Solomon Olusegun Nwhator

Analysis of matrix metalloproteinases, especially MMP-8, in gingival creviclular fluid, mouthrinse and saliva for monitoring periodontal diseases.

Matrix metalloproteinase-8 is a promising candidate biomarker for oral fluid (gingival crevicular fluid, peri-implant sulcular fluid and saliva) and mouthrinse chair-side/point-of-care diagnostics to predict, diagnose and determine the progressive phases of episodic periodontitis and peri-implantitis, as well as to monitor the treatments and medications. Matrix metalloproteinase-8 can be used alone or together with interleukin-1beta and Porphyromonas gingivalis to calculate cumulative risk score at the subject level as a successful diagnostic tool, especially in large-scale public health surveys, in which a thorough periodontal examination is not feasible.

Pilot Study on Oral Health Status as Assessed by an Active Matrix Metalloproteinase-8 Chairside Mouthrinse Test in Adolescents

BACKGROUND Matrix metalloproteinase (MMP)-8 is a major destructive collagenase involved in periodontitis and can be regarded as a periodontitis biomarker. A neutrophil collagenase 2 (active MMP-8 [aMMP-8]) oral fluid immunoassay has recently been demonstrated to be a periodontitis risk indicator among adults. The aim of this study is to investigate whether a point-of-care mouthrinse test based on an aMMP-8 immunoassay could identify patients with oral inflammatory burden (periodontitis and caries) among adolescents with early pathologic findings. METHODS This cross-sectional study was carried out at the Kotka Health Center, Finland. First, the aMMP-8 chairside mouthrinse test was performed on enrolled individuals (adolescents aged 15 to 17 years, n = 47), and the results were read based on a color change within 5 minutes. Then, full-mouth clinical parameters of oral health were assessed, including periodontal, oral mucosal, and caries status. RESULTS The sensitivity and specificity of the test for bleeding on probing were 71.8% and 77.5%, respectively (P = 0.05); for ≥1 site with probing depth (PD) ≥4 mm, 48.3% and 100% (P <0.001); for ≥2 sites with PD ≥4 mm, 63.6% and 100% (P <0.001); and for >2 sites with PD ≥4 mm, 76.5% and 96.7% (P <0.01). Regarding periodontitis (≥1 site with PD ≥4 mm), hardly any false-positive results were identified. The sensitivity of the immunoassay for ≥1 caries lesions was 76.5%, and the specificity was 96.7% (P <0.01). CONCLUSIONS In 5 minutes, the aMMP-8 chairside test showed promising results, recognizing oral inflammatory burden in adolescents with early initial signs of periodontitis. Caries lesions could also be detected, but less efficiently.

Could Periodontitis Affect Time to Conception

Background: Chronic periodontitis is gaining increasing prominence as a potential influnce on systemic health. Time to conception has been recently investigated in relation to chronic periodontitis among Caucasians. The authors set out to replicate the study among Nigerian pregnant women. Aim: The etiology of many medical conditions have been linked with the state of the oral health and one of such is the time to conception (TTC) among women. This study was aimed to assess the effect of periodontitis on TTC. Subjects and Methods: A cross-sectional study in a hospital setting involving 58 fertility clinic attendees and 70 pregnant controls using the simplified oral hygiene index, community periodontal index (CPI) and matrix metalloproteinase-8 immunoassay. Statistical analysis used included Spearman′s rank order correlation statistic, Z-statistic and logistic regression. Results: Good oral hygiene correlated with shorter TTC (<1 year) than fair oral hygiene, but not statistically significant. The odds of increased conception were higher with CPI (odds ratio [OR]: 0.482, 95% confidence interval [CI]: 0.259-0.895, P = 0.02), periodontitis risk (OR 0.157, 95% CI 0.041-0.600, P < 0.01) and age (OR 0.842, 95% CI 0.756-0.938, P < 0.01). Conclusion: Chronic periodontitis was positively associated with increased TTC in the present study. The authors are recommending that women in child bearing age should be encouraged to have regular preventive dental check-ups in order to maintain good oral and periodontal health.

Black Women's Predisposition to Preterm Birth; Could We Be Near The Answer?

Background: Pre-term Premature Rupture of Membranes (PPROM) is attributable to several causes including asymptomatic bacterial vaginosis among Caucasians and is commoner among black pregnant women. While malaria and high Body Mass Index (BMI) have been reported among Nigerians, the influence of metalloproteinases on PPROM has never been studied in Nigeria. Methods: A qualitative estimation of active matrixmetalloproteinase-8 (a-MMP-8) to assess the effect of chronic periodontitis on time to conception led to an accidental discovery of widespread elevation of a-MMP-8 among pregnant participants. Values of aMMP-8 were compared across demographics of participants as well as educational Original Research Article International Journal of TROPICAL DISEASE & Health, 3(2): 194-203, 2014 195 status, BMI and other parameters. Results : One hundred and seventeen of 134 participants (117, 87.3%) had elevated aMMP-8 based on a novel qualitative assessment using salivary diagnostics. Levels were increased across independent of age, Estimated Gestational Age(EGA), BMI, educational level and trimester. Conclusion: This population of black pregnant women exhibited higher a-MMP-8 levels than reported among pregnant Caucasians independent of demographics, educational level and trimester of pregnancy. Reasons for the association need to be further investigated.

Prevalence and Determinants of Chronic periodontitis in HIV positive patients in Nigeria

Abstract Objective To determine the prevalence and determinants of chronic periodontitis in HIV positive patients. Methods A total of 120 HIV positive patients attending the dedicated HIV outpatient clinic of the Lagos University Teaching Hospital, Nigeria were recruited for the study. Their periodontal status was assessed using the community periodontal index of treatment needs. Their CD4+ cell count was determined using the flow-cytometer method. The risk factors for periodontitis including age, gender, education, smoking, CD4+ cell counts, bleeding on probing (BOP) were determined. Results Prevalence of periodontitis was high (63.3%) in the HIV positive patients. In a bivariate analysis, significant associations were observed between severity of periodontitis and age ≥35 years (P=0.021), male gender (P=0.005), smoking (P=0.040) and ≥3 community periodontal index of treatment needs sextants exhibiting BOP (P=0.004). In a binary logistic regression, independent predictors of periodontitis were ≥3 sextants exhibiting BOP (odds ratio 1.738, 95% CI 1.339 to 2.256, P=0.000) and age ≥35 years (odds ratio 1.057, 95% CI 1.005 to 1.111, P=0.030). The CD4+ cell counts were not associated with periodontitis in the HIV positive patients (P=0.988). Conclusions A high prevalence of periodontitis was found among the HIV positive Nigerian patients in this study. Older age ≥35 years and BOP were the determinants of periodontitis. There is therefore a need for close periodontal monitoring of HIV positive Nigerian patients with emphasis on preventive, professional oral prophylaxis.

Emerging trends in dental specialty choice in Nigeria

Asymmetry in the distribution of dental specialists in Nigeria has the potential to negatively affect dental education at all levels. There is a dearth in Nigerian studies on the trends of influencing factors on the choice of dental specialty in Nigeria. Past efforts have not resulted in policy change thus necessitating the current study. One hundred and twelve (51 male, 61 female) Nigerian dental graduates aged 23-55 years with a mean age of 35.21 ± 8.21 years completed self-administered questionnaires to assess the impact of 16 influencing factors on their choice of dental specialty. The graduation period of respondents, which ranged between 0 and 30 years was recorded into three decades and cross-tabulated against 16 influencing factors to assess their relative impact on specialty choice. Diagnostic challenge, predictable work hours and patient type appeared to have maintained a consistent popularity while affluence and income, although less popular influences three decades ago are becoming increasingly relevant while length of programme, prestige and level of crowding exerted less influence on choice of specialty than other factors. The potential influence of incentives such as career counselling and grants for overseas training to encourage enrollment in less popular programmes was assessed based on recommendations from previous studies. However, these measures appeared to be unpopular among Nigerian dental graduates. Diagnostic challenges and predictable work hours remain popular as influencing factors on choice of dental specialty among Nigerian dental graduates. Affluence and income, although previously unpopular are now gaining popularity among Nigerian dental graduates.

Oral fluid matrix metalloproteinase (MMP)-8 as a diagnostic tool in chronic periodontitis

Periodontal diseases that affect the marginal and apical periodontium result from the interaction between bacterial biofilm and the host response. Oral fluid biomarkers might aid clinical diagnosis. Matrix metalloproteinases (MMPs) are a family of 24 proteases that act in physiological and pathological conditions. They can degrade almost all extracellular matrix constituents and regulate inflammatory processes. They are mainly inhibited by tissue inhibitors of metalloproteinases. The aim of this study was to perform a current literature review with a special reference on the diagnostic and clinical utility of oral fluid MMPs, especially MMP-8, and their inhibitors in periodontal and oral diseases. MMP-8 is the main collagenolytic MMP detected in oral fluids, such as saliva, oral mouthrinse, gingival crevicular fluid, and peri-implant fluid. MMP-8, and potentially MMP-9, in oral fluids represent strong biomarker candidates associated especially with periodontal disease diagnosis, severity, progression, and follow-up. Additionally, they show diagnostic potential for systemic conditions, such as pregnancy, myo- cardial infarction, and smoking. A commercially available mouthrinse, active MMP-8 chair-side/ point-of-care lateral flow immunoassay, shows enough sensitivity and specificity to detect clinical signs of periodontitis. The current literature supports that high MMP-8 levels reflect the loss of periodontal supporting tissues rather than inflammation, representing a potentially useful side-

Nigerian dentists' knowledge of aggressive periodontitis

Objective: To assess the general knowledge of Nigerian dentists on aggressive periodontitis (AgP) and specific knowledge of distinguishing between the clinical features of localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP). Materials and Methods: A cross-sectional, non-random convenience survey was done on 200 dentists, in three geopolitical zones of Nigeria, using pre-tested, closed question– type questionnaires. Eventually, only 133 questionnaires were analyzed. Relationships between six outcome variables namely clinical features of LAP, clinical features of GAP, LAP oral hygiene, GAP oral hygiene, laser therapy option and type of laser therapy, and the explanatory variables of gender and experience were analyzed. Results: A total of 33.8% of the dentists had poor general knowledge, 16.5% had fair knowledge, 31.9% had good knowledge, while 10.5% had excellent knowledge. Gender- and experience-related differences were found, but they were not statistically significant. Conclusion: Both the general and specific knowledge of aggressive periodontitis among Nigerian dentists is less than expected and needs improvement through targeted, continuing dental education.

Gingival recession in a child-patient; Easily missed etiologies: Case report with video

Gingival recession is commonly associated with plaque-induced inflammation and calculus. A high frenal attachment is more important in gingival recession in the child-patient. A healthy child-patient with impeccable oral hygiene presented with localized gingival recession without plaque-induced inflammation which led to the exploration of other possible etiologies. Multiple factors appeared to be acting in consonance (Concomitant multiple etiologies [CME]). The factors were a high frenal attachment, traumatic overbite and bruxism induced by premature tooth contacts. Pedodontists and periodontists should rule out CME in cases of gingival recession in the child-patient.

Is Periodontitis the Missing Link? A Metaethnographic Review of Glycemic Control Measures by Nigerian Diabetologists

Diabetologists have always been aware of the adverse infect of infection on glycemic control. Periodontitis is a state of chronic subclinical inflammation exerting a similar adverse influence on glycemic control. The mortality of diabetes mellitus in Nigeria remains high despite attempts at “tight glycemic control” using diet, life style modification, oral hypoglycemic and insulin. Reported attainment of glycemic control is at times as low as 15%. The result of the failure in meeting glycemic control targets has taken in toll on the life of Nigerians and stretched our meager resources to the limits due to frequent admissions as a result hyperglycemic emergencies. These emergencies leave in their trail, reduced sexual function, microangiopathy and attendant end stage renal disease, blindness, limb amputations and death, Could lack of consideration for periodontitis be the missing link in the glycemic control protocols of Nigerian diabetologists? Using the search phrase Nigeria AND (diabetes OR diabetic OR diabetics), we conducted a search of existing literature in Cochrane Library, MEDLINE (PubMed), Mesh (MEDICAL SUBJECT HEADINGS (MeSH) databases. An initial number of 709 results were trimmed to 31 after application of inclusion criteria. We conducted a combination of metaethnography and narrative synthesis on the 31 studies and arrived at the hypotheses that the average Nigerian diabetologists appears UNAWARE of the link between glycemic control and periodontitis. Urgent training is recommended for Nigerian diabetologists through continuing education courses and collaboration with periodontologists.