclusion of wisdom teeth and premolars extracted for orthodontic reasons (intact teeth with attachment > 90%), coronal and root caries, fillings, pulp exposure and incomplete root fillings (based on X-rays) were registered. The periodontal ligament was stained with 1% Fuchsin Red and measured with a light microscope., Results: For intact teeth (DF = 0, periodontal disease definition I), the mean periodontal attachment (50.5% +/- 16.0) was significantly lower than for teeth with carious defects or fillings (64.7% +/- 18.8. unpaired t-test: p < 0. 00 1). There was a marked increase in frequency of extractions in intact teeth below 70% periodontal attachment and 37% were extracted at attachment levels between 50 and 69%. Teeth with pulpal involvement showed significantly different frequency distributions and mean attachment values (77.9% +/- 17.8) than the remaining teeth (periodontal disease definition II; 55,2% +/- 15.5)., Conclusions: A considerable number of teeth with no or minor coronal destruction were extracted at an attachment level of 50-70%, regardless of the tooth type. The threshold for 'periodontal' extractions seem to be too low and undifferentiated, which calls for an improvement in knowledge of periodontal diagnosis and treatment.

Aim: To explore whether adjunctive antibiotics can relevantly influence long‐term microbiota changes in stage III–IV periodontitis patients. Materials and Methods: This is a secondary analysis of a randomized clinical trial on periodontal therapy with adjunctive 500 mg amoxicillin and 400 mg metronidazole or placebo thrice daily for 7 days. Subgingival plaque samples were taken before and 2, 8, 14 and 26 months after mechanical therapy. The V4‐hypervariable region of the 16S rRNA gene was sequenced with Illumina MiSeq 250 base pair paired‐end reads. Changes at the ribosomal sequence variant (RSV) level, diversity and subgingival‐microbial dysbiosis index (SMDI) were explored with a negative binomial regression model and non‐parametric tests. Results: Overall, 50.2% of all raw reads summed up to 72 RSVs (3.0%) that were generated from 163 stage III–IV periodontitis patients. Of those, 16 RSVs, including Porphyromonas gingivalis, Tannerella forsythia and Aggregatibacter actinomycetemcomitans, changed significantly over 26 months because of adjunctive systemic antibiotics. SMDI decreased significantly more in the antibiotic group at all timepoints, whereas the 2‐month differences in alpha and beta diversity between groups were not significant at 8 and 14 months, respectively. Conclusions: Mechanical periodontal therapy with adjunctive antibiotics induced a relevant and long‐term sustainable change towards an oral microbiome more associated with oral health. [ABSTRACT FROM AUTHOR]

Aim: According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. Materials and Methods: We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER‐MV; sub‐sample of the Federal State of Mecklenburg‐Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP‐TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. Results: For moderately to severely affected groups, YTL and incidence rates were higher in BARMER‐MV patients (0.35 and 0.18, respectively) than in untreated SHIP‐TREND controls (0.19 and 0.08, respectively). In line, treated SHIP‐TREND participants exhibited higher YTL rates than untreated SHIP‐TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. Conclusion: Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short‐ to mid‐term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long‐term tooth retainment. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the relationship between periodontal treatment and pre-clinical Alzheimer’s disease (AD). Methods: In this quasi-experimental design, 177 periodontally treated patients from the “Greifswald Approach to Individualized Medicine” cohort, which used the same protocols as the population-based Study of Health in Pomerania TREND (SHIPTREND), and 409 untreated subjects from SHIP-TREND were analyzed. Subjects were younger than 60 years at the magnetic resonance imaging examination, with a median observation period of 7.3 years. Imaging markers for brain atrophy in late-onset AD and brain aging were used as the outcomes. Results:Robust to sensitivity analyses, periodontal treatment had a favorable effect on AD-related brain atrophy (–0.41; 95% confidence interval: –0.70 to –0.12; P = .0051), which corresponds to a shift from the 50th to the 37th percentile of the outcome distribution. For brain aging, the treatment effect was uncertain. Conclusion: Periodontitis is related to pre-clinical AD in our population. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Evidence for reducing Helicobacter (H.) pylori by periodontal therapy comes from small studies in China, limiting generalizability. To estimate the association between periodontal disease and anti‐H. pylori IgG titer levels in a European country, we used population‐based data from the Study of Health in Pomerania. Materials and Methods: For pocket depth as the primary exposure, we restricted the age range to participants younger than 60 years (n = 2,481) to avoid selection bias due to edentulism in this cross‐sectional study. For the full age range up to 81 years, we chose the number of missing teeth (n = 3,705). Results: The association between pocket depth and the outcome was weak. Given the ceiling effect for the number of missing teeth (ordinal logistic regression; odds ratio of the interquartile range effect = 1.6; 95% CI: 1.3–1.9; p‐value for linearity = 0.005), we checked whether wearing removable dental prosthesis was associated with higher anti‐H. pylori IgG titer levels (odds ratio = 1.3; 95% CI: 1.1–1.5). Conclusions: Tooth loss and wearing removable dental prosthesis were weakly to moderately associated with higher anti‐H. pylori IgG titer levels in the general population of a European country. [ABSTRACT FROM AUTHOR]

