Mohammad S. Al-Zahrani

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

BACKGROUND Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed. METHODS Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not. RESULTS Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P <0.001), and serum TNF-alpha (P <0.05). There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI. CONCLUSIONS Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

Short-term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes.

BACKGROUND Periodontitis is a major cause of tooth loss among adults. Several studies have shown a possible systemic impact of periodontal infection, including poor glycemic control in patients with diabetes. Recently, photodynamic therapy (PDT) was used to successfully treat periodontal infection. PDT provides a broad spectrum antimicrobial efficacy with no local or systemic side effects. The objective of this study was to examine the effect of the adjunctive use of PDT on periodontal status and glycemic control of patients with diabetes and periodontitis. METHODS Forty-five patients with type 2 diabetes and moderate to severe chronic periodontitis were selected and randomly assigned to one of the following three treatment modalities (15 subjects each): scaling and root planing (SRP) only, SRP plus systemic doxycycline, and SRP plus PDT. The plaque and bleeding scores, probing depth, clinical attachment level, and glycosylated hemoglobin (HbA1c) level were recorded at baseline and 3 months after periodontal treatment. Descriptive statistics, the paired t test, and analysis of variance (ANOVA) were used for data analysis. RESULTS Statistically significant differences in the mean probing depth, clinical attachment level, plaque deposit, and bleeding on probing were found between baseline and 12 weeks post-treatment for all groups. No significant differences in periodontal parameters and glucose levels were detected among the three groups. Reduction in the mean HbA1c level after treatment was observed in all groups but was only significant for the SRP plus doxycycline group. CONCLUSION The results of the present study indicate that PDT does not benefit conventional non-surgical periodontal therapy in patients with diabetes.

Response to Periodontal Therapy in Patients Who Had Weight Loss After Bariatric Surgery and Obese Counterparts: A Pilot Study

BACKGROUND Periodontitis and obesity are both chronic health problems, and the literature supports an association between the two. Weight loss after bariatric surgery (BS) has been shown to decrease overall mortality as well as the development of new health-related conditions in morbidly obese patients. The present study aims to assess whether significant weight loss would improve the response to non-surgical periodontal therapy in obese patients. METHODS This study included 30 obese (body mass index >30 kg/m(2)) patients affected with chronic periodontitis. Of these, 15 patients had previously undergone BS and lost ≥40% of their excess weight for ≥6 months after surgery. The other 15 patients were also obese but did not have the surgery, nor did they lose weight to serve as a control group. All participants received non-surgical periodontal therapy (scaling and root planing and oral hygiene instructions). Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index were measured at baseline and at 4 to 6 weeks after the periodontal treatment. Descriptive statistics, linear mixed-effects models, and linear regression models were used for data analysis. RESULTS The mean age of the study participants was 47.1 ± 11.5 years, and 36.7% of the participants were males. There was a statistically significant improvement after periodontal therapy in the BS compared with the obese group (P <0.05). The PD had a mean reduction of 0.45 mm in the BS group versus 0.28 mm in the control group. The reduction in CAL was 0.44 mm versus 0.30 mm, percentage of BOP sites was 16% versus 15%, and GI was 1.03 versus 0.52 in the BS and control groups, respectively. CONCLUSION An improved response to non-surgical periodontal therapy is observed in obese patients who had significant weight loss after BS compared with obese patients who did not have such a surgery.

Smoking habits among Saudi female university students: prevalence, influencing factors and risk awareness.

Smoking is a recognized health problem worldwide. Smokers are at an increased risk of developing several serious and potentially fatal diseases such as heart disease cancer and respiratory illness. Women who smoke also experience gender-specific health consequences including various adverse reproductive outcomes. The prevalence of smoking among women is consistently lower than men especially in developing countries where there is a strong influence of culture and tradition. The situation however is changing and the epidemic of smoking among women in the developing world is increasing. Eastern Mediterranean countries including Saudi Arabia follow the same global trend of gender differences in smoking patterns. Several studies conducted over the past 20 years showed that the tobacco epidemic is firmly established in the Kingdom of Saudi Arabia. However most of studies were conducted in males limited to cigarette smoking and confined to the central region. The aims of this study were to assess the prevalence and patterns of smoking among Saudi female students at King Abdulaziz University in Jeddah city Western Region and to determine factors influencing student smoking behavior and their knowledge about its adverse health effects. (excerpt)

Clinical Assessment of Peri‐Implant Tissues in Patients with Varying Severity of Chronic Periodontitis

PURPOSE This retrospective study assessed the health of peri-implant tissues in patients with varying severity of chronic periodontitis. MATERIALS AND METHODS Sixty-one subjects aged 44 to 70 years (median age 58 years) were recruited. Based on severity of periodontitis, 31 subjects were classified as having severe generalized chronic periodontitis, and the remaining 30 subjects had mild or no periodontitis. Social and medical histories were obtained from each patient. A comprehensive periodontal examination included: plaque index, gingival index, bleeding index, probing depth, clinical attachment level, and radiographic bone loss. Data were analyzed using Fishers exact and chi-square tests for categorical variables, and t-test for continuous variables. RESULTS There was a statistically significant greater loss of attachment (p < .05) around implants in the group with severe periodontitis compared to the no/mild periodontitis group. CONCLUSION Because of the greater loss of clinical attachment around implants placed in patients with generalized severe chronic periodontitis, close monitoring of these patients is suggested to prevent both development of peri-implantitis and recurrence of periodontal infection.

Effect of lip position and gingival display on smile and esthetics as perceived by college students with different educational backgrounds.

Aim The aim of this study was to evaluate the influence of education on the perception of female college students on the effect of lip position and gingival display upon smiling and esthetics. Methods A photograph of a smiling subject was altered to show varying degrees of gingival display. Female students, who were studying in different colleges, assessed a total of five images, using a numerical rating scale. Results A total of 440 college students from eight educational faculties (dentistry, dental assistants, medicine, medical technology, nursing, science, arts, and pharmacology) participated in this study. There was no difference found between students’ ratings of the altered images (P<0.05). The perception of a gummy smile was found to be similar among the participants. There was agreement between all participants that 2 mm of gingival display was the most attractive smile, while a 4 mm covering of the teeth by the upper lip was the least attractive. Conclusion Educational influence did not have an effect of the perception of a gummy smile.

Periodontal findings in systemic lupus erythematosus patients and healthy controls

Objectives: To compare periodontal findings in systemic lupus erythematosus (SLE) patients and healthy controls, and to determine, whether there is a correlation between periodontal parameters and SLE biomarkers. Methods: This cross-sectional study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between November 2012 and February 2014. Twenty-five participants diagnosed with SLE and 50 healthy controls were selected. Periodontal assessment consisted of clinical attachment level (CAL), probing depth (PD), bleeding on probing, and plaque scores. For the SLE group, several laboratory tests were obtained, such as, white blood cell count, hemoglobin level, platelet count, anti-nuclear antibody, anti-double-stranded DNA antibody, calcium level, and vitamin D. Results: Periodontal findings in SLE patients and controls were not significantly different. The SLE patients who had no flare-ups for more than a year showed significant bleeding on probing and deeper PD compared with those who had flare-ups less than a year before starting the study. The SLE patients with arthritis symptoms showed more CAL than those without arthritis. In the SLE patients, no significant correlation was found between their periodontal findings and SLE biomarkers. Conclusion: Periodontal health was not different between SLE patients and healthy controls. In SLE patients however, flare-ups and presence of arthritis had a significant relation with periodontal health.

Self reported halitosis in relation to glycated hemoglobin level in diabetic patients.

Objective: This study was conducted to examine the relationship between the glycated hemoglobin level (HbA1c) and halitosis status among diabetic patients affected with periodontitis and to examine if there is a relationship between halitosis and different periodontal parameters. Methods and Materials: Consecutive type 2 diabetic patients were recruited from patients presented for treatment at a University hospital. Age, gender and smoking were recorded. A structured questionnaire on patients’ perception of their oral health, halitosis and diabetes severity and control was completed. Peripheral blood samples were obtained and analyzed for HbA1c levels. In addition, periodontal clinical parameters including probing depth, clinical attachment level, bleeding on probing and plaque scores were recorded. Results: A total of 38 type 2 diabetic patients were selected. The mean age was 52.1 (±8.8) years. Sixteen subjects (42.1%) reported halitosis. Of these, 62.5% were females, and only one subject was a current smoker. The mean levels of HbA1c were significantly different between those with and without halitosis, mean 9.6 (±2) and 8.2 (±1.6), respectively (p=0.03). No significant differences were found in the mean periodontal parameters between those with and without halitosis. Conclusion: The results of this study suggest an association between halitosis and increased levels of HbA1c. Further studies are needed to explain the nature of this association.

The relationship between periapical lesions and the serum levels of glycosylated hemoglobin and C-reactive protein in type 2 diabetic patients

Objectives: To investigate the relationship between the presence of periapical lesions (PL) and levels of glycosylated hemoglobin (HbA1c), and C-reactive protein (CRP) in patients with type 2 diabetes. Methods: This cross-sectional study was conducted at Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia, between September 2013 and February 2015. Medical and dental history and Sociodemographic data were obtained from participants. Dental and periodontal examinations were conducted and blood samples were obtained to determine levels of HbA1c and CRP. The presence of PL was recorded from panoramic and periapical radiographs. Descriptive statistics and multivariable linear and logistic regression models were used for data analyses. Results: One hundred patients were included; mean age was 48.9 ± 8.5 years. Of these patients, 14% had no PL, whereas 25% had one or 2 lesions, 32% had 3 or 4 lesions, and 29% had ≥5 PL. The mean HbA1c was 9.8% (± 2.5) mg/L and CRP was 6.9 mg/L (± 6.3). The presence of PL was significantly associated with a higher level of HbA1c independent of age, gender, probing depth, and plaque index (p=0.023). Individuals with PL were also more likely to have a high CRP level (>3 mg/L) independent of the previous covariates (odds ratio: 1.19; 95% confidence interval: 1.01-1.41). Conclusion: Periapical lesions are associated with a poorer glycemic control and a higher CRP level in type 2 diabetic patients.