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This chapter deals with the association of diabetes with various oral diseases, including gingivitis, periodontitis, caries, hyposalivation, candidal infection, and cancer. The incidence of gingivitis is particularly high in children and adolescents with newly discovered type 1 diabetes, and in individuals with diabetes with glycated haemoglobin values above 10%. The role of neutrophils in the development of periodontitis in general is considered protective, and impaired neutrophil function may account for an increased susceptibility to periodontitis. Indeed, neutrophil function in individuals with diabetes and periodontitis has been studied intensively. A model‐based cost‐effectiveness analysis of periodontal treatment among individuals with type 2 diabetes has shown that providing non‐surgical periodontal treatment for people with type 2 diabetes and periodontitis would likely have meaningful public health benefits. In the oral cavity various types of malignancy may occur, with squamous cell carcinoma accounting for the vast majority., This chapter deals with the association of diabetes with various oral diseases, including gingivitis, periodontitis, caries, hyposalivation, candidal infection, and cancer. The incidence of gingivitis is particularly high in children and adolescents with newly discovered type 1 diabetes, and in individuals with diabetes with glycated haemoglobin values above 10%. The role of neutrophils in the development of periodontitis in general is considered protective, and impaired neutrophil function may account for an increased susceptibility to periodontitis. Indeed, neutrophil function in individuals with diabetes and periodontitis has been studied intensively. A model-based cost-effectiveness analysis of periodontal treatment among individuals with type 2 diabetes has shown that providing non-surgical periodontal treatment for people with type 2 diabetes and periodontitis would likely have meaningful public health benefits. In the oral cavity various types of malignancy may occur, with squamous cell carcinoma accounting for the vast majority.

Aim To investigate the association between previous periodontal treatment and recurrent events after first-time myocardial infarction (MI). Materials and Methods From the Danish nationwide registries, patients with first-time MI between 2000 and 2015 were divided into three groups according to oral health care within 1 year prior to first-time MI. A multiple logistic regression model provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs) to assess the 3-year risk of major adverse cardiovascular events (MACE). Results A total of 103,949 patients were included. Patients with treated periodontitis (PD) prior to first-time MI had an adjusted 3-year risk of MACE similar to patients presumed periodontally healthy (OR 0.97 [95% CI 0.92–1.03]). Patients with no prior dental visits were significantly older, had more comorbidities and showed significantly increased adjusted 3-year risks of MACE (OR 1.47 [95% CI 1.42–1.52]), cardiovascular death (OR 1.71 [95% CI 1.64–1.78]) and heart failure (OR 1.13 [95% CI 1.07–1.20]) compared with patients presumed periodontally healthy. Conclusions Patients with treated PD 1 year prior to first-time MI had a similar risk of recurrent cardiovascular events as patients presumed periodontally healthy. No dental visit prior to first-time MI was an independent risk factor for recurrent events., Aim: To investigate the association between previous periodontal treatment and recurrent events after first-time myocardial infarction (MI). Materials and Methods: From the Danish nationwide registries, patients with first-time MI between 2000 and 2015 were divided into three groups according to oral health care within 1 year prior to first-time MI. A multiple logistic regression model provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs) to assess the 3-year risk of major adverse cardiovascular events (MACE). Results: A total of 103,949 patients were included. Patients with treated periodontitis (PD) prior to first-time MI had an adjusted 3-year risk of MACE similar to patients presumed periodontally healthy (OR 0.97 [95% CI 0.92–1.03]). Patients with no prior dental visits were significantly older, had more comorbidities and showed significantly increased adjusted 3-year risks of MACE (OR 1.47 [95% CI 1.42–1.52]), cardiovascular death (OR 1.71 [95% CI 1.64–1.78]) and heart failure (OR 1.13 [95% CI 1.07–1.20]) compared with patients presumed periodontally healthy. Conclusions: Patients with treated PD 1 year prior to first-time MI had a similar risk of recurrent cardiovascular events as patients presumed periodontally healthy. No dental visit prior to first-time MI was an independent risk factor for recurrent events.

Periodontitis is a chronic inflammatory disease of the tooth-supporting connective tissue and alveolar bone that is initiated by a bacterial biofilm in periodontal pockets. It affects about half of adults in the Western world, and is associated with a range of systemic comorbidities, e.g., cardiovascular disease (CVD), diabetes and rheumatoid arthritis, and these diseases share overlapping systemic and target tissue inflammatory mechanisms. Indeed, mounting evidence has indicated that their association is causal and built on the presence of systemic low-grade inflammation (LGI). Prior research linking periodontitis to CVD has mainly been derived from experimental studies, observational data, and small interventional trials with surrogate markers of CVD, e.g., endothelial dysfunction. However, recent data from randomised studies have demonstrated that intensive treatment of periodontitis can reduce blood pressure in patients with hypertension in conjunction with reduction of systemic inflammatory markers. Furthermore, targeted anti-inflammatory therapy has been shown to reduce recurrent events in patients with established CVD and LGI. Along this line, the concept of residual inflammatory risk has emerged as an independent new risk factor for atherothrombotic CVD. The present review summarizes translational evidence indicating that periodontitis is a risk factor for CVD dependent on LGI, and we conclude that treatment of periodontitis is likely to contribute importantly to reduction of residual inflammatory risk.

