• Obesity is a life-threatening disease affecting 34% of adults in the U.S.; 68% of adults are either overweight or obese • Between 2000 and 2005, obesity (BMI ≥30) increased by 24%, morbid obesity (BMI ≥ 40) increased by 50% and super obesity (BMI ≥ 50) increased by 75% • In 2008, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty-two states had a prevalence equal to or greater than 25%; six of these states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia) had a prevalence of obesity equal to or greater than 30%

Obesity in America.

Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test (TG) and control group (CG). One month before BS (pre-BS), patients in the TG (n = 15) received non-surgical periodontal therapy, while patients in the CG (n = 15) received only mechanical plaque removal. Patients were re-examined 3 and 6 months after BS. Differences between the TG and CG in clinical periodontal parameters, systemic health-related serum biomarkers, parameters of obesity, and prevalence of obesity-related diseases were evaluated. Results: From the 30 included patients, 26 were re-examined at 3 months and 20 patients at 6 months. Periodontal parameters bleeding on probing (p = 0.015), periodontal pocket dept (PPD, p = 0.0015), % PPD > 4 mm (p < 0.001), and full-mouth plaque levels (p = 0.002) were lower in the TG than in the CG at 6 months after BS. There is a general improvement in systemic health after BS without significant differences (p > 0.05) between the TG and CG at the 6-month follow-up. The TG shows a tendency for improvement in metabolic syndrome components at the 6-month follow-up compared to pre-BS (p < 0.05). Conclusions: Non-surgical periodontal therapy in periodontitis patients before the BS may improve periodontal health 3 and 6 months after the surgery. The possible benefits of periodontal therapy on the overall health of BS patients should be further explored.

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Periodontal Therapy in Bariatric Surgery Patients with Periodontitis: Randomized Control Clinical Trial

Design and validation of a quantitative polymerase chain reaction test for the identification and quantification of uncultivable bacteria associated with periodontitis.

AIM
To investigate the differences between the subgingival microbiota of healthy subjects (HS) and periodontitis patients (PP) from four different countries through a metagenomic approach.


MATERIALS AND METHODS
Subgingival samples were obtained from subjects from four different countries. Microbial composition was analysed through high-throughput sequencing of the V3-V4 region of the 16S rRNA gene. The country of origin, diagnosis and clinical and demographic variables of the subjects were used to analyse the microbial profiles.


RESULTS
In total, 506 subgingival samples were analysed: 196 from HS and 310 from patients with periodontitis. Differences in richness, diversity and microbial composition were observed when comparing samples pertaining to different countries of origin and different subject diagnoses. Clinical variables, such as bleeding on probing, did not significantly affect the bacterial composition of the samples. A highly conserved core of microbiota associated with periodontitis was detected, while the microbiota associated with periodontally HS was much more diverse.


CONCLUSIONS
Periodontal diagnosis of the subjects was the main variable explaining the composition of the microbiota in the subgingival niche. Nevertheless, the country of origin also had a significant impact on the microbiota and is therefore an important factor to consider when describing subgingival bacterial communities.

Comparative 16S rRNA gene sequencing study of subgingival microbiota of healthy subjects and patients with periodontitis from four different countries.

AIMS
To characterise the subgingival microbiome in subjects with different periodontal health statuses.


MATERIAL AND METHODS
In this cross-sectional observational study, subgingival samples were harvested from Spanish subjects with different periodontal health statuses, based on the 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions. Samples were processed using high throughput sequencing technologies (Illumina® MiSeq). Taxa differentially abundant were identified using Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC). α- and β-diversity metrics were calculated using q2-diversity in QIIME2. The analyses were adjusted for age, gender and smoking.


RESULTS
The identified subgingival microbiome demonstrated statistically significant differences among subjects, categorised in periodontal health, gingivitis, stages I-II and stages III-IV periodontitis (p < 0.05). In severe (stages III-IV) periodontitis patients, genera Filifactor and Fretibacterium were detected 24 times more than in periodontal health. Similarly, genera Porphyromonas, Prevotella and Tannerella were detected four times more (p < 0.05). Genera Granulicatella, Streptococcus, Paracoccus, Pseudomonas, Haemophilus, Actinobacteria, Bergeyella and Capnocytophaga were significantly associated with the categories of healthier periodontal status (p < 0.05).


CONCLUSIONS
Significant differences were detected in the subgingival microbiome among periodontal health, gingivitis and stages I-II or III-IV periodontitis, suggesting overlapping, yet distinguishable microbial profiles. This article is protected by copyright. All rights reserved.

The subgingival microbiome in periodontal health, gingivitis and different stages of periodontitis.

No microbiological criteria were included in the 2018 EFP-AAP classification of periodontal diseases that could be used to differentiate between stages and grades. Furthermore, differences in the subgingival microbiome depending on stage and grade have not been established. Sixty subgingival biofilm samples were collected in Spain (n = 30) and Colombia (n = 30) from three distinct patient categories: those with periodontal health/gingivitis (n = 20), those with stage I-II periodontitis (n = 20), and those with stage III-IV periodontitis (n = 20). Patients were evaluated by 16S rRNA gene amplification sequencing. Amplicon sequence variants were used to assign taxonomic categories compared to the Human Oral Microbiome Database (threshold ≥97% identity). Alpha diversity was established by Shannon and Simpson indices, and principal coordinate analysis, ANOSIM, and PERMANOVA of the UNIFRAC distances were performed using QIIME2. Although differences in the alpha diversity were observed between samples according to country, Filifactor alocis, Peptostreptococcaceae [XI][G-4] bacterium HMT 369, Fretibacterium fastidiosum, Lachnospiraceae [G-8] bacterium HMT 500, Peptostreptococcaceae [XI][G-5] [Eubacterium] saphenum, Peptostreptococcus stomatis, and Tannerella forsythia were associated with periodontitis sites in all stages. However, only F. alocis, Peptostreptococcaceae [XI][G-4] bacterium HMT 369, Peptostreptococcaceae [XI][G-9] [Eubacterium] brachy, Peptostreptococcaceae [XI][G-5] [Eubacterium] saphenum, and Desulfobulbus sp. HMT 041 were consistent in stage III-IV periodontitis in both countries. Porphyromonas gingivalis and Tannerella forsythia were differentially expressed in severe lesions in the countries studied. Although some non-cultivable microorganisms showed differential patterns between the different stages of periodontitis, they were not the same in the two countries evaluated. Further studies using larger samples with advanced next-generation techniques for high-throughput sequencing of phyla and non-cultivable bacteria within the subgingival microbiome could provide more insight into the differences between stages of periodontitis.

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Differences in the subgingival microbiome according to stage of periodontitis: A comparison of two geographic regions

The effect of weight loss on the periodontal condition remains unclear. The present prospective study thus aimed to evaluate the effect of weight loss on the peri‐ odontal status of 57 obese patients (BMI ≥30 kg/m2) with ages ranging from 18 to 60 years, at 12 months following bariatric surgery. Demographic, biological and behavioral variables were analyzed. All participants underwent a peri‐ odontal examination, including plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL). Anthropometric measurements, such as weight, height and body mass index (BMI) were calculated. Fisher's exact test, ANOVA, Bonferroni, Spearman's rank correlation and Wilcoxon signed‐rank tests were used for the statistical analysis (P<0.05). Prior to surgery, 49% of patients were clas‐ sified as having obesity class I, 33% as obesity class II and 18% as obesity class III. Variables, such as BMI and PD exhibited statistically significant differences among the obesity class I, II and III groups (P<0.05). As regards periodontal diagnosis, 37% of patients were classified as having gingivitis, 46% as having periodontitis stages I‐II, and 17% as having periodon‐ titis stages III‐IV. BMI, PI, BOP and PD exhibited statistically significant differences following bariatric surgery (P<0.0001). No statistically significant differences were observed in the CAL (P>0.05). Thus, the findings of the present study suggest that weight loss was associated with decreased periodontal inflammation and an improved plaque control following bariatric surgery. CAL remained unaltered during the study period. Introduction Obesity involves the abnormal or excessive accumulation of fat in the body that impairs the health of affected individuals (1). The etiology of obesity involves a myriad of genetic, cultural and societal factors (2). The American Medical Association officially recognized obesity as a human disease in 2013, in order to increase awareness of the condition and due to its associated severe comorbidities, to provide effective treatment options, to reduce mortality and costs (2). Obesity continues to be a risk factor for chronic health conditions, such as hyperten‐ sion, coronary heart disease, type 2 diabetes, stroke, metabolic syndrome, dyslipidemia and certain types of cancer (2,3). Obesity is also associated with chronic periodontitis (4). Obesity has several harmful biological effects that have been associated with the pathogenesis of periodontitis (5). The most important mediators related to this association are tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6). These pro‐inflammatory cytokines may exert pleiotropic effects, altering the activities of leukocytes, osteoblasts and osteoclasts (6). Hence, increased levels of pro‐inflammatory biomarkers may promote the tissue remodeling process, causing periodontal tissue destruction (6). The prevalence of obesity continues to increase signifi‐ cantly in developed and developing countries worldwide (7). In 2017‐2018, the age‐adjusted prevalence of obesity in adults was 42% (8). It has been projected that by 2030, up to 58% of the world's adult population could be either overweight or obese (7). However, to date, there is no indication of how to prevent the disease efficiently (9). Diet, medications and exercise alone are often ineffective as methods for adults with obesity to achieve long‐term weight loss (9). High‐quality evidence indicates that bariatric surgery is considered the most effec‐ tive long‐term treatment for severe obesity in individuals with a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 in those with obesity‐related comorbidities (3). The benefits of bariatric surgery include significant and durable weight loss, and an improvement or remission in comorbidities, including hypertension, type 2 diabetes, lipid abnormalities, sleep apnea and depression, thus improving the quality of life of patients and reducing the mortality rate (10,11). Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow‐up SILIE ARBOLEDA1, ROQUELINA PIANETA2, MIGUEL VARGAS1, GLORIA INÉS LAFAURIE3, FANNY ALDANA‐PARRA4 and CARLOS FELIPE CHAUX4 1School of Dentistry, Unit of Clinical Oral Epidemiology Investigations‐UNIECLO, El Bosque University, Bogotá 110121; 2School of Dentistry, Rafael Núñez University Corporation, Cartagena 130001; 3School of Dentistry, Unit of Basic Oral Investigation‐UIBO, El Bosque University; 4Obesity Surgery Clinic, Bogotá 110121, Colombia Received February 26, 2021; Accepted June 10, 2021 DOI: 10.3892/mi.2021.4 Correspondence to: Dr Silie Arboleda, School of Dentistry, Unit of Clinical Oral Epidemiology Investigations‐UNIECLO, El Bosque University, Ak. 9 # 131A‐20, Bogotá 110121, Colombia E‐mail: siliesoad@gmail.com

