A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity. This case–control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR). A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02–70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24–5.74, p = 0.012). A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.

Porcine acellular dermal matrix has recently been introduced in dentistry as an alternative to the gold standard connective tissue graft especially for the use in gingival recession treatments and soft tissue augmentation in implant surgery. Connective tissue grafts are inconvenient and require a second surgical site leading to greater morbidity, longer surgical procedures, and a more painful postoperative phase for the patient. Other options such as allografts have ethical concerns and are less available in Europe. Thus, dental professionals have sought other techniques and materials. Porcine acellular dermal matrix results in periodontal recession treatment with a gain in recession coverage as well as increased keratinized tissue and soft tissue augmentation. This leads to more keratinized mucosa and greater tissue thickness. Many studies have been published using collagen matrices, but a few strictly use porcine acellular dermal matrix, which have been studied in prospective randomized clinical trials with a large number of patients and longer follow-up periods (more than 5 years). Nevertheless, more data are needed to confirm that the porcine acellular dermal matrix is a suitable alternative although its favourable results to date suggest a positive future.

Background: Xenogenic collagen matrices (XCMs) are gaining popularity for soft tissue augmentation in dental implants; yet, gaps exist in our understanding of their comparative effectiveness.Objective: This systematic review and meta‐analysis focuses on studies that utilize soft tissue augmentation techniques for dental implants to improve keratinized mucosa width (KMW), soft tissue thickness (STT), and soft tissue volume (STV). We compared porcine collagen matrices with autogenous grafts when no bone grafts were utilized.Materials and Methods: We searched databases such as PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for randomized controlled trials and controlled clinical trials published between January 2013 and July 2023 that assessed the efficacy of XCM in peri‐implant soft tissue augmentation. The primary outcome included KMW changes while the secondary outcome was STT/STV changes. Statistical analyses were conducted using a random‐ or fixed‐effects model, and heterogeneity was assessed using I² statistics.Results: Nine studies were included in the qualitative analysis, and six were included in the meta‐analysis. No significant intergroup differences were observed (p > 0.05), but a significant difference was observed in favor of KMW ≥ 2 mm. Heterogeneity among the studies varied at the 6‐ and 12‐month follow‐ups, with I² values of 78% and 0%, respectively. The pooled mean difference between the XCM and autograft groups was −0.96 (−1.71 to −0.21), which shows that there was a larger increase in KMW in the autograft group compared with the XCM group (p < 0.05).Conclusions: Collagen matrices are less effective than autogenous grafts at increasing keratinized tissue and STT/STV, but the two techniques yield comparable aesthetic outcomes. Additional studies are necessary to better guide clinical practice and improve patient outcomes.

The World Health Organization declared a pandemic on March 11, 2020, due to a virus named SARS-CoV-2 discovered in Wuhan, China, in December 2019. Many countries have been hit hard including Spain, with the highest number of healthcare workers being infected (>50,000). A lack of personal protective equipment and protocols at the time of the outbreak led to many fatalities. Although few of these healthcare workers are dental professionals, this community required protective measures as well. Fortunately, there are no reported cases of SARS-CoV-2 transmission in dental practices. Dental professionals were advised only to treat dental emergencies, and such cases were screened via telephone to maintain social distancing. Nevertheless, new protocols and measures are needed as dental professionals return to normal practice after weeks of confinement in many countries. Relatively, few articles have discussed the management of dental practice during the SARS-CoV-2 with no known articles on postpandemic outbreak guidelines. Though some protocols and measures are the same, there are also many differences. Here, we describe protocols and measures for dental practice in Spain in accordance with the Spanish Health Ministry.

Background Recent clinical-epidemiological data suggest that periodontitis (P) shows higher prevalence in patients with rheumatoid arthritis (RA). However, the strength of association is limited, with odds ratios (OR) ranging from 1,82–8,05. Meanwhile, prevalence of P in adult Spanish population¹ varies from 16–30%,with smaller prevalence of severe P (5–11%). Nevertheless, there is no evidence of the P prevalence in RA patients in Spanish population. Objectives 1.To describe the prevalence of P and its association with RA in patients located in our reference area. 2.To explain the characteristics of P in RA patients. Methods Observational, descriptive, cross-sectional, case-control study of RA patients ≥18 years old (ACR/EULAR 2010) in a hospital Rheumatology Service, and a control group with a non-inflammatory joint disease, who had at least 4 teeth, had not received dental prophylaxis or antibiotic intake 6 months before study. Socio-demographic and anthropometric variables with smoking status, Graffar scale, stress level, annual dental prophylaxis, and co-morbidities such as osteoporosis (OP),diabetes mellitus (DM),dyslipidemia (DS),ischemic cardiovascular disease (ICD). Periodontal Variables: plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), recession (REC), clinical attachment level (CAL). Dental team: 2 periodontists/2 general dentists with inter-observer variability n° of males in controls), socioeconomic status (lower level in RA), >n° of current and former smokers RA (19,25%vs 8,92%/ 24,6%vs 11,46%),OP (23,45% RA vs 7,8%), DS (hipertrygliceridemia 11,23% RA vs 4,46%). There were182/187 (97, 33%) RA patients with P vs 104/157 (66,24%) patients with P in controls; N1T 52,41% RA vs 54,14%; N2T 44,92% RA vs 12,1% controls p<0,001, OR 18,55 (CI 95% 7,188–47,872),which is maintained after adjusting by confounding variables: OR 16,248 ± 9,295 (CI95% 5,295–49,858).Moreover, there was a poor periodontal status in RA patients with a dramatic increase in all periodontal parameters: PI, PPD, n° and percentage of PPD ≥5mm and BoP (p<0,001) compared with control group. Conclusions 1.Our study shows a strong association between RA and P with an adjusted OR 16,25 2.RA patients presented an increased prevalence of severe P compared to controls with statistical significance, and estimated prevalence in Spanish population. 3. RA patients showed a more severe periodontitis than control patients.4. there were no differences in the prevalence of mild periodontitis between both groups. Bravo-Pérez M C-PE. Encuesta de salud oral en España 2005. RCOE 11(4):409–56. Disclosure of Interest None declared

Background Environmental, genetic and epigenetic factors can induce citrullination of structural peptides by the enzyme PAD,which induce anti-citrullinated protein antibodies (ACPA) preceding RA. Among the environmental factors are cigarette smoke, infections, such as P. gingivalis in periodontitis (PD) and Prevotella copri of intestinal microflora, and silica dust. Given the implication of these two exogenous factors, tobacco and PD,in citrullination, and tobacco enhancer factor in PD, we studied: Objectives 1. The risk of smoking for developing advanced PD in patients with RA. 2. Possible influence of smoking on the expression of severe PD and ACPA in RA patients. Methods Observational, descriptive, cross-sectional study in RA patients older tan 18y.o.(ACR/EULAR 2010), with ≥4 teeth, without tooth cleaning nor antibiotic intake 6 months previously. Socio-demographic and anthropometric variables included smoking status, social indicators such as Graffar scale, stress level, annual dental prophylaxis, and co-morbidities such as diabetes mellitus, dyslipidemia, ischemic cardiovascular disease. Serum ACPA detection: semiquantification Ab IgG against citrullinated peptides (ELISA) with Immunoscan CCPlus®test kit. Eurodiagnostica: positive >25; ACPA title stratification: Low (25–75), moderate (76–300) and high (>300). Periodontal parameters: plaque index (PI), Bleeding on probing (Bop), probing pocket depth, recession, clinical attachment level (CAL). CAL loss was categorized according to European Workshop 2005 (Tonetti)¹: T level 0 (abscence), TL1 (mild), TL2 (severe). Statistical analysis: t-student, Kruskal Wallis, Chi-cuadrado by Stata program 13.1. Results We studied 187 patients, F/M 78.6%/21.4%, mean age 54.4 y.o. Follow-up time 8.8 y.o. RF+ 74.2%, ACPA positive in 114/168 patients (67.86%). Smoking habit:Current smoker (19.25%), former smoker (24.6%); low socioeconomical status (36.4%)/ relative poverty (33.7%).PD was observed in 97.3%: TL1 52.4%, TL2 44.9%. A “risk gradient” was observed for PD related to smoking habit: former smoker OR 1.62 (95% CI 0.81–3.27),p=0.174; smokers, OR 2.27 (95% CI 1.05–4.91), p=0.037. When analyzing the influence of smoking on PD development according to ACPA profile, a gradient effect of developing severe PD was observed from former smokers OR 2.37 (IC95% 0.52–7.64) to current smokers OR 6.99 (IC95% 1.53–32.07) (p=0.029) in ACPA(-) patients. This relationship was not observed in ACPA (+) patients (p=0.383). Conclusions 1.There is a “risk gradient” to develop PD in RA in relation to past or current exposure to tobacco, so that, although not significant, former smokers are at greater risk than non-smokers, and current smokers have a significant risk 2.3 times higher. 2. This risk gradient is shown in ACPA (-) patients, but not in ACPA (+) patients, which suggests an independent relationship between PD and ACPA (+) RA. References Tonetti MS, et al. J Clin Periodontol 2005. References Disclosure of Interest None declared