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Machine learning-based analysis of oral rinse samples to identify candidate proteomic signatures for severe periodontitis: a pilot study.

This pilot study investigated whether candidate protein signatures from oral rinse samples can distinguish patients with severe periodontitis (stage III/IV) and its subtypes, generalized and localized periodontitis, from non-periodontitis controls. Participants rinsed with phosphate-buffered saline, and samples were analyzed using a Proximity Extension Assay targeting 92 inflammatory and 92 immuno-oncology proteins. A machine learning approach using repeated nested cross-validation and SHAP was implemented to identify protein signatures. The study included 38 patients (18 with localized periodontitis and 20 with generalized periodontitis) and 16 controls. After data preprocessing, 54 samples and 141 proteins were retained. Proteins Gal-1, HGF, TNFSF14, CD27, and ARG1 distinguished periodontitis from controls (ROC-AUC = 0.85, 95% CI 0.82, 0.87). For generalized periodontitis, we found a protein signature including TNFSF14, Gal-1, STAMBP, MUC-16, S100A12, HGF, CASP-8, CD27, LAP TGF-β1, TNFRSF9, and uPA (ROC-AUC = 0.92, 95% CI 0.90, 0.94). For localized periodontitis, we identified ARG1 (ROC-AUC = 0.72, 95% CI 0.68, 0.76). No proteomic signature distinguishing generalized periodontitis from localized periodontitis was identified. This pilot study indicated that oral rinses are suitable for proteomic profiling, and there was a putative protein signature that could differentiate periodontitis, generalized periodontitis, and localized periodontitis from controls. These findings warrant validation in larger independent cohorts, including a clearly defined gingivitis group, before real-world non-invasive screening applications can be considered.

Humans

Gingival crevicular fluid: a new diagnostic aid in managing the periodontal patient.

On the whole, the studies on GCF have demonstrated that the flow of this fluid is sufficiently indicative of the inflammatory state that it can be used under a variety of clinical conditions to monitor and control gingival inflammation. Since gingivitis is extremely common, and since some cases of gingivitis presumably do not progress to periodontitis, the question could be posed whether or not a concerted effort to control inflammation (i.e. trying to achieve a GCF flow as near to zero as possible) would be clinically significant. Until there is evidence to the contrary, the answer must be "yes", since few cases are known where periodontitis occurs without being preceded by gingivitis. In other words, the control of all gingivitis, if feasible, should prevent most cases of periodontitis. Although control of all gingivitis would mean the treatment of many cases that would not progress to periodontal breakdown, such efforts would be worth-while if most periodontal destruction were prevented. Even the early destructive lesion exhibiting little or no inflammation may soon be identified, mainly because the minute volume of fluid collected from the gingival crevice can now be measured accurately. Accordingly, the concentration of various constituents in the GCF can be determined, which should lead to the development of tests to differentiate between pockets undergoing active destruction with minimal inflammation from the majority of active lesions that are intimately involved with frank inflammation. Thus, a clinician would measure sub-clinical gingival inflammation by measuring GCF flow, then differentiate destructive from quiescent lesions by analyzing the GCF sample for some constituent(s), chemical or microbial (Listgarten et al. 1975) indicative of the periodontal destructive process. Monitoring the flow of GCF might be of value in other clinical situations. For example, one could monitor the response of gingival tissues to various restorative and prosthetic procedures (Strauss et al. 1975) to ensure that these procedures do not aggravate the periodontal tissues and induce gingivitis or periodontitis. The education of the patient should be easier since patients can read their own numbers on the GCF meter at each examination and self-evaluate their personal periodontal condition and the effectiveness of their home care. Even the education of the dental student should be easier since he or she would have the means of self-evaluating the effectiveness of treatment, and not be as dependent upon the subjective assessment of his efforts by an instructor. Finally, monitoring GCF for various components could provide the dentist with a valuable means of easily screening patients for systemic disease. Obviously, this area of investigation is in its infancy, but does promise an exciting future for the oral diagnostician.

Ammonia

A histologic study of age changes in the adult human periodontal joint (ligament).

