Periodontal disease damages tissues as a result of dysregulated host responses against the chronic bacterial biofilm insult and approximately 50% of US adults >30 years old exhibit periodontitis. The association of five blood nutrients and periodontitis were evaluated due to our previous findings regarding a potential protective effect for these nutrients in periodontal disease derived from the US population sampled as part of the National Health and Nutrition Examination Survey (1999–2004). Data from over 15,000 subjects was analyzed for blood levels of cis-β-carotene, β-cryptoxanthin, folate, vitamin D, and vitamin E, linked with analysis of the presence and severity of periodontitis. Moderate/severe disease patients had lower cis-β-carotene levels across all racial/ethnic groups and these decreased levels in moderate/severe periodontitis were exacerbated with age. β-cryptoxanthin demonstrated lower levels in severe disease patients across the entire age range in all racial/ethnic groups. Folate differences were evident across the various age groups with consistently lower levels in periodontitis patients >30 years and most pronounced in females. Lower levels of vitamin D were consistently noted across the entire age range of patients with a greater difference seen in females with periodontitis. Finally, an analytical approach to identify interactions among these nutrients related to age and periodontitis showed interactions of vitamin D in females, and folate with race in the population. These findings suggest that improving specific nutrient intake leading to elevated blood levels of a combination of these protective factors may provide a novel strategy to affect the significant increase in periodontitis that occurs with aging.

Periodontal disease (PD) is a chronic inflammatory disorder characterized by the destruction of connective tissue, tooth loss, and systemic infections. Clinically, treatment of PD includes control of the etiologic factors via several modalities: initial therapy including scaling and root planing (SRP), corrective phase of surgical treatment, both with and without adjunct antimicrobial/pharmacological agents, followed by a maintenance/supportive periodontal therapy phase. Each treatment phase aims to control oral biofilm by addressing risk factors and etiology. Monotherapy of systemic antibiotics is insufficient compared to their use as an adjunct to SRP. The critical issue of systemic antimicrobial usage includes adverse patient outcomes and increased bacterial resistance. Therefore, alternative adjuncts to periodontal therapy have been sought. Statins are widely prescribed for the treatment of hypercholesterolemia and cardiovascular disease. Statins have demonstrated anti-inflammatory properties and immunomodulatory effects, and a few retrospective studies showed that statin patients exhibit fewer signs of periodontal inflammation than subjects without the medication. Despite the available clinical studies on the local administration of statins for PD, no studies have reported the macrophage polarization response. We have developed a gingival fibroblast–macrophage co-culture model to track macrophage response when exposed to a battery of microenvironmental cues mimicking macrophage polarization/depolarization observed in vivo. Using our model, we demonstrate that simvastatin suppresses macrophage inflammatory response and upregulates tissue homeostasis and M2 macrophage markers. Our findings support the usage of statins to mitigate periodontal inflammation as a valid strategy.

Periodontitis is a chronic inflammation that destroys periodontal tissues caused by the accumulation of bacterial biofilms that can be affected by environmental factors. This report describes an association study to evaluate the relationship of environmental factors to the expression of periodontitis using the National Health and Nutrition Examination Study (NHANES) from 1999–2004. A wide range of environmental variables (156) were assessed in patients categorized for periodontitis (n = 8884). Multiple statistical approaches were used to explore this dataset and identify environmental variable patterns that enhanced or lowered the prevalence of periodontitis. Our findings indicate an array of environmental variables were different in periodontitis in smokers, former smokers, or non-smokers, with a subset of specific environmental variables identified in each population subset. Discriminating environmental factors included blood levels of lead, phthalates, selected nutrients, and PCBs. Importantly, these factors were found to be coupled with more classical risk factors (i.e. age, gender, race/ethnicity) to create a model that indicated an increased disease prevalence of 2–4 fold across the sample population. Targeted environmental factors are statistically associated with the prevalence of periodontitis. Existing evidence suggests that these may contribute to altered gene expression and biologic processes that enhance inflammatory tissue destruction.

Purpose of the Review: This review provides an in-depth evaluation of the existing information on peri-implant wound healing basics with a specific focus on local and systemic determinants affecting short and long-term clinical outcomes. Recent Findings: Peri-implant wound healing has been heavily studied in relation to biocompatibility of biomaterials and various surgical techniques for predictable and stable osseointegration. Short-term outcomes have been explored as a response to immediate, early and delayed implant placement and/or mechanical loading while long-term stability has been investigated as a response of time, restorative design and well-established risk factors such as periodontitis and smoking. It has been also reported that peri-implant bone remodeling is a continuous phenomenon, and several ill-described local factors may differentially affect implant fixture and bone interface. Summary: As research presents better evidence on implant soft tissue interface, we now understand that established peri-implant sulcus consists of a modified mucosal seal/ soft tissue attachment with short junctional epithelium, significant fibrotic connective tissue and limited wound healing capacity. In addition, long-term response of the soft tissue against titanium alloy as a transmucosal device within oral cavity has raised significant challenges negatively affecting success of implant supported dental restorations.

Background and Objective: The oral microbiome plays an important role in oral health and disease, including periodontitis, which affects about 40% of the adult population in the United States. Bacterial pathogens have been well studied and documented in their relationship with periodontitis; however, the role of fungi in periodontitis is still unclear. The purpose of this study is to determine the relationship of specific fungal species with periodontal pathogenic bacteria in healthy, mild periodontitis, and severe periodontitis patients. Methods: In this study, human participants were recruited, and saliva samples were collected. Twelve participants representing periodontal health (n = 2), mild periodontitis (n = 3), and severe periodontitis (n = 7) were included. Salivary samples were sequenced for analysis of their mycobiome (ITS sequencing) and microbiome (16s RNA sequencing). Results: A total of 375 species of bacteria and 39 species of fungi were identified among all samples. Clustering was observed for bacteria in healthy and mild periodontitis, but more variability was observed in the severe periodontal disease group. Variability was observed for fungi among all samples and groups. Red complex bacteria were negatively correlated with Candida species for the disease groups, although the correlation was not statistically significant. A significant correlation was observed between red-complex bacteria in the severe periodontal disease group. Additionally, a significant correlation was observed among Candida species in all groups. Conclusions: This pilot study simultaneously processed saliva samples for microbiome and mycobiome sequencing and found a trend towards negative correlation between Candida species and red complex bacteria.