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Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow‑up

Abstract Objectives Culturable and unculturable microorganisms have been associated with periodontitis. Their differential proportions and composition have not been evaluated by their severity and complexity defined by stages in the 2018 AAP-EEP classification. Methods One hundred eighty subgingival biofilm samples were collected in Spain and Colombia from subjects categorized as health/gingivitis: periodontitis stages I/II periodontitis stages III/IV. Target culturable microorganisms ( Porphyromonas gingivalis , Aggregatibacter actinomycetemcomitans, Tannerella forsythia , Treponema denticola , and Eubacterium nodatum) and target unculturable microorganisms ( Filifactor alocis , Eubacterium saphenum , Eubacterium brachy , Desulfobulbus oralis) were evaluated by quantitative PCR analysis. In addition, their differences and association with periodontal status were analyzed by ANCOVA and logistic regression models once adjusted to age, current smoking, and country. Results P. gingivalis was significantly associated with periodontitis stages I/II, OR 2.44 (CI 95% 1.08–5.47) and stages III/V, OR 6.43 (CI 95% 2.43–16.9). T forsythia , OR 7.53 (CI 95% 2.07–27.4); D. oralis , OR 5.99 (CI 95% 2.71–13.23); F. alocis , OR 10.9 (CI 95% 4.56–23.2); E. brachy , 3.57 (CI 95% 1.40–9.11); and E. saphenum , 4.85 (CI 95% 1.99–11.7) were significantly associated only with stages III/IV periodontitis. P. gingivalis evidenced significant differences with the increase in the severity of the periodontal lesion: 2.97 colony forming unit (CFU)/μL (CI 95% 2.32–3.54) health/gingivitis, and 4.66 CFU/μL (CI 95% 4.03–5.30) and 5.90 CFU/μL (CI 95% 5.20–6.48) in stages I/II and III/IV respectively ( p &lt; 0.0001). Unculturable microorganisms only evidenced differences in concentration in stages III/IV compared with health-gingivitis ( p ≤ 0.001). Conclusion Culturable and unculturable are strongly associated with stages III/IV periodontitis. Classic culturable microorganisms are more sensitive to differentiate between stages of periodontitis in the quantitative analysis. Clinical relevance Future interventional studies of periodontal disease should include Filifactor alocis , Eubacterium saphenum , Eubacterium brachy , and Desulfobulbus oralis as possible markers of therapy response and as indicators of progressive disease. 

/pdf/differential-analysis-of-culturable-and-unculturable-3ji7pazw.pdf

Roquelina Pianeta

Papers

Differences in the subgingival microbiome according to stage of periodontitis: A comparison of two geographic regions

Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow‑up

Design and validation of a quantitative polymerase chain reaction test for the identification and quantification of uncultivable bacteria associated with periodontitis.

Differential analysis of culturable and unculturable subgingival target microorganisms according to the stages of periodontitis