Background: Periodontitis (PD) is classified by Grades A through C according to the risk of further progression, PD Grade C (PD-C) being the most severe progressing form. It is a matter of controversy, whether the disease activity observed in PD-C is due to impaired immune reactivity toward bacteria embedded in biofilms or a hyper-reactive immune response causing tissue damage as a bystander phenomenon. Little is known about the role of complement in this respect. Methods: Plasma and unstimulated saliva samples were collected from patients with PD-B (n = 34) or -C (n = 27) and healthy controls (HCs) (n = 28). Salivary and plasma levels of total C3, C3c, and C3dg were quantified using sandwich enzyme-linked immunosorbent assay (ELISA). Results: Salivary levels of total C3 and C3dg were elevated in PD-B and PD-C patients compared to HCs (both P < 0.05), while the levels of C3c were elevated in PD-C compared to HCs. Plasma levels of C3c were higher in PD-B patients than in HCs (P < 0.05). Conclusion: PD-B and PD-C patients show increased complement activation compared to HCs, but no difference was found between the two disease grades. PD-B, but not PD-C, is associated with increased systemic complement activation as assessed by C3c in plasma.

Background: The facultative bacterium Aggregatibacter actinomycetemcomitans (Aa) is strongly associated with periodontitis and is occasionally found in periodontally healthy subjects. We aimed to determine the prevalence of salivary Aa among patients with either periodontitis grade B (periodontitis-B) or grade C (periodontitis-C), periodontally healthy controls (HCs), and to determine if systemic antibodies against Aa or its virulence factor leukotoxin A (LtxA) may serve as biomarkers that reveal the oral presence of the bacterium and discriminate subjects with periodontitis-C, periodontitis-B, or no periodontitis from each other. Methods: Serum and unstimulated saliva samples were collected from patients with periodontitis-C (n = 27), patients with periodontitis-B (n = 34), and HCs (n = 28). Serum level of immunoglobulin G antibodies to fragmented whole Aa and to LtxA were quantified using a bead-based assay. Aa was identified in saliva using quantitative polymerase chain reaction (qPCR). All analyses were adjusted for age, sex, and current smoking status. Results: Aa was present in saliva from 11% of HCs, in 32% of patients with periodontitis-B (P = 0.04 versus HCs), and in 37% of patients with periodontitis-C (P = 0.02 versus HCs). Serum antibodies to fragments of Aa associated significantly with periodontitis-C (P = 0.03), while serum anti-LtxA antibodies associated with both periodontitis-B and periodontitis-C (P = 0.002 and P = 9×10−4, respectively). Moreover, a significant association between serum anti-LtxA antibodies and Aa count in saliva was observed (P = 0.001). On the basis of serum anti-LtxA antibody levels, patients with periodontitis could be discriminated from HCs (AUC = 0.74 in ROC curve-analysis, P = 0.0003), and carriers of Aa could be discriminated from non-carriers (AUC = 0.78, P <0.0001). Conclusions: Aa is highly prevalent in saliva of patients with periodontitis-B or periodontitis-C. Systemic immunoglobulin G antibodies agai

Denne artikel beskriver de funktioner, der skal overvejes ved køb og brug af en lyspolymeriseringslampe. Effekten, lysets bølgelængder og betydning af afstand til plastmaterialet er ikke den samme for alle lamper. Billeder af lampers stråleprofiler viser, at brug af en enkelt gennemsnitlig irradians (lysstyrke eller lysintensitet) til at beskrive en lyspolymeriseringslampe kan være vildledende. Nogle lamper har ‘hot spots’ med høj irradians, så nogle områder modtager meget større og andre meget mindre lys, end den gennemsnitlige strålingseffekt antyder. Det kan føre til en ujævn polymerisering af plasten og kan også være farligt for blødtvæv. Artiklen beskriver, hvad klinikeren bør fokusere på ved valg af lyspolymeriseringslampe, samt på hvordan optimal lyspolymerisering udføres i mundhulen.

Background and Aim: The aims of this study were to describe the prevalence of various oral diseases and to examine the association of the oral diseases with complications and mortality of cirrhosis. Methods: A total of 184 cirrhosis patients were enrolled and were followed up for 2 years. They underwent oral clinical and radiographic examination. At study entry, the associations between oral diseases with nutrition, inflammation, and cirrhosis complication status were examined. Then, the associations of oral diseases with all-cause and cirrhosis-related mortality were examined using Cox regression to adjust for confounding by age, gender, smoking, alcohol use, alcoholic cirrhosis, cirrhosis complications, comorbidity, Child-Pugh, and Model of End-Stage Liver Disease (MELD) score. Results: At entry, 26% of the patients had gross caries, 46% periapical lesions, 27% oral mucosal lesions, and 68% periodontitis. Having one or more oral diseases was associated with a higher prevalence of cirrhosis complications (46.7 vs 20.5%), higher C-reactive protein (28.5 mg/L vs 10.4 mg/L), and higher nutritional risk score (4 vs 3). Two-thirds of the patients died during follow-up. The patients with more than one oral disease had an increasingly higher all-cause mortality (two diseases: hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.02–1.98; three and four diseases: HR 1.75, 95% CI 1.05–3.24) and even higher cirrhosis-related mortality (two diseases: HR 1.60, 95% CI 1.01–2.40; three and four diseases: HR 2.04, 95% CI 1.05–8.83) compared to those with no oral disease. Conclusion: In cirrhosis, having more than one oral disease was associated with more complications and with higher mortality.

