BACKGROUND: Rapidly evolving evidence, from preclinical and clinical studies, indicates a possible connection between inflammatory bowel disease and periodontitis. This study aimed to summarize the evidence from preclinical in vivo studies regarding the possible link between periodontitis and colitis.

METHODS: A systematic literature search was performed and resulting studies were screened against predefined eligibility criteria; data from included studies were extracted, and meta-analyses were performed whenever possible.

RESULTS: Thirty-four publications using mice or rats were included; 26 experiments evaluated the effect of inoculation with oral bacteria on experimental colitis, 3 the effect of experimental periodontitis on experimental colitis, and 7 the effect of experimental colitis on periodontal status; 45% (9), 78% (14), 57% (12), and 89% (16) of the studies found a significantly higher body weight loss, shorter colon length, higher disease activity index (DAI), and higher intestinal histopathological assessment scores (IHA), respectively, in animals exposed to inoculation with oral bacteria and experimental colitis compared with animals with only colitis. Meta-analyses confirmed that inoculation with oral bacteria significantly aggravated colitis, that is, significant negative overall effect on body weight, colon length, DAI, and IHA. Among the tested bacteria, Fusobacterium nucleatum had the strongest effect followed by Porphyromonas gingivalis. The results of the remaining interactions and comparisons are inconclusive due to a limited number of studies and differences in study design.

CONCLUSIONS: Inoculation with the periodontitis-associated bacteria F. nucleatum and probably also P. gingivalis exacerbates experimental colitis in mice. It is yet unclear whether colitis can affect periodontal health and/or disease.

OBJECTIVE: To evaluate the impact of implant surface and instrumentation time on the efficacy of two air powder water-jet (APWJ) devices in cleaning the implant surface in a simulation of non-surgical peri-implantitis treatment.

MATERIALS AND METHODS: Turned and modified surface implants (28 each) were coated with a biofilm imitation and mounted on resin models replicating peri-implant intra-osseous defects, including a soft tissue replica. The entire implant periphery was instrumented for 5 or 15s per implant sextant (i.e., in total 30 or 90s per implant), with one of two different APWJ devices using either a glycine or an erythritol powder. Residual biofilm imitation was automatically assessed on standardized photographs and expressed as percentage of the exposed implant surface.

RESULTS: Implant surface (ε2:0.253, p < 0.001) and instrumentation time (ε2:0.044, p = 0.036) had a moderate and small effect, respectively, on the outcome, that is, instrumenting turned compared to modified surface implants as well as using a longer compared to a shorter instrumentation time resulted in less residual biofilm imitation. Complete biofilm imitation removal was achieved only in four turned implants, treated for 15s per sextant. Every second turned implant presented with a maximum of 5% residual biofilm imitation, while only two modified implants achieved this level of cleanliness.

CONCLUSION: In a non-surgical peri-implantitis treatment simulation with APWJ devices, superior biofilm imitation removal was achieved at turned implants, and a longer instrumentation time resulted in less residual biofilm imitation. Modified implants had high chances of incomplete biofilm imitation removal, especially at the apical part of the defect. Complete biofilm imitation removal was in general largely unpredictable.

Objective: To evaluate, in a simulation of surgical peri-implantitis treatment, the impact of type of handpiece, device settings, and instrumentation time on the efficacy of airflowing in cleaning the implant surface, depending on the type of bone defect and implant surface. Methods: Turned and modified surface implants (54 each) were coated with biofilm imitation and mounted on resin models replicating purely horizontal or circumferential intraosseous peri-implant defects (both 5 mm deep). Implants were instrumented with an airflowing device using a supra- or submucosal handpiece, with three settings: (a) power 5, 5 s (b) power 10, 5 s, and (c) power 5, 15 s per implant/defect sextant. Results: The amount of residual biofilm imitation was associated with defect configuration, type of handpiece, and device settings (p < 0.15); implant surface did not have an effect. In horizontal defects, with the supramucosal handpiece, only 3 of 54 implants showed > 5% residual biofilm imitation and 23 of 54 implants were completely clean; with the submucosal handpiece, 12 of 18 implants showed ≤ 5% residual biofilm imitation when used for 15 s/sextant, yet none were completely clean. In intraosseous defects, all implants presented ≤ 5% residual biofilm imitation and 10 of 18 implants were completely clean with the submucosal handpiece used for 15 s/sextant; the supramucosal handpiece was largely inefficacious. Conclusion: Within the limitations of this laboratory study, peri-implant bone defect configuration should dictate the choice of airflowing handpiece (i.e., for horizontal defects, the supramucosal handpiece; for intraosseous defects, the submucosal handpiece) and intrasurgical airflowing requires a prolonged instrumentation time, but not increased power.