Background: Rate of progression of periodontitis has been used to inform the design of classifications of periodontal diseases. However, the evidence underpinning this topic is unclear and no systematic review has yet been conducted. Objectives: The focused question for this systematic review was: in adults, what is the progression of periodontitis in terms of clinical attachment loss, radiographic bone loss, and tooth loss? Data sources: Highly sensitive electronic search was conducted for published data in MEDLINE, EMBASE, LILACS, and unpublished grey literature in OpenGrey up to February 2016. Reference lists of retrieved studies for full‐text screening and reviews were hand‐searched for potentially eligible studies. Study eligibility criteria and participants: Prospective, longitudinal observational studies with follow‐up of at least 12 months and presenting data on the primary outcome, change in clinical attachment level, in adults (age ≥18 years). Secondary outcomes, tooth loss and bone level change, were only assessed in studies reporting the primary outcome. Studies investigating specific disease populations or only on treated periodontitis patients were excluded. Study appraisal and synthesis methods: Risk of bias and methodology were assessed using the Newcastle‐Ottawa Scale with two additional questions on security of outcome assessment. Studies were pooled by abstracting or estimating mean annual attachment or bone level change and annual tooth loss. Random effects meta‐analysis was conducted with investigation of effect of potential modifiers where possible. Results: A total 11,482 records were screened for eligibility; 33 publications of 16 original studies reporting on more than 8,600 participants were finally included as eligible for the review. The studies represented populations from both developing and developed economies. Mean annual attachment loss was 0.1 mm per year (95% CI 0.068, 0.132; I2 = 99%) and mean annual tooth loss was 0.2 teeth per year (95% CI 0.10, 0.33; I2 = 94%). Observational analysis of highest and lowest mean attachment change quintiles suggested substantial differences between groups with minimal annual change in the lowest quintile and an average deterioration of 0.45 mm mean attachment loss per year in the highest group. This value increased to 0.6 mm per year with periodontitis alone. There was surprisingly little effect of age or gender on attachment level change. Geographic location, however, was associated with more than three times higher mean annual attachment loss in Sri Lanka and China (0.20 mm, 95% CI 0.15, 0.27; I2 = 83%) vs North America and Europe (0.056 mm, 95% CI 0.025, 0.087; I2 = 99%) P < 0.001. Limitations: There were a limited number of studies (N = 16), high variability of design in key study components (sampling frames, included ages, data analyses), and high statistical heterogeneity that could not be explained. Conclusions: Within the limitations of the research, the data show that mean annual attachment level change varies considerably both within and between populations. Overall, the evidence does not support or refute the differentiation between forms of periodontal diseases based upon progression of attachment level change. [ABSTRACT FROM AUTHOR]

Empiric antibiotics are often used in combination with mechanical debridement to treat patients suffering from periodontitis and to eliminate disease-associated pathogens. Until now, only a few next generation sequencing 16S rDNA amplicon based publications with rather small sample sizes studied the effect of those interventions on the subgingival microbiome. Therefore, we studied subgingival samples of 89 patients with chronic periodontitis (solely non-smokers) before and two months after therapy. Forty-seven patients received mechanical periodontal therapy only, whereas 42 patients additionally received oral administered amoxicillin plus metronidazole (500 and 400 mg, respectively; 3x/day for 7 days). Samples were sequenced with Illumina MiSeq 300 base pairs paired end technology (V3 and V4 hypervariable regions of the 16S rDNA). Inter-group differences before and after therapy of clinical variables (percentage of sites with pocket depth ≥ 5mm, percentage of sites with bleeding on probing) and microbiome variables (diversity, richness, evenness, and dissimilarity) were calculated, a principal coordinate analysis (PCoA) was conducted, and differential abundance of agglomerated ribosomal sequence variants (aRSVs) classified on genus level was calculated using a negative binomial regression model. We found statistically noticeable decreased richness, and increased dissimilarity in the antibiotic, but not in the placebo group after therapy. The PCoA revealed a clear compositional separation of microbiomes after therapy in the antibiotic group, which could not be seen in the group receiving mechanical therapy only. This difference was even more pronounced on aRSV level. Here, adjunctive antibiotics were able to induce a microbiome shift by statistically noticeably reducing aRSVs belonging to genera containing disease-associated species, e.g., Porphyromonas, Tannerella, Treponema, and Aggregatibacter, and by noticeably increasing genera containing health-associated species. Mechanical therapy alone did not statistically noticeably affect any disease-associated taxa. Despite the difference in microbiome modulation both therapies improved the tested clinical parameters after two months. These results cast doubt on the relevance of the elimination and/or reduction of disease-associated taxa as a main goal of periodontal therapy. [ABSTRACT FROM AUTHOR]

