Jørgen Slots

Background: The primary goal of periodontology is to prevent tooth loss and reduce the risk of focal infections. Periodontitis lesions can harbor hundreds of thousands of active cytomegaloviruses (virions), which can easily enter the systemic circulation and potentially infect the fetus of a mother with compromised immunity. The healthy, non‐inflamed periodontium contains no PCR‐detectable cytomegalovirus. Maternal cytomegalovirus may be linked to cleft lip and cleft palate, prepubertal and juvenile periodontitis, and systemic diseases. Aim: This article presents an anti‐cytomegalovirus periodontal therapy aimed at preventing congenital cytomegalovirus disorders. Materials and Methods: Immunodeficient and periodontitis‐affected women in the pre‐gestational period or the first trimester of pregnancy are prime candidates for periodontal treatment. The periodontal diagnosis and drug treatment ought to be performed by well‐informed dentists (periodontists). Treatment consists of a one‐time valacyclovir regimen (1 g BID on days 1 and 2, and 500 mg BID on days 3–7), subgingival and supragingival ultrasonic scaling using a 0.1%–0.2% sodium hypochlorite cooling solution, individually tailored oral hygiene instructions, and patient‐administered daily subgingival irrigation with a 0.1%–0.2% sodium hypochlorite solution. Results: Cytomegalovirus in maternal periodontitis likely serves as a critical nidus for fetal infection. The combined treatment of valacyclovir, ultrasonic scaling, and sodium hypochlorite rinses markedly reduces or eliminates the mother’s periodontal cytomegaloviruses. Clinical relevance: The proposed noninvasive anti‐cytomegalovirus periodontal therapy is highly safe for the pregnant mother and the fetus. The anti‐cytomegalovirus periodontal treatment is expected to control the mother’s periodontal cytomegalovirus load and, consequently, part of the baby’s congenital disease risk. Research is encouraged on the relationship between periodontal cytomegalovirus and congenital diseases.

Periodontal disease, including gingivitis and periodontitis, is a chronic inflammatory condition that leads to the destruction of the supporting structures of teeth. The disease is characterized by a complex immune response, where cytokines play a central role in regulating both inflammation and tissue breakdown. Cytokines are small signaling proteins that mediate communication between immune cells, driving the progression of periodontal diseases by activating immune cells, promoting osteoclast differentiation, and stimulating the production of matrix metalloproteinases. This leads to the degradation of periodontal ligament fibers, alveolar bone resorption, and eventual tooth loss. Cytokines contribute not only to localized tissue damage but also to systemic inflammation. Given that periodontal diseases are a chronic inflammatory diseases, their systemic implications are significant. Increasing evidence shows an association between periodontal diseases and other systemic conditions, suggesting that serum cytokine levels could provide valuable insights into both periodontal and systemic health. Understanding the role of serum cytokines in periodontal diseases is critical for identifying systemic inflammatory patterns and disease progression. Evaluating serum cytokine profiles may lead to the discovery of new diagnostic biomarkers and therapeutic targets. Cytokine‐modulating therapies could potentially reduce the inflammatory burden in periodontal diseases and improve patient outcomes, especially in individuals with comorbid systemic conditions. This review highlights the current evidence on serum cytokines in periodontal diseases and emphasizes the need for further research to develop cytokine‐targeted therapies for improved management of periodontal diseases.

Severe periodontitis lesions can harbor hundreds of thousands of copies of productive cytomegalovirus. Cytomegalovirus virions from maternal periodontitis can enter the bloodstream and potentially infect a fetus, leading to serious congenital disorders or diseases. Cleft lip and palate have been associated with congenital cytomegalovirus infections. A review of the literature suggests that babies are at increased risk for developing orofacial clefts if born to a woman with severe periodontitis, a weakened immune system, and an active cytomegalovirus infection during the first trimester of pregnancy. The proposed periodontal treatment aims to eliminate cytomegalovirus from the periodontium, thereby reducing the risk of orofacial clefts. The treatment involves 1 week of systemic valacyclovir and daily sodium hypochlorite oral rinsing during the 2 months before conception and the first trimester of pregnancy. In summary, cytomegalovirus in maternal periodontitis is a risk factor for the development of orofacial clefts in an unborn baby, who may benefit from preemptive periodontal treatment. Women should be informed that untreated maternal periodontitis can lead to serious birth defects in the mouth and throughout the body.

Severe periodontitis lesions can harbor several hundred‐thousand copies of active cytomegalovirus, and this paper proposes that cytomegalovirus in maternal periodontitis can infect the fetus. Cleft lips and palates may be oral examples of congenital cytomegalovirus infection. Anti‐cytomegalovirus periodontal treatment is indicated for high‐risk women who exhibit severe periodontitis and weakened immune system and are contemplating pregnancy or are in the first trimester of pregnancy.

Objectives: Periodontal inflammation may be assessed by bleeding on probing and subgingival temperature. This pilot study evaluated the intrapatient relationship between subgingival temperature and selected bacterial groups/species in deep periodontal pockets with bleeding on probing.Materials and Methods: In each of eight adults, an electronic temperature probe identified three “hot” pockets with elevated subgingival temperature and three “cool” pockets with normal subgingival temperature among premolars/molars with 6‒10 mm probing depths and bleeding on probing. Microbial samples collected separately from the hot and cool periodontal pockets were cultured for selected periodontal pathogens.Results: Hot compared to cool periodontal pockets revealed significantly higher absolute and normalized subgingival temperatures and yielded higher mean proportions of Porphyromonas gingivalis (10.2% for hot vs. 2.5% for cool, p = 0.030) and total red/orange complex periodontal pathogens (48.0% for hot vs. 24.6% for cool, p = 0.012).Conclusions: Hot versus cool deep periodontal pockets harbored significantly higher levels of major periodontal pathogens. Subgingival temperature measurements may potentially be useful to assess risk of periodontitis progression and the efficacy of periodontal therapy.

This study evaluated a combined systemic and topical anti-infective periodontal treatment of 35 adults who had experienced ongoing periodontal breakdown following conventional surgical periodontics. The prescribed anti-infective therapy, based on microbiological testing, consisted of a single course of metronidazole plus ciprofloxacin (23 patients), metronidazole plus amoxicillin/clavulanic acid (10 patients), and metronidazole plus ciprofloxacin followed by metronidazole plus amoxicillin/clavulanic acid (2 patients). In addition, the study patients received 0.1% povidone-iodine subgingival disinfection during non-surgical root debridement and daily patient administered oral irrigation with 0.1% sodium hypochlorite. At 1 and 5 years post-treatment, all study patients showed gains in clinical periodontal attachment with no further attachment loss, and significant decreases in pocket probing depth, bleeding on probing, and subgingival temperature. The greatest disease resolution occurred in patients who at baseline harbored predominantly major periodontal pathogens which post-antibiotics became non-detectable and substituted by non-periodontopathic viridans streptococci. The personalized and minimally invasive anti-infective treatment regimen described here controlled periodontitis disease activity and markedly improved the clinical and microbiological status of the refractory periodontitis patients.

This bibliometric study assessed periodontal/implant articles that were part of the five most‐cited dental articles in each of the years 2005‐2019. Periodontal/implant articles made up one to four articles in each of 14 years and totaled 40% of the yearly five most‐cited dental articles. The three core periodontal journals (Journal of Clinical Periodontology, Journal of Periodontology, and Periodontology 2000) increased ~50%‐100% in Journal Impact Factor from 2005 to 2015 and were among the 10 most‐cited dental journals in the 2015‐2019 period. The Journal of Clinical Periodontology and Periodontology 2000 were in several years assigned the highest Journal Impact Factor in dentistry. In summary, periodontal journals continue to publish high‐impact articles that are relevant for both oral health care and medicine.

Severe/progressive periodontitis is associated with cardiovascular disease, cancer, Alzheimer’s disease, and dozens of other serious diseases. Herpesviruses are implicated in severe periodontitis and in specific subsets of each of the above systemic diseases. That both periodontitis and herpesviruses are linked to the same nonoral diseases is consistent with a systemic pathogenic role of periodontal herpesviruses. Effective control of periodontitis‐related systemic diseases requires collaboration between dentistry and medicine. Periodontology has emerged as an important preventive medical discipline, and periodontal teaching and practice need to adjust accordingly.

Periodontology is an infectious disease‐based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti‐infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone‐iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.