Exploring the Feasibility and Acceptance of Delivering Oral Health Interventions in a Primary Care Diabetes Context in North East England: A Qualitative Two-Case Study

\ua9 2024 The Author(s). International Journal of Dental Hygiene published by John Wiley & Sons Ltd.The evidence base supporting a bidirectional relationship between diabetes and periodontitis is well-established and published guidance recommends inter-professional management. This two-case study describes the development and implementation of an evidence-based oral health intervention delivered in diabetes review consultations in NHS primary medical care in Northeast England. Aim: The intervention aim was to inform people with diabetes about the links between diabetes and periodontitis, and signpost them to a dental professional for assessment. Methods: The study utilised focus groups in the design phase and a mixture of focus groups and interviews in the evaluation phase. Results: Two research active primary care medical practices were recruited. The interventions were informed by their diabetes management protocols to reduce disruption. The interventions were piloted for 2 months, and staff and patient perceptions were evaluated. The findings from this study suggested that the oral health interventions were feasible and acceptable particularly for nurses and health care assistants when delivering diabetes education, but they caused disruption to the GPs review, which included complex medication reviews and referrals. The patients (n = 2) found the intervention to be acceptable and appropriate in the context of their diabetes review. Conclusion: Medical staff and patient evaluation data appear to suggest acceptance of the introduction of an oral health intervention into the diabetes review, but it is difficult to assess the impact of the intervention. Further research, such as a realist review, is needed to evaluate the outcomes and utility of an oral health intervention in the context of the medical management of diabetes in primary care

An Evaluation of a New Ultrasonic Water Irrigator in the Management of Gingival Health: A Randomised Study

\ua9 2024 The Author(s). International Journal of Dental Hygiene published by John Wiley & Sons Ltd.Introduction: This randomised, single-blind, controlled study aimed to compare daily adjunctive use of an ultrasonic water irrigation device to dental floss in controlling plaque and gingival inflammation in patients with gingivitis. Methods: Participants were randomly allocated to either daily use of an ultrasonic water irrigator or dental floss as an adjunct to manual toothbrushing for 4 weeks, with periodontal assessment repeated at 1 and 4 weeks after baseline (Rustogi Modified Navy Plaque Index [PI], Loe and Silness Gingival Index [GI] and bleeding on marginal probing [BOMP]). Results: Sixty-two participants completed the investigation. Statistically significant reductions in total and marginal PI at Weeks 1 and 4 were noted in both groups compared to baseline (p < 0.05) with no significant differences between groups. BOMP and GI scores were likewise significantly reduced in both groups at Weeks 1 and 4 compared to baseline (p < 0.01). However, at Week 4, those using the ultrasonic water irrigator showed a significantly greater reduction in GI scores when compared to the floss group (−0.35 \ub1 0.26 vs. −0.16 \ub1 0.25, respectively, p < 0.01) and a significantly greater reduction in BOMP scores when compared to floss (−0.26 \ub1 0.12 vs. −0.15 \ub1 0.15, respectively, p < 0.01). Those using the ultrasonic water irrigator also reported easier usage scores (p < 0.05) when compared to the floss group. Conclusion: Daily use of the ultrasonic water irrigator resulted in significantly greater reductions in gingival inflammation (gingival index and BOMP) than dental floss after 4 weeks, whereas plaque removal was similarly effective using the irrigator or floss

Activation of the Urokinase Plasminogen Activator/Urokinase Plasminogen Activator Receptor System in Periodontitis: A Case–Control Study

\ua9 2024 The Author(s). International Journal of Dental Hygiene published by John Wiley & Sons Ltd.Introduction: The plasminogen activating (PA) system has a multitude of functions such as wound healing, proteolytic activity, collagen degradation and cell growth, and the role of the urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) system has been studied in many disease states. The aim of this study was to investigate salivary concentrations of uPA, uPAR and uPA activity in patients with periodontitis to identify biomarkers and novel pathogenic relationships. Methods: Saliva samples were obtained from 169 participants, comprising patients with periodontitis (n = 103) and periodontally healthy volunteers (n = 66) and analysed for uPA and uPAR with a multiplex protein assay using proximity extension analysis in a subset of samples, followed by validation with ELISA. The protease activity of salivary uPA was quantified using a fluorometric assay. Results: Patients with periodontitis had a 4.0-fold higher (p < 0.001) salivary uPA and a 2.5-fold higher (p < 0.001) salivary uPAR concentration in comparison to periodontally healthy participants. The salivary uPA activity (median [IQR]) from patients with periodontitis (123.21 [188.29] U/mL) was 1.6-fold higher (p < 0.01) than the salivary uPA activity from periodontally healthy participants (76.83 [98.09] U/mL). Levels of uPA and uPAR were strongly correlated with periodontal indices, whereas only weak correlations were found with BMI and age. Conclusion: Activation of uPA/uPAR likely plays a role in the pathogenesis of periodontal diseases. uPA/uPAR may have potential utility as candidate salivary biomarkers in periodontal pathogenesis

Baicalin Downregulates Porphyromonas gingivalis Lipopolysaccharide-Upregulated IL-6 and IL-8 Expression in Human Oral Keratinocytes by Negative Regulation of TLR Signaling

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Periodontitis and diabetes: a two-way relationship

Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management

Expression of caspase-3, p53 and Bcl-2 in generalized aggressive periodontitis

BACKGROUND: Apoptosis, or programmed cell death is a form of physiological cell death. It is increased or decreased in the presence of infection, inflammation or tissue remodelling. Previous studies suggest that apoptosis is involved in the pathogenesis of inflammatory periodontal disease. The aim of the present study was to investigate the clinical features and known indicators of apoptosis (p53, Bcl-2, Caspase-3) in patients with generalized aggressive periodontitis (GAP) METHODS: Eight patients with GAP, who had sites with probing depths (PD) > 5 mm, and 10 periodontally-healthy persons were included in the study. Clinical examinations and PD were performed, and the plaque index and gingival index were recorded. Gingival tissues biopsies were obtained from active site of each patient and from healthy individuals. The expression of caspase-3, Bcl-2, and p53 was evaluated by immunohistochemistry RESULTS: There were no significant differences between GAP and control group with respect to levels of caspase-3 and p53 expression (P > 0.05). Contrary, the frequency of grade 3 expression of Bcl-2 was higher in GAP group than the control group. CONCLUSION: The higher frequency of Bcl-2 expression in GAP group indicates and delayed apoptosis can lead to increasing resident inflammatory cells in periodontal tissues and resulting in progressive periodontal destruction