Aim Whereas the relationship between myeloperoxidase and periodontitis has been widely examined that between salivary peroxidase and periodontitis has received little attention. We examined how periodontitis depends on both salivary peroxidase activity and concentration. Materials and Methods A full mouth, clinical assessment of probing depth was performed in a sample of 46 participants aged 25-54 years. To minimise bias, these data were corrected by data from the general population (Study of Health in Pomerania). Using five repeated measurements of activity and concentration over 1 day, we assessed daily biological variability and increased the reliability of salivary peroxidase measurements. Results Salivary peroxidase activity was associated with probing depth (interquartile range effect = −0.48; robust estimates of 95% confidence interval: −0.90 to −0.31; p = .0052), and its effect was not confounded by salivary peroxidase concentration. In turn, the effect of salivary peroxidase concentration was confounded by salivary peroxidase activity, and it was smaller than that of activity. Conclusions We found an inverse association between salivary peroxidase activity and probing depth. Thus, our results imply that salivary peroxidase activity could be a protective factor against periodontitis. However, large, well-designed studies are needed to explore the causal mechanisms of this association. [ABSTRACT FROM AUTHOR]

Aim To examine associations of pre-diabetes and well-controlled diabetes with periodontitis. Materials and Methods The Study of Health in Pomerania ( SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3086 participants (49.4% men; age 20-82 years). Clinical attachment loss ( CAL) and periodontal probing depth ( PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Pre-diabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated haemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance ( NGT), pre-diabetes, newly detected type 2 diabetes (T2 DM), known T2 DM with HbA1c<7.0% and known T2 DM with HbA1c≥7.0%. Results Pre-diabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism ( OR = 1.09 (95%- CI: 0.69-1.71)) and number of teeth ( OR = 0.96 (95%- CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well-controlled previously known diabetes (for edentulism: OR = 2.19 (95%- CI: 1.18-4.05), and OR = 1.40 (95%- CI: 0.82-2.38), respectively, for comparison with NGT). Conclusions Periodontitis and edentulism were associated with poorly controlled T2 DM, but not with pre-diabetes and well-controlled diabetes. [ABSTRACT FROM AUTHOR]

Patients with halitosis contact primary care practitioners, dentists, and gastroenterologists alike. It is unclear whether gastroesophageal reflux disease (GERD) is a risk factor for halitosis. We studied this possible relationship in the general population using the cross-sectional Study of Health in Pomerania (SHIP). Employing structured interviews, self-reported halitosis was assessed among 417 edentulous (toothless) subjects aged 40 to 81 years and among 2,588 dentate subjects aged 20 to 59 years. The presence of heartburn or acid regurgitation (GERD-related symptoms) at 4 levels (absent, mild, moderate, severe) was taken as exposure and used for logistic regression. Analyses were adjusted for relevant confounders, such as age, sex, depressive symptoms, history of chronic gastritis, history of gastric or duodenal ulcer, smoking, school education, and dental status. We found a strong positive association between GERD-related symptoms and halitosis (odds ratio 12.94, 95% confidence interval (CI) 2.66–63.09, P = 0.002 for severe compared to no GERD-related symptoms) in denture-wearing subjects and a moderate, positive association between GERD-related symptoms and halitosis (odds ratio 2.24, 95% CI 1.27–3.92, P = 0.005) in dentate subjects with a clear dose–effect relationship. The present study provides clear evidence for an association between GERD and halitosis. As there are effective treatments for GERD, these results suggest treatment options, such as proton pump inhibitors, for halitosis. These should be studied in randomized controlled trials. [ABSTRACT FROM AUTHOR]

Abstract Background/aims: This retrospective study determined the treatment outcomes of 142 compliant periodontal patients observed for at least 10 years at the University of Kiel. All patients had been treated for moderate to advanced periodontitis and regularly received supportive periodontal therapy (SPT). Methods: Patient- and tooth-related variables [tooth loss and pocket probing depth (PPD)] were analysed. Results: Of a total of 3353 teeth, 167 were extracted during active treatment and 99 during SPT, mainly for periodontal reasons. Forty-five per cent of the patients did not lose any teeth during 11.7 years of observation. Thirty-seven per cent underwent extractions during active treatment or SPT, 18% both during active periodontal therapy and SPT. Mean tooth loss per patient was 0.07 teeth/year during SPT. Mobility, furcation involvement, smoking, and prescription antibiotics had a negative impact on prognosis. Intraindividual differences in PPD were significant between single- and multirooted teeth with initial PPD ≥ 4 mm at baseline, following active treatment and at the end of SPT, and between firm and mobile teeth at baseline. Interindividual differences in mean PPD were only significant between smokers and non-smokers at the end of the observation period. Conclusions: Long-term maintenance of our patients was effective. Periodontal disease represented the major cause of tooth loss in a minority of the population. [ABSTRACT FROM AUTHOR]