Background and Objective The complement system is engaged in inflammatory reactions both in the periodontal pockets and in the periodontium itself, where it can mediate tissue destruction. The aim of this study was, first, to compare salivary levels of the total complement system protein C3 and its split product, fluid-phase C3c in patients with periodontitis and periodontally healthy controls. Next, to determine if C3 and C3c levels had biomarker potential in diagnosing and monitoring periodontitis and its treatment. We hypothesized that salivary levels of total C3 and the split product C3c associated with the severity of periodontitis and reflected decreased inflammatory activity after periodontal treatment. Methods At baseline, stimulated saliva samples were collected from patients with periodontitis (n = 18) and periodontally healthy controls (n = 15). Subsequently, non-surgical periodontal treatment was performed in the patients, and saliva sampling from patients was repeated two-, six-, and twelve weeks post-treatment (NCT02913248 at clinicaltrials.gov). The patients were grouped as good and poor responders to treatment according to the achieved reduction in bleeding on probing (BOP). Salivary levels of C3 and C3c were quantified using sandwich ELISA. Results Patients with periodontitis had higher baseline levels of both total C3 and the split product C3c in saliva than did periodontally healthy controls (P <.0001). Receiver operating curve (ROC) analyses discriminated patients with periodontitis from controls based on both C3 (AUC (area under curve) = 0.91,P <.001) and C3c levels (AUC = 0.84,P <.001) in saliva. Periodontal treatment improved all clinical parameters (P <.01). Good responders (n = 10) had lower baseline levels of C3c than poor responders (n = 8), (P <.05), and baseline levels of C3c discriminated between good and poor responders (AUC = 0.80,P <.05). Conclusion In conclusion, patients with periodontitis had higher salivary l

Background: During periodontal inflammation, bacteria induces chemokine expression and migration of various inflammatory cells. The aim of the study was to learn if periodontal treatment alters salivary concentrations of macrophage activation-related chemokines and if such alterations correlate with abundance of periodontitis-associated bacteria. Methods: Twenty-five patients with periodontitis completed the study (NCT02913248 at clinicaltrials.gov). Periodontal parameters and stimulated saliva samples were obtained at baseline and 2, 6 and 12 weeks after non-surgical periodontal treatment. Salivary concentrations of monocyte chemoattractant proteins (MCP-1-4), macrophage-derived chemokine (MDC), macrophage migration inhibitory factor (MIF), monokine induced by interferon-gamma (MIG), macrophage inflammatory protein (MIP-1α) and interferon-inducible protein (IP-10) were quantified using the Luminex® xMAP™ technique and abundance of bacteria was quantified using next-generation sequencing. Results: The treatment improved all periodontal parameters and caused an increase in the concentrations of MCP-2, MDC and MIP-1α at week 12 compared to baseline, week 2 and week 6, respectively. Salivary concentrations of MCP-1-2, MDC, MIG, MIP-1α and IP-10 correlated with the abundance of specific periodontitis-associated bacteria. Conclusions: Periodontal treatment impacts salivary concentrations of MCP-2, MDC and MIP-1α, which correlate with the abundance of specific periodontitis-associated bacteria. This indicates that these chemokines reflect periodontal status and possess potential in illustrating a response to treatment.

En række systemiske sygdomme er forbundet med en betydeligt øget risiko for at udvikle sygdomme i mundhulen. Tilstedeværelse af systemisk sygdom kan desuden komplicere den odontologiske behandling og påvirke patientens evne til at opretholde en sufficient mundhygiejne. I denne artikel gennemgås oral sygdomsforekomst, risikofaktorer for sygdomsudvikling i mundhulen og forebyggelse af orale sygdomme ved diabetes, Sjögrens syndrom, osteoporose, demenssygdomme, psykiske lidelser og ved følger af strålebehandling i hoved-hals-regionen. Endvidere omtales forebyggelse af infektiøs endocarditis. Tandlæger spiller en central rolle i tidlig opsporing og diagnostik af flere af disse sygdomme, hvor tidlig iværksættelse af behandling og forebyggelse er afgørende for at mindske den betydelige morbiditet og i nogle tilfælde mortalitet, som disse udbredte sygdomme ofte er forbundet med. Endelig er kendskab til risikofaktorer afgørende for iværksættelse af relevant forebyggende odontologisk behandling.