This study evaluated the histological age changes in 80 periodontal joints from 24 human cadavers ranging in age from 20 to 90 years. The limitations of such a descriptive study were reviewed to prevent overextrapolation of the findings to whole populations. In the young speciments, the bone surface of the tooth socket was smooth and regular with the insertion of Sharpey's fibers evenly distributed in the woven bone. Interstitial lamellae were found between secondary osteons in the alveolar bone. Copious periodontal fibers passed around small vascularized interstitial spaces to insert evenly into the cementum as Sharpey's fibers. Numerous cells, probably fibroblasts, were present within and between the fiber bundles. Like the bone surface, the cemental surface was smooth and regular. Both cellular and acellular cementum were present. Cemental splits were found both intracementally and at the cemento-dentinal junction. In the older specimens, the periodontal surface of the alveolar bone was jagged and uneven with Sharpey's fibers inserting irregularly into the woven bone. Subjectively an increased amount of internal remodeling was seen in the periodontal bone. A relative decrease in both suspensory fibers and cellular content was noted in the periodontal ligaments of the older specimens. Large vascularized interstitial spaces encroached upon areas formerly occupied by periodontal fibers and bone. Fat cells also were observed replacing the suspensory fibers. The cementum showed an irregular surface into which Sharpey's fibers were unevenly inserted. Both cellular and acellular cementum were present, and cemental splits were seen with the same frequency as in the young specimens. There was a tendency for greater cemental apposition, particularly in the apical region of the tooth. In many respects the aging periodontal joint showed atrophic and degenerative changes similar to those in cranio-facial sutures. However, these changes did not include either bony ankylosis or osteoporosis related to increasing age. In summary, the periodontal joints of the younger specimens were well organized while those of the older specimens showed a more irregular structure and a decrease in fiber and cellular content. Intermediate changes were seen in the intermediate age groups.

Adult

GWAS for Periodontitis Phenotypes Using Multi-Ancestry All of Us Research Platform.

Periodontitis is a multifactorial inflammatory disease whose pathogenesis is associated with intricate interactions between genetic and environmental factors. Leveraging electronic health records data from the All of Us Research Program, we stratified periodontitis by clinically relevant dimensions: stage, grade, and extent. Based on these phenotypes, we performed a multi-ancestry genome-wide association study, focusing on predominant ancestry populations of African, European, and Admixed American. Our study cohort comprised 3,881 periodontitis patients and a control group of 10,760 patients with dental caries and without periodontitis. Ancestry-specific GWAS revealed significant genetic associations (P<5&#xd7;10-8) in periodontitis grade phenotypes at the LINC00294 and CLMN loci in the African ancestry population and also confirmed via the multi-ancestry meta-analysis. In addition, the XYLT1 locus emerged as a significant signal associated with periodontitis grade phenotype in the admixed American GWAS. Our GWAS comparing periodontitis to dental caries in the admixed American population identified several significant loci, including RABGAP1L, previously linked to immune regulation, DCHS2, a cadherin-related gene involved in bone mineralization and tissue morphogenesis, and OSTM1, known to be crucial for bone remodeling. The findings of our study highlight the potential of integrating EHR and genomic data from large-scale biobanks to achieve informative dental phenotyping, uncover novel molecular insights into periodontal disease, and personalize treatment approaches.

Journal Article

Periodontal disease and oral hygiene in Arussi province, Ethiopia.

A dental health survey was conducted in the Arussi province in Ethiopia. The survey comprised 1,700 persons between 6 and 54 years of age in five age groups from four regions of the province. Findings concerning periodontal disease and oral hygiene are reported in the present paper. The onset of periodontal disease was early, with 60% of the children in the 6-7 year group having gingivitis. In general, periodontal disease was found in a majority of the surveyed population (83%). Severe periodontal destruction was, however, unusual before the age of 30, but at the age of 45-54 years 52% of the sample exhibited pocket formation. The level of periodontal disease in Ethiopia was judged as low to moderate. A close relationship was observed between oral cleanliness and periodontal condition. A possible favorable influence of the diet and traditional oral cleaning methods is conceivable.

Adolescent

Periodontal treatment need in a Finnish industrial population.

A periodontal study was conducted in a paper mill in Finland. To adapt the Periodontal Treatment Need System (PTNS) to a Finnish adult population the estimates of Finnish periodontologists were used. The mean estimate of periodontal treatment need was 97 +/- 58 (s.d.) min per person and 32 +/- 18 min per jaw segment. Periodontal treatment need increased with age. No significant differences in periodontal treatment need by sex, education, type of employment, regularity of working hours or frequency of dental visits were observed. Adjusted family income and toothbrushing frequency did not produce significant differences in periodontal treatment need, except in the group having four dentulous jaw segments. The groups using sugar, other sweetening agents or neither of these, mainly in coffee or tea, differed significantly: the non-users of sugar had lowest treatment time and those who used other sweetening agents than sugar had highest treatment time.

Adult

[Lateral periodontal cysts].

The lateral periodontal cyst is a rather infrequently reported odontogenic cyst. The cyst seems to develop in direct contact to the periodontal membrane of an erupted vital tooth. This type of cyst should not be confused with a radicular cyst in a lateral position developing as a consequence of inflammation from an infected or necrotic branch of the pulp canal. Several authors do not differentiate between the lateral periodontal cyst and the gingival cyst, but it seems justified to consider the lateral periodontal cysts as a separate entity of odontogenic cysts. In this origin of the lateral periodontal cyst is reviewed and several possibilities are discussed. It is concluded that the epithelial lining of this type of cysts most probably originates from the cell rests of Malassez. Case report of one lateral periodontal cyst is presented.

Adult