Crystal Marruganti

Periodontitis is a highly prevalent chronic inflammatory disease characterized by a dysbiotic biofilm‐induced host immune dysregulation and sustained low‐grade systemic inflammation. Psoriasis and other inflammatory skin disorders, including atopic dermatitis and alopecia, are immune‐mediated conditions driven by complex interactions between genetic susceptibility, environmental triggers, microbial factors, and cytokine network activation. Mounting epidemiological and experimental evidence suggests a consistent association between periodontitis and psoriasis, with emerging links to other skin disorders. This narrative review critically appraised the current available evidence regarding the epidemiological association between periodontitis and inflammatory skin disorders, explored the shared pathogenic mechanisms underpinning a potential oral–skin axis, and evaluated the impact of periodontal therapy on dermatological outcomes. Epidemiological and meta‐analytical data suggest a positive association between periodontitis and psoriasis across diverse populations, although direct causality remains unclear. Mechanistically, overlapping pathways include systemic dissemination of pro‐inflammatory cytokines (e.g., IL‐6, TNF‐α, IL‐17), Th17‐driven immune responses, neutrophil priming and NETosis, microbial translocation, and shared lifestyle‐related determinants within the multimorbidity framework. Preclinical and clinical randomized controlled trials suggest that non‐surgical periodontal therapy may reduce psoriasis severity and extent over the short term (8–10 weeks), potentially acting as a relevant adjunct to dermatologic medications. While heterogeneity and residual confounding limit definitive conclusions, the convergence of epidemiological, mechanistic, and interventional evidence supports the plausibility of a bidirectional interaction between periodontal and skin inflammation and the potential existence of an oral‐skin axis. Interdisciplinary clinical strategies integrating periodontal and dermatologic care should be implemented for the early diagnosis and management of both periodontal and skin diseases and conditions.

Background: Dentin hypersensitivity (DH) is a common yet inconsistently defined condition impacting oral health and quality of life. Variability in diagnostic criteria and trial methodologies has limited comparability of previous research. Objectives: To map current definitions, diagnostic frameworks, and clinical trial methodologies in DH research. Assess alignment with current best practice guidelines and CONSORT reporting standards. Establish a consensus‐based DH definition and core outcome set to guide future trials. Methods: A scoping review was conducted in accordance with the PRISMA‐ScR framework examining DH definitions published post‐1997 and design of randomized controlled trials (RCTs) over the last 5 years. A hybrid AI‐assisted and manual data extraction approach was employed maximizing efficiency and rigor. Data were retrieved on definitions, diagnostic criteria, stimuli, outcomes, and design features. Quantitative summaries and thematic syntheses were generated for two domains: (i) definitions and diagnostic criteria (ii) trial design, stimuli, and outcomes. Results: Definitions of DH varied widely in the 72 included papers. Few studies incorporated all elements of the currently accepted definition, particularly with respect to exclusion of alternative pathologies. Recent literature introduced patient‐centered and mechanistic extensions to the definition. Among 58 RCTs, CONSORT adherence was inconsistent, especially reporting of randomization, blinding, and effects estimates. The Delphi study achieved consensus on a refined case definition, minimum diagnostic criteria, validated assessment tools, and core outcome set (COS) encompassing clinician assessed, patient reported, and QoL measures. Conclusions: Substantial conceptual and methodological variation persists in DH research. The consensus‐derived definition and COS offer foundations for standardized, high quality DH trials aligned with current evidence and patient priorities. Protocol Registration: This protocol was registered a priori with Open Science Framework (OSF) – ( https://doi.org/10.17605/OSF.IO/J6D7N ). The scoping review was reported according to the PRISMA Extension for Scoping Reviews (PRISMA‐ScR).

Background: The contribution of oral inflammatory conditions to systemic disease burden remains underexplored within multimorbidity frameworks. Emerging evidence suggests that periodontal inflammation may play a role in the clustering of chronic diseases, yet few studies have evaluated this at a population level using robust datasets. The aims of this study were to investigate whether periodontal diseases are associated with Multiple long-term conditions (MLTCs) burden and severity in two population-based cohorts and to examine whether systemic inflammatory biomarkers mediate these associations. Materials and Methods: We analyzed two population-based cohorts: the UK Biobank (UKB; n = 500,612) and the US National Health and Nutrition Examination Survey (NHANES; n = 10,714). MLTCs were defined as the coexistence of ≥2 chronic diseases. Associations between periodontal diseases and MLTCs were assessed using multivariable logistic and multinomial logistic regression. Causal mediation analyses examined the contribution of systemic inflammatory markers. Results: Approximately half of all participants had MLTCs. The prevalence of periodontal diseases was 17.8% in UKB (self-reported symptoms), and 42.3% in NHANES (clinically assessed). Periodontal diseases were independently associated with greater odds of MLTCs in both UKB (OR 1.12; 95% CI 1.10–1.14) and NHANES (OR 1.22; 95% CI 1.09–1.37). Associations were stronger among adults aged ≤ 60 years. A consistent dose-response relationship was observed between periodontal status and the number and severity of chronic conditions, as well as inflammatory-related MLTCs. Mediation analyses suggested partial effects through white blood cell count, neutrophils, and C-reactive protein. Conclusions: Periodontal inflammation is independently associated with greater multimorbidity burden, particularly in younger adults. Systemic inflammation may offer a plausible biological link, and these findings position oral health as an underrecognized and modifiable target in multimorbidity prevention and management frameworks, warranting prospective investigation.