BACKGROUND: Periodontitis and inflammatory bowel disease (IBD) are chronic, progressive inflammatory diseases with shared aetiopathogenetic mechanisms. Research suggests that IBD patients are at increased risk of developing periodontitis, which may, in turn, exacerbate IBD activity and disability. This study examines whether periodontitis is associated with increased IBD activity, severity, disability and reduced quality of life.

METHODS: An online survey was distributed to Swedish IBD patients, covering demographics, oral health, and IBD characteristics. Validated tools were used where possible, and data were combined with a similar Danish study.

RESULTS: A total of 786 IBD patients (371 Crohn's disease [CD] and 415 ulcerative colitis [UC]) completed the survey. Self-reported severe periodontitis was significantly associated with poorer IBD disability scores [coef. 5.07 (1.86; 8.27)], more self-reported active disease [OR 1.72 (1.19; 2.49)], higher self-reported disease activity in the preceding 12 months [OR 1.44 (1.05; 1.98)], and reduced quality of life [Coef. -1.45 (-3.01; 0.10)]. Self-reported tooth loss also correlated with poorer disability scores [Coef. 4.47 (0.71; 8.22)] and showed a trend toward greater self-reported disease severity [OR 1.57 (0.97; 2.52)]. Combined Danish-Swedish analysis confirmed these findings.

CONCLUSIONS: This study, although based purely on self-reported data at a single timepoint, reinforces associations between periodontitis, tooth loss and worse IBD outcomes, emphasizing the need for greater focus on oral health in IBD management.

Objective: To map oral health-related standard of care in the context of head and neck cancer (HNC) treatment across the European Union (EU).

Materials and Methods: Six hundred and ninety centers across the European Union were contacted. The questionnaire contained questions focusing on the team/department structure, HNC treatment planning routines, and assessment and handling of dental treatment needs prior to cancer treatment.

Results: Eighty-seven centers across the EU responded. Department structure and number of HNC patients treated per year varied widely and dental professionals are included as part of the team in about 25% of the centers. Standard of care, in terms of dental assessment and preventive dentistry routines, such as recording an orthopantomogram, offering dental treatment, and providing a radiation protection splint and splint for fluoride application, differed significantly among the European regions. Independent of the region, these aspects are positively affected if dental professionals are part of the interdisciplinary treatment team and if dental treatment is offered within the center.

Conclusion: Dental professionals are still only to a very limited extent included in interdisciplinary treatment planning teams of HNC patients. However, their inclusion and/or offering dental treatment within the same hospital/center appears to improve oral health-related standard of care.

Clinical Relevance: Inclusion of dental professionals in treatment planning teams of HNC patients appears to improve oral health-related standard of care within HNC treatment.

Aim: To (i) evaluate structured postgraduate part-time programs in periodontology, including those addressing peri-implant diseases, among members of the European Federation of Periodontology (EFP), (ii) the impact of the 2018 classification scheme and EFP clinical practice guidelines and (iii) propose a framework for periodontal vocational education and training.

Materials and methods: A summary of relevant European guidelines for vocational education and training was compiled. In a survey and in a systematic review, current part-time programs in continuing professional education in periodontology as well as in prevention and management of peri-implant diseases were examined. The implementation and dissemination of the 2018 classification scheme and the EFP clinical practice guidelines were assessed by literature analysis. Based on these findings, a framework for periodontal vocational education and training was generated.

Results: Part-time programs for professional development in periodontology are established in nine EFP member countries. The systematic review identified lack of knowledge in prevention and management of peri-implant diseases among dental practitioners and hygienists. Continuing professional development was found to be important for education in prevention, classification and management of periodontal as well as peri-implant diseases. The proposed European framework consists of an escalator model with three levels (certificate, diploma and master).

Discussion: Considering the identified variation in the national programs, there is a need to improve education in periodontal and peri-implant diseases. The proposed frameworkmay will help harmonize the national structures.

Conclusion: The proposed framework for part-time professional development is expected to enhance professional qualification.

OBJECTIVES: Fusobacterium can contribute to oral diseases, but also pose as a systemic risk factor. This genus, and especially F. nucleatum, can be found in colorectal cancer (CRC) tissue and is involved in multiple aspects of this type of cancer. Previous studies indicated a possible oral origin of these bacteria; however, stronger evidence is needed to reach a definitive conclusion. This pilot study aimed to establish a method to successfully compare, at the strain level, fusobacteria from the oral cavity and CRC resection material for future cohort studies of CRC patients.

