BACKGROUND AND OBJECTIVE

The primary determinant for patient referral by general dental practitioners (GDPs) to periodontists differs based on the country of practice. Moreover, previous research has revealed that GDP preferences for managing periodontal patients, actual number of referrals, and the overall decision-making process have evolved over time. Understanding the periodontal referral pattern of Filipino GDPs could help identify factors that promote or inhibit referral to periodontists. These factors may in turn be used as basis for the formulation of periodontal referral guidelines for use by GDPs in the Philippines. Therefore, this study aimed to determine the factors that affect the referral patterns of Filipino GDPs to periodontists, with GDPs practicing in the City of Manila as the representative population.

A descriptive cross-sectional study design with the use of a self-administered survey was utilized for this study. Participants were 75 licensed dentists practicing in the City of Manila who were members of the Philippine Dental Association-Manila Dental Chapter. The questionnaire collected information on sociodemographic characteristics of the participants, periodontal referral pattern, and the factors considered by the participants when referring patients to a periodontist. Descriptive statistics (frequency and percentage) were used to report the study’s findings.

Majority (92%) indicated that they regularly referred patients with periodontal disease to periodontists, with a personal estimate of up to 20 periodontal case referrals monthly by 81.3% of the participants and >20 referrals for 10.7%. The clinical factors considered as most important when referring to a periodontist were the type of periodontal disease (81.3% of the participants), periodontitis severity (74.7%), and the presence of a complex medical history 61.3%). Among the nonclinical factors, the most influential were the following: uncooperative patient (32% of the participants), perceived personal skill (24%), postgraduate training of the periodontist (21.3%), and the patient’s financial capacity (13.3%).

Multiple factors affect the decision of general dental practitioners in the City of Manila when referring patients to a periodontist. Majority are influenced by clinical factors such as the type and severity of periodontal disease and the systemic condition of the patient. Although considered to a much lesser degree compared to clinical factors, the top nonclinical factors that Manila GDPs base their referral decisions include the assessment that a patient is uncooperative and the perceived adequacy of personal skills in managing periodontal patients.

INTRODUCTION AND OBJECTIVE

Periodontitis is highly prevalent worldwide, and previous investigations have reported increased prevalence and severity among elderly. Regular monitoring of dental health, which includes periodontal conditions, has been recommended by the Philippine Department of Health, as basis for the development and updating of policies and laws that will address the public health problem of periodontal disease among the ageing Filipino population. Therefore, this present study aimed to determine the prevalence and severity of periodontal disease among Filipino older adults who participated in the Focused Interventions for Frail Older Adults Research and Development Program (FITforFRAIL) study.

This study on the periodontal status of Filipino older adults is a cross-sectional substudy of the FITforFRAIL research of the Institute on Aging, National Institutes of Health, University of the Philippines Manila. Participants aged ≥ 60 years were from four identified geographical regions in the Philippines. Three hundred sixteen completed oral health assessment, which included full mouth periodontal recording, and 183 participants were eligible for inclusion in the periodontal component. Periodontal diagnoses were determined using the Centers for Disease Control-American Academy of Periodontology (CDC-AAP) case definitions for surveillance of periodontitis and the 2018 European Federation of Periodontology (EFP)/AAP classification. Descriptive statistics (frequency, percentage, and mean) were used to report the sociodemographic characteristics and periodontal diagnoses of the participants. The clinical periodontal measures used to indicate the extent and severity of periodontitis were presented as mean [standard error (SE)] or percentage (SE).

Using the CDC/AAP case definitions, majority (97.3%) were diagnosed with periodontitis, with 33.3% having severe periodontal destruction. On the other hand, based on the 2018 EFP/AAP classification, all participants had periodontitis and most (94.5%) presented with severe disease. Moreover, using the latter classification system, the percentage of severe periodontitis was observed to increase with age. Among the young-old, 93.1% had severe disease, while 94.1% of the middle-old and 100% of the oldest-old were found to have severe destruction.

Based on the results of the study, the prevalence of total and severe periodontitis is high among this sample of Filipino older adults. Future studies for regular monitoring of the oral health of Filipino older adults are recommended.

Background and Objective: The primary determinant for patient referral by general dental practitioners (GDPs) to periodontists differs based on the country of practice. Moreover, previous research has revealed that GDP preferences for managing periodontal patients, actual number of referrals, and the overall decision-making process have evolved over time. Understanding the periodontal referral pattern of Filipino GDPs could help identify factors that promote or inhibit referral to periodontists. These factors may in turn be used as basis for the formulation of periodontal referral guidelines for use by GDPs in the Philippines. Therefore, this study aimed to determine the factors that affect the referral patterns of Filipino GDPs to periodontists, with GDPs practicing in the City of Manila as the representative population. Methods: A descriptive cross-sectional study design with the use of a self-administered survey was utilized for this study. Participants were 75 licensed dentists practicing in the City of Manila who were members of the Philippine Dental Association-Manila Dental Chapter. The questionnaire collected information on sociodemographic characteristics of the participants, periodontal referral pattern, and the factors considered by the participants when referring patients to a periodontist. Descriptive statistics (frequency and percentage) were used to report the study’s findings. Results: Majority (92%) indicated that they regularly referred patients with periodontal disease to periodontists, with a personal estimate of up to 20 periodontal case referrals monthly by 81.3% of the participants and >20 referrals for 10.7%. The clinical factors considered as most important when referring to a periodontist were the type of periodontal disease (81.3% of the participants), periodontitis severity (74.7%), and the presence of a complex medical history 61.3%). Among the nonclinical factors, the most influential were the following: uncooperative patient (32% of the participants), perceived personal skill (24%), postgraduate training of the periodontist (21.3%), and the patient’s financial capacity (13.3%). Conclusion Multiple factors affect the decision of general dental practitioners in the City of Manila when referring patients to a periodontist. Majority are influenced by clinical factors such as the type and severity of periodontal disease and the systemic condition of the patient. Although considered to a much lesser degree compared to clinical factors, the top nonclinical factors that Manila GDPs base their referral decisions include the assessment that a patient is uncooperative and the perceived adequacy of personal skills in managing periodontal patients.
Human ; periodontal diseases ; referral and consultation ; dentists ; periodontists

OBJECTIVE: To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss. METHODS: A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed. RESULTS: In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss. CONCLUSION In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.
Humans ; Tooth Loss/etiology* ; Periodontitis/complications* ; Tooth ; Periodontal Diseases ; Molar

The number of diabetic patients visiting stomatology for periodontal disease is increasing, and the symptoms are relatively severe, and often complications increase the complexity of periodontal treatment. This article briefly describes the research progress and clinical manifestations of the epidemiology and related pathological mechanisms of periodontitis with diabetes, focusing on the treatment and providing reference for stomatologists in the clinical diagnosis and treatment of patients with diabetic periodontitis.
Humans ; Periodontitis/therapy* ; Diabetes Mellitus/therapy* ; Periodontal Diseases ; Dental Care ; Diabetes Mellitus, Type 2 ; Diabetes Complications/complications*

While several previous studies have indicated the link between periodontal disease (PD) and myocardial infarction (MI), the underlying mechanisms remain unclear. Autophagy, a cellular quality control process that is activated in several diseases, including heart failure, can be suppressed by Porphyromonas gingivalis (P.g.). However, it is uncertain whether autophagy impairment by periodontal pathogens stimulates the development of cardiac dysfunction after MI. Thus, this study aimed to investigate the relationship between PD and the development of MI while focusing on the role of autophagy. Neonatal rat cardiomyocytes (NRCMs) and MI model mice were inoculated with wild-type P.g. or gingipain-deficient P.g. to assess the effect of autophagy inhibition by P.g. Wild-type P.g.-inoculated NRCMs had lower cell viability than those inoculated with gingipain-deficient P.g. This study also revealed that gingipains can cleave vesicle-associated membrane protein 8 (VAMP8), a protein involved in lysosomal sensitive factor attachment protein receptors (SNAREs), at the 47th lysine residue, thereby inhibiting autophagy. Wild-type P.g.-inoculated MI model mice were more susceptible to cardiac rupture, with lower survival rates and autophagy activity than gingipain-deficient P.g.-inoculated MI model mice. After inoculating genetically modified MI model mice (VAMP8-K47A) with wild-type P.g., they exhibited significantly increased autophagy activation compared with the MI model mice inoculated with wild-type P.g., which suppressed cardiac rupture and enhanced overall survival rates. These findings suggest that gingipains, which are virulence factors of P.g., impair the infarcted myocardium by cleaving VAMP8 and disrupting autophagy. This study confirms the strong association between PD and MI and provides new insights into the potential role of autophagy in this relationship.
Mice ; Rats ; Animals ; Porphyromonas gingivalis ; Gingipain Cysteine Endopeptidases ; Autophagosomes ; Myocardium ; Periodontal Diseases ; Heart Rupture

Periodontal diseases are inflammatory diseases caused by oral pathogens around the periodontal supporting tissues, leading to systemic and chronic inflammatory conditions. The continuous chronic systemic inflammation may be a trigger of neuroinflammation, which is the prominent feature of a variety of neurological disorders. It implies that there may be a causal link between periodontal diseases and neurological disorders. This article presents epidemiological and biological evidences that periodontal diseases can induce or exacerbate neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis and major depressive disorder, and analyzes the possible mechanisms. The importance of maintaining oral health as well as preventing and treating periodontal diseases are emphasized. At the same time, this may provide novel approaches to study the relationship between periodontal diseases and neurological disorders in the prevention and treatment strategies of neurological disorders.
Alzheimer Disease ; Depressive Disorder, Major/complications* ; Humans ; Inflammation/complications* ; Periodontal Diseases/complications* ; Periodontium

ABSTRACT Oral health professionals frequently provide oral hygiene instruction (OHI) during dental visits, yet the evidence for its effectiveness is inconclusive. The main objective of this study was to examine the evidence on the effectiveness of various oral hygiene teaching approaches on periodontal health in adults. The study searched the PubMed, Google Scholar and Scopus databases for reports published between January 2000 and June 2020 in the English language. The quality of the selected papers was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two authors. Overall, five reports met the inclusion and exclusion criteria. The heterogeneity of outcome measurements across studies did not allow for direct comparison. Verbal and brochures were among the methods used in the studies. OHI was found to have short-term (up to 13 weeks) effects on dental plaque levels and/or gingiva bleeding. No significant differences were noted among the different oral hygiene methods affecting periodontal health. There is evidence that OHI is effective in reducing plaque and gingival bleeding scores in adult individuals, but it is still unclear if the effect continues beyond 13 weeks. No single method can be highlighted as the best medium of instruction.
Oral Hygiene ; Periodontal Diseases ; Adult

ABSTRACT Phenolic compounds are secondary metabolites of plants metabolism and can be found in olive oil. They exhibit antimicrobial activity towards both gram-positive and gram-negative bacteria. However, little is known about the antibacterial activity of the compounds towards periodontopathogens. The study aimed to investigate the potential of these compounds as antibacterial agents towards pathogens, specifically Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. Phenolic compounds were extracted from extra virgin olive oil (EVOO) through liquid-liquid separation using methanol:water (70:30), and hexane. It was then prepared in various concentrations to determine its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against the periodontopathogens. The anti-adhesion activity was quantified using crystal violet staining while the effects on the morphology were examined through scanning electron microscopy (SEM). The MICs of the phenolic compounds on A. actinomycetemcomitans, P. gingivalis and F. nucleatum were 31.25 mg/mL, 62.5 mg/mL and 125 mg/mL, respectively. The MBCs of the phenolic compounds on A. actinomycetemcomitans and F. nucleatum were 62.5 mg/mL and 125 mg/mL, respectively suggesting this compound can eradicate these bacteria. There was no bactericidal effect on P. gingivalis. The adhesion of all the bacteria was interrupted by the compounds at the lowest concentration (1.95 mg/mL). SEM findings showed disruption of bacterial cell surfaces such as blebs and disintegration of cells after exposure to this extract. Phenolic compounds of olive oil exhibited antibacterial activity against the tested pathogens, with bactericidal effects on A. actinomycetemcomitans and F. nucleatum and bacteriostatic effects on P. gingivalis.
Anti-Bacterial Agents ; Phenols ; Periodontal Diseases ; Olive Oil

ABSTRACT Epidemiological and longitudinal studies have shown that pregnancy is associated with increased gingival inflammation and worsening of periodontal status. Prospective studies suggested that periodontal therapy during pregnancy might reduce the risk of adverse pregnancy outcomes and significant periodontal status improvement. The objectives of this study were to evaluate the prevalence of periodontal disease amongst pregnant women, and to compare periodontal conditions before and after non-surgical periodontal therapy. This study was a cross-sectional and intervention study of pregnant women at the Mother and Child Health Clinic, Jalan P. Ramlee, Kuching, who were referred to the Periodontic Unit, Jalan Masjid Dental Clinic, Kuching for further periodontal examination and treatment. All participants were examined and diagnosed with healthy periodontium or diseased periodontium. Sixty women became the subjects and 85% were diagnosed with periodontal disease, while 15% had healthy periodontium. Plaque score (PS) and bleeding score (BS) were evaluated at baseline and at eight weeks. At baseline, all periodontal parameters (mean ± SD) were higher in the diseased periodontium group compared to the healthy group (BS, 39.6 ± 21.5 vs 6.5 ± 3.9; PS, 46.4 ± 30.1 vs 33.5 ± 31.1). After two months, both groups showed improvement in all periodontal parameters; diseased periodontium (p = 0.001) and healthy periodontium group (p = 0.016). In conclusion, 85% of the participants in this study had periodontal diseases and, the non-surgical periodontal therapy improved the participants’ periodontal status. Furthermore, there was no significant adverse pregnancy outcomes reported in this study.
Periodontal Diseases ; Pregnant Women ; Malaysia (Kuching, Sarawak)