Among oral tissues, the periodontium is permanently subjected to mechanical forces resulting from chewing, mastication, or orthodontic appliances. Molecularly, these movements induce a series of subsequent signaling processes, which are embedded in the biological concept of cellular mechanotransduction (MT). Cell and tissue structures, ranging from the extracellular matrix (ECM) to the plasma membrane, the cytosol and the nucleus, are involved in MT. Dysregulation of the diverse, fine-tuned interaction of molecular players responsible for transmitting biophysical environmental information into the cell’s inner milieu can lead to and promote serious diseases, such as periodontitis or oral squamous cell carcinoma (OSCC). Therefore, periodontal integrity and regeneration is highly dependent on the proper integration and regulation of mechanobiological signals in the context of cell behavior. Recent experimental findings have increased the understanding of classical cellular mechanosensing mechanisms by both integrating exogenic factors such as bacterial gingipain proteases and newly discovered cell-inherent functions of mechanoresponsive co-transcriptional regulators such as the Yes-associated protein 1 (YAP1) or the nuclear cytoskeleton. Regarding periodontal MT research, this review offers insights into the current trends and open aspects. Concerning oral regenerative medicine or weakening of periodontal tissue diseases, perspectives on future applications of mechanobiological principles are discussed.

From the Matrix to the Nucleus and Back: Mechanobiology in the Light of Health, Pathologies, and Regeneration of Oral Periodontal Tissues

To analyze the effect of tooth loss/periodontitis on disease activity in early and established rheumatoid arthritis (RA).Participants of the Course And Prognosis of Early Arthritis (CAPEA) early arthritis cohort reported their number of teeth at baseline. The number of teeth had been validated as a predictor of periodontitis. Clinical end points, including disease activity score (Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [ESR]), swollen joint count (SJC), ESR, and C-reactive protein level were collected at baseline, 3, 6, 12, 18, and 24 months. We used linear mixed regression models to estimate the association between tooth loss and clinical end points over time in early arthritis. For established RA, we analyzed cross-sectional data from the German National Database (NDB). All models accounted for age, sex, smoking, seropositivity, education level, and disease duration (only NDB).Among 1,124 CAPEA participants with early arthritis, those with higher tooth loss were older, more often male, smokers, and seropositive, and they had higher disease activity and inflammation markers at baseline. Tooth loss was associated with higher disease activity and ESR values over time. Inflammatory markers decreased comparably across tooth loss categories. Glucocorticoid use was higher among those with more tooth loss, whereas dose reduction was similar across tooth loss categories. Among 7,179 NDB participants with longstanding RA, disease activity and inflammation markers but not SJC were significantly higher in patients with more tooth loss.Although we observed an association between tooth loss and disease activity scores and inflammation markers in early and established RA, longitudinal results suggest that tooth loss does not hamper treatment response. 

Association Between Rheumatoid Arthritis Disease Activity and Periodontitis Defined by Tooth Loss: Longitudinal and <scp>Cross‐Sectional</scp> Data From Two Observational Studies

OBJECTIVE To analyze the effect of tooth loss/periodontitis on disease activity in early and established RA. METHODS Participants of the CAPEA early arthritis cohort reported their number of teeth at baseline. The number of teeth had been validated as predictor of periodontitis. Clinical endpoints including disease activity score (DAS28-ESR), swollen joint count (SJC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected at baseline, 3, 6, 12, 18, and 24 months. We used linear mixed regression models to estimate the association between tooth loss and clinical endpoints over time in early arthritis. For established RA, we analysed cross-sectional data from the German National Database (NDB). All models accounted for age, sex, smoking, seropositivity, education level, and disease duration (only NDB). RESULTS Among 1,124 CAPEA participants with early arthritis, those with higher tooth loss were older, more often male, smokers, seropositive, and they had higher disease activity and inflammation markers at baseline. Tooth loss was associated with higher disease activity and ESR values over time. Inflammatory markers decreased comparably across tooth loss categories. Glucocorticoid use was higher among those with more tooth loss while dose reduction was similar across tooth loss categories. Among 7,179 NDB participants with longstanding RA, disease activity and inflammation markers but not SJC were significantly higher in patients with more tooth loss. CONCLUSIONS While we observed an association between tooth loss and disease activity scores and inflammation markers in early and established RA, longitudinal results suggest that tooth loss does not hamper treatment response.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.24799

Association between RA disease activity and periodontitis defined by tooth loss: longitudinal and cross-sectional data from two observational studies.

In den vergangenen 28 Jahren hat das Deutsche Rheuma-Forschungszentrum Berlin verschiedene epidemiologische Studien initiiert, in denen jeweils bundesweit und multizentrisch Daten zu Patienten mit entzundlich rheumatischen Erkrankungen erfasst werden. Das Spektrum reicht von rheumatoider Arthritis uber Spondyloarthritiden bis zu Kollagenosen und rheumatischen Erkrankungen im Kindesalter. Ausgehend von der jeweiligen wissenschaftlichen Fragestellung, wurden Studien unterschiedlicher Art etabliert. Die Kerndokumentationen fur Erwachsene und fur Kinder erheben jahrlich Daten, um die Versorgung der Patienten abzubilden. In 2 Inzeptionskohorten werden Erwachsene mit fruher Arthritis und Patienten mit juveniler idiopathischer Arthritis ab Krankheitsbeginn beobachtet. Die Langzeitkohorten/Register RABBIT, RABBIT-SpA und JuMBO haben die Langzeitwirksamkeit und -sicherheit von Biologika und anderen zielgerichteten Therapien im Fokus. Rhekiss untersucht Frauen mit entzundlich rheumatischen Erkrankungen bei Kinderwunsch, wahrend der Schwangerschaft und postpartal. Dieser Beitrag beleuchtet jede dieser Beobachtungsstudien mit ihren Besonderheiten sowie nationalen und internationalen Kooperationen.

Register- und Kohortenstudien

Register- und Kohortenstudien: Eine Übersicht über die wichtigsten Datenquellen am Deutschen Rheuma-Forschungszentrum

The aim of this study was to develop a patient-reported questionnaire that is suitable to detect periodontitis (PD) in patients with rheumatoid arthritis (RA). A self-reported questionnaire containing 12 items potentially relevant to PD and dentists’ semiquantitative assessment of PD (no/mild/moderate/severe) was obtained from 353 patients from an early arthritis cohort. Available radiographs (n = 253) and blinded assessment of 3 independent dentists were used for validation. By defining the dentists’ assessment as the reference standard, relevant questionnaire items were identified with factor analysis methods. Receiver operator characteristic (ROC) plots were used to determine sensitivities and specificities to detect PD in varying severity. Ordinal regression models were used to determine the coefficients for the final score. Seventy percent had at least mild PD. The items from the questionnaire correlating best with the dentists’ assessment were selected for a final 6-item score (number of teeth, gum pockets, receding gums, loose teeth, receding jaw bone and tooth extractions and age). For the detection of any/moderate/severe PD, the bias-corrected areas under the curve (AUC) were 0.81/0.83/0.90. Sensitivity to detect mild PD was 85% and specificity 57%. Very high specificity was achieved for the detection of severe PD with 99% at the cost of low sensitivity (28%). This patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings. We propose to use the score as a measure of periodontitis without applying cut-off values.

/pdf/a-patient-reported-questionnaire-developed-in-a-german-early-zgcbx8c097.pdf

Mariya Chubrieva

Papers

A patient-reported questionnaire developed in a German early arthritis cohort to assess periodontitis in patients with rheumatoid arthritis.