MATERIAL AND METHODS: In a first cohort of eight periodontitis patients, gingival crevicular fluid and saliva were collected. Fusobacterium was isolated on two different media. In a second cohort, saliva and CRC resection material were collected from ten CRC patients. These samples were used for screening of Fusobacterium with culturing, 16S rRNA gene profiling and a PCR-based approach.

RESULTS: In the first cohort, different Fusobacterium species were identified in GCF and saliva samples. However, as the total yield of Fusobacterium seemed slightly higher in saliva samples, it was therefore preferred for subsequent sample collection. Thus, in the second cohort, patient-matched saliva and CRC resection material were screened for Fusobacterium and this showed that nine patients were culture-positive in the saliva samples; however, no Fusobacterium could be isolated from the resection material. On the other hand, 16S rRNA gene profiling of the resection material indicated that eight CRC patients were positive for Fusobacterium. All eight of these patients carried Fusobacterium in their saliva, indicated by both marker gene PCR and culture-based screening.

CONCLUSIONS: These pilot results are compatible with data from previous studies, indicating a possible link between oral and CRC-associated Fusobacterium, and a more in-depth analysis of specific strains and their characteristics in a larger cohort is justified.

TRIAL REGISTRATION: The protocol was registered at clinicaltrials.gov (NCT05945082).

Objectives The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD). Methods A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss. Results Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low. Conclusions Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients. Clinical relevanceEven though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

Background: To describe the frequency and impact of oral lesions and professional dental care costs in patients with inflammatory bowel disease (IBD) (i.e., Crohn disease [CD] or ulcerative colitis [UC]) compared to matched controls).

Methods: IBD patients and matched controls were surveyed on general anamnestic information, eating and drinking habits, and oral health- and dental care-related questions; IBD patients were additionally surveyed on oral lesions. Problems related to oral lesions and the amount of money spent for professional dental care in the past 12 months were defined as primary outcome parameters.

Results: Answers from 1108 IBD patients and 3429 controls were analyzed. About 30% of the patients indicated having had problems with oral lesions, with CD patients having 46% higher odds and having them more often in a generalized form compared to UC patients. Further, self-reported severe periodontitis increased the odds of having oral lesions by almost 2.3-times. However, only about 12.5% of IBD patients were informed by their physician about oral lesions and about 10% indicated receiving treatment for them. Compared to controls, IBD patients required more often dental treatment and spent more money; specifically, UC and CD patients had 27 and 89% higher odds, respectively, for having spent ≥3000 DKK (ca. 440 USD) at the dentist compared to controls.

Conclusions: IBD patients have more often oral health problems and higher expenses for professional dental care compared to matched controls. This included problems with IBD-related oral lesions, but these are rarely addressed by the medical or dental team.Keywords: Crohn disease; case-control studies; colitis; dental care; inflammatory bowel diseases; surveys and questionnaires; ulcerative.

BackgroundLarge variation in the prevalence of ankylosis and replacement resorption (ARR) is reported in the literature and most studies have relatively small patient numbers. The present retrospective study aimed to provide an overview on prevalence, location of, and associated risk factors with ARR based on a large sample of computed tomography (CT) / cone beam computed tomography (CBCT) scans of impacted teeth. The results should allow clinicians to better estimate the risk of ARR at impacted teeth.MethodsThe CT/CBCT scans of 5764 patients of a single center in Central Europe were screened with predefined eligibility criteria. The following parameters were recorded for the finally included population: gender, age, tooth type/position, number of impacted teeth per patient, and presence/absence of ARR. For teeth with ARR the tooth location in reference to the dental arch, tooth angulation, and part of the tooth affected by ARR were additionally registered.ResultsAltogether, 4142 patients with 7170 impacted teeth were included. ARR was diagnosed at 187 impacted teeth (2.6%) of 157 patients (3.7%); 58% of these patients were female and the number of teeth with ARR per patient ranged from 1 to 10. Depending on the tooth type the prevalence ranged from 0 (upper first premolars, lower central and lateral incisors) to 41.2% (upper first molars). ARR was detected at the crown (57.2%), root (32.1%), or at both (10.7%). After correcting for confounders, the odds for ARR significantly increased with higher age; further, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest. More specifically, for 20-year-old patients the risk for ARR at impacted incisors and first/second molars ranged from 7.7 to 10.8%, but it approximately tripled to 27.3-35.5% for 40-year-old patients. In addition, female patients had significantly less often ARR at the root, while with increasing age the root was significantly more often affected by ARR than the crown.ConclusionARR at impacted teeth is indeed a rare event, i.e., only 2.6% of 7170 impacted teeth were ankylosed with signs of replacement resorption. On the patient level, higher age significantly increased the odds for ARR and on the tooth level, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest.