Background: Latest evidence suggests that periodontitis is prevalent among patients with chronic obstructive pulmonary disease (COPD), while recent studies have also reported a potential benefit of periodontal treatment on several COPD outcomes. This systematic review aims to determine the impact of periodontal treatment on exacerbation rate, lung function and quality of life of COPD patients. Methods: A systematic search of electronic databases of PubMed, Scopus, Virtual Health Library, ScienceDirect, Wiley Online Library, Web of Science, ProQuest Dissertation and Theses Global and Google Scholar was conducted. Search restricted to studies involving human subjects which were published from January 2000 to March 2020 in English language. Distiller Systematic Review software was used for data management. Risk of bias was assessed using Risk of Bias 2 (RoB2) and Risk of Bias for non-randomized studies of intervention (ROBINS-I) tools. Overall quality of evidence was judged based on Grading of Recommendations Assessment, Development and Evaluation working group methodology. Results: Out of 1442 articles retrieved, 7 full text articles were included in the review. Limited evidence suggests that periodontal treatment in patients with COPD and periodontitis is associated with reduced exacerbation frequency and a slower lung function decline rate, while its effects on quality of life remain unclear. In addition, periodontal treatment in COPD is associated with lower hospitalization rates and reduced all-cause mortality. Significant methodological differences were noted amongst included studies, while very low-to-moderate overall quality of evidence was demonstrated. Conclusions: Although it is reasonable to advise COPD patients not to neglect their dental health, further studies are warranted to determine the role of periodontal therapy on COPD clinical outcomes. Trial Registration: PROSPERO 2020 (CRD42020158481). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158481

Background and Objectives: The role of surgical extraction of the third molar in patients’ sleep quality remains unclear, although it is one of the most common oral surgical procedures. The aim of this study is to assess the changes in patient-reported sleep health outcomes after third molar surgery and to investigate any associations between sleep parameters and post-extraction pain. Materials and Methods: Young adults without known comorbidities who were in need of mandibular third molar surgical extraction were included. All participants completed a sleep diary, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires, which were used to assess sleep habits, daytime sleepiness, sleep quality and insomnia severity one week before and after extraction. In addition, a visual analog scale was completed postoperatively to assess the perception of pain. Results: Out of 75 patients who completed the study protocol, 32 (42.7%) were males and 43 (57.3%) were females, with a mean age of 24.01 (±3.43) years. Postoperatively, statistically significant higher scores were observed for PSQI [4.85 (±2.32) before vs. 5.39 (±2.75) after, p = 0.041], AIS [5.56 (±3.23) before vs. 6.91 (±4.06) after, p < 0.001] and average weekly number of nocturnal awakenings [2.01 (±3.72) before vs. 4.19 (±5.20) after, p < 0.001] but not for ESS, average weekly sleep duration and average weekly sleep onset latency. Pain perception was increased in patients who slept worse on almost all seven postoperative days, although this did not reach statistical significance. Conclusions: Third molar surgery impacts sleep quality and insomnia severity in the first week after extraction, while there is no effect on daytime sleepiness. The worsening of subjective sleep symptoms after extraction may be associated with an increased perception of pain.

Background and Objectives: Evidence shows that COPD-OSA overlap syndrome (OS) is more frequently accompanied by cardiovascular disease (CVD) in comparison to either disease alone. The aim of the study was to explore whether patients with OS have a higher burden of subclinical myocardial injury and wall stress compared with OSA patients. Materials and Methods: Consecutive patients, without established CVD, underwent polysomnography and pulmonary function testing, due to suspected sleep-disordered breathing. An equal number of patients with OS (n = 53, with an apnea hypopnea index (AHI) > 5/h and FEV₁/FVC < 0.7) and patients with OSA (n = 53, AHI > 5/h and FEV₁/FVC > 0.7) were included in the study. The detection of asymptomatic myocardial injury and wall stress was performed via the assessment of serum high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), respectively. Results: OS patients were older (p < 0.001) and had worse hypoxemic parameters, namely average oxyhemoglobin saturation (SpO2) (p = 0.002) and time spent with SpO2 < 90% (p = 0.003) during sleep as well as daytime pO2 (p < 0.001), than patients with OSA. No difference was observed between groups in terms of Epworth Sleepiness Scale (p = 0.432) and AHI (p = 0.587). Both levels of hs-cTnT (14.2 (9.1–20.2) vs. 6.5 (5.6–8.7) pg/mL, p < 0.001) and NT-proBNP (93.1 (37.9–182.5) vs. 19.2 (8.3–35.4) pg/mL, p < 0.001) were increased in OS compared to OSA patients. Upon multivariate linear regression analysis, levels of NT-proBNP and hs-cTnT correlated with age and average SpO2 during sleep. Conclusions: Our study demonstrated higher levels of hs-cTnT and NT-proBNP in OS patients, indicating an increased probability of subclinical myocardial injury and wall stress, compared with OSA individuals.

Purpose: This overview summarized different interventions that were performed for minimizing periodontal defects distal to the mandibular second molar and improve hard and soft tissue healing after third molar surgery. Methods: Literature search was conducted in the following 9 databases: Medline (via Pubmed), ScienceDirect, Scopus, Virtual Health Library, Wiley Online Library, Web of Science, ProQuest Dissertations and Theses Global and Google Scholar. Systematic reviews with or without meta-analysis investigating the effect of different interventions on soft and hard tissue healing after third molar surgery were considered. Methodological quality of included reviews was assessed with AMSTAR-2 tool. The degree of overlapping of index publications in the eligible reviews was presented and calculated with the GROOVE tool. Results: Thirty-three reviews were included, collectively encompassing 191 distinct primary studies that evaluated flap design, extraction socket management, and postsurgical care. Quantitative data retrieved from the methodologically rigorous MAs revealed that the application of autologous platelet concentrates (APCs) is the best choice to improve soft tissue healing [MD = 1.01; 95% CI (0.77, 1.24), 7 days follow-up] and bone mineral density [SMD = 2.34; 95% CI (0.18,4.51), 4 months follow-up] and alleviate pain [SMD= -0.86; 95% CI (-1.26, -0.46), 3 days follow-up], trismus [SMD= -0.26; 95% CI (-0.48, -0.03), 7 days follow-up], alveolar osteitis [RR = 0.43; 95% CI (0.28, 0.65)] and swelling [MD= -1.66; 95% CI (-2.43, -0.90), 3 days follow-up]. Ridge preservation is the most effective intervention in improving pocket probing depth [MD= -1.42; 95% CI (-2.01, -0.83), 6–72 months follow-up], clinical attachment level [MD = 1.98; 95% CI (1.44, 2.52), 4.5-72months follow-up] and alveolar bone height [MD = 1.21; 95% CI (0.21, 2.21), 6–12 months follow-up] distal to mandibular second molar. Conclusion: Minimizing tissue trauma is key in surgical extractions. Our overview found that triangular flaps reduce PPD, while envelope flaps lower postoperative pain. APCs improved healing and reduced adverse events, and HyA mainly alleviated pain. All regenerative techniques enhanced periodontal outcomes, though high heterogeneity and variable study quality urge cautious interpretation.