Aim: In systemically healthy humans with gingivitis, what is the efficacy of active agents compared to negative control/placebo when used adjunctively to mechanical biofilm control in terms of changes in gingivitis/bleeding indices and/or disease resolution in randomised controlled clinical trials (RCTs) with at least 3‐months follow‐up? Material and Methods: Electronic searches, study selection, data extraction, risk of bias analysis, meta‐analyses and certainty of the evidence were performed (GRADE). Results: Seventy‐two RCTs were included (antiseptics n = 71; systemic intake n = 1). High heterogeneity was found in the definition of gingivitis. Antiseptic agents showed greater reductions in bleeding (%) than control groups at 3 months ( n _comparison [ n _c ] = 19; weighted mean differences [WMD] = 10.66%; p < 0.001) and 6 months ( n _c = 20; WMD = 10.79%; p < 0.001). Gingivitis resolution was rarely determined. Prevalence of local adverse effect (tooth‐related and soft‐tissue‐related) varied from 0% to 13.1%. Systemic effects were scarcely evaluated. Conclusions: In adults with gingivitis, the adjunctive use of specific antiseptics determined higher reduction of gingival inflammation at 3 months (moderate evidence for stannous fluoride and low‐to‐very low for chlorhexidine, essential oils or cetylpyridinium chloride [CPC]) and 6 months (moderate for chlorhexidine, low for CPC and very low for essential oils) over placebo/negative controls. Adverse effects are neither frequently nor extensively reported. Gingivitis resolution is rarely reported and achieved.

Aim: To assess the association between apical periodontitis (AP) and subclinical symptoms of anxiety, depression and disordered eating. Methodology: A total of 120 individuals were included in this case–control study. Sixty subjects were assigned to case (AP+) and 60 to control group (AP−). The periapical and dental status were assessed using radiographic images (OPT, periapical radiographs) and dental examination. The DMFT index (decayed, missing and filled teeth) and the periapical index (PAI) scores were recorded. All subjects were interviewed to compile medical history data, anxiety (Hamilton A), depression (Hamilton D) and eating disorder (EAT‐26) questionnaires. Inferential and both simple and multiple logistic regression analyses were performed. Results: Significant associations were observed between AP and higher scores on HAM‐A, HAM‐D and EAT‐26. The regression model showed that higher PAI scores were significantly associated with increased odds of anxiety, depression and disordered eating. A PAI score of 3 showed increased odds of anxiety (OR = 5.57, p = 0.004) and depression (OR = 3.65, p = 0.025). A PAI score of 4 showed even greater odds for anxiety (OR = 8.68, p = 0.001), depression (OR = 14.07, p = 0.001) and disordered eating (OR = 3.98, p = 0.032). Participants with more than one periapical lesion were 3.56 times more likely to report higher levels of anxiety ( p = 0.007), 3.59 times more likely to experience elevated depression ( p = 0.018) and 3.08 times more likely to exhibit disordered eating behaviours ( p = 0.028). Additionally, higher DMFT scores were associated with an increased likelihood of higher HAM‐A scores (OR = 1.18, p = 0.001). Conclusions: The study results show a statistically significant higher prevalence of mood disorders and mental health‐related conditions including anxiety, depression and eating disorders in patients with AP. Longitudinal studies are needed to determine the nature of the observed association. Trial Registration: ClinicalTrials.gov identifier: NCT06589076

Aim: To evaluate the performance and implementation of the 2018 Classification of Periodontal Diseases for periodontitis through systematic review and survey methodology. Materials and Methods: A two‐part systematic review was conducted. Part 1 aimed, with descriptive statistics, to evaluate performance metrics of the 2018 Classification, including diagnostic accuracy, prognostic performance and examiner reliability. Part 2 used thematic analysis to elucidate facilitators and barriers to the implementation of the classification. A survey collected evidence of barriers, facilitators and local implementation. Results: Part 1 of this review included 14 individual studies of moderate risk of bias. Eight studies examined diagnostic accuracy, three studies examined prognostic efficacy and three studies examined inter‐/intra‐rater reliability. Part 2 included 33 individual studies with data considered at high risk of bias. The survey returned 1113 responses. The thematic analysis in Part 2 led to seven findings, five related to facilitators and two concerning barriers to the implementation. Survey results showed that 78% of respondents currently use the classification, but the most common concerns relate to its complexity. Conclusions: The 2018 Classification performs well as a classification in comparison with previous classifications. Specific identified barriers have potentially limited the comprehensive uptake of the classification.

Aim: To assess the adjunctive effect of periodontal therapy on psoriasis‐related outcomes in a combined experimental model of ligature‐induced periodontitis and Imiquimod (IMQ)‐induced psoriasis. Also, this experiment aimed to study the impact of TNF‐α inhibitors on the periodontium.Methods: Fifty‐six C57/BL6J mice were randomly allocated to seven experimental groups: (a) control group (P–Pso–) with no treatment; (b) periodontitis (P+Pso–) with periodontal therapy; (c) periodontitis (P+Pso–) with TNF‐α inhibitor; (d) psoriasis (P–Pso+) with TNF‐α inhibitor; (e) periodontitis and psoriasis (P+Pso+) with periodontal therapy; (f) P+Pso+ with TNF‐α inhibitor; and (g) P+Pso+ with both periodontal therapy and TNF‐α inhibitor. Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis distance between the cemento‐enamel junction and alveolar bone crest (CEJ–ABC) and number of osteoclasts and psoriasis (epidermal thickness and infiltrate cells (per 0.03mm²)) severity, as well as systemic inflammation (IL‐6, IL‐17A and TNF‐α) were collected.Results: In the P+Pso+ group, a significant adjunctive effect of periodontal therapy to TNF‐α inhibitors was found in the reduction of epidermal thickening and inflammatory infiltrate of the dorsal skin (p < 0.05). Similarly, treatment with TNF‐α inhibitor resulted in a significant adjunctive effect to periodontal therapy in the reduction of alveolar bone loss (p < 0.05). These changes were accompanied by a significant decrease in the circulating levels of IL‐6 and IL‐17A when both periodontal therapy and TNF‐α inhibitor were administered.Conclusions: The combination of periodontal therapy and TNF‐α inhibitor showed a positive synergetic effect in the treatment of comorbid experimental ligature‐induced periodontitis and IMQ‐induced psoriasis via the reduction of systemic inflammation.

Aim: To evaluate the prevalence of apical periodontitis (AP) and caries in subjects with psoriasis vulgaris.Methodology: In total, 152 patients with psoriasis vulgaris were included in the study. The severity and extent of psoriasis were assessed according to the Psoriasis Area Severity Index (PASI), the Body Surface Area (BSA) and the Physician's Global Assessment Scale (PGA). Periapical status was assessed through dental examination and periapical radiographs. Data regarding the Periapical Index (PAI), caries experience expressed as the Decayed, Missing, Filled Teeth Index (DMFT) and psoriasis medications were recorded. A predictive logistic regression model for the presence of AP and a linear regression model were then built to relate the severity and extent of AP to the type of drug therapy taken for psoriasis and to the severity and extent of the skin disease.Results: Subjects with severe/moderate psoriasis showed a significantly higher prevalence of AP (p = .002) and a higher PAI score (p = .0035) than subjects with mild psoriasis. No significant correlation was found between AP and caries experience (p = .76). The logistic regression model showed that moderate/severe psoriasis increased the odds of having AP [odds ratio (OR) = 1.30 ± 1.088, 1.55]. A negative linear relationship between biological drug intake and PAI score value was observed (coefficient = −.54; p = .04).Conclusions: The degree of severity of psoriasis is significantly associated with AP, suggesting that psoriasis may play a role in the pathogenesis of AP. However, no significant correlation was observed for caries experience. Furthermore, the immune‐modulating drugs taken by these patients did not seem to have different effects on the prevalence of AP.

Objectives: The aim of this study was to describe the structure and assess the efficacy of a patient-centered framework for managing periodontitis, utilizing the Bioperio^® protocol, a standardized treatment approach incorporating both clinical and extra-clinical phases. Methods: Patients diagnosed with periodontitis were included in this multicenter, single-arm, clinical observational study with a 3-month follow-up. All patients were treated following the Bioperio^® protocol, involving professional supra-gingival scaling, oral hygiene instructions, and scaling and root planing following a full-mouth approach. In Stage III/IV periodontitis cases, enamel matrix derivatives (EMD) were applied in periodontal pockets > 5 mm. Monthly recalls were performed until the 3-month follow-up. Results: In total, 663 patients were enrolled, with 76.4% being diagnosed with Stage II/III periodontitis. At 3 months, all clinical periodontal parameters improved regardless of the initial stage of periodontitis, achieving pocket closure in 75.4% of cases and patient resolution in 91.3% of the sample. Stages I/II showed significantly improved outcomes compared to Stage IV. The adjunct of EMDproved beneficial, especially in stage III patients, increasing pocket closure by 15% and doubling the odds of patient resolution. No adverse effects of the treatment protocol were observed throughout the study. Conclusions: The Bioperio^® protocol appears to be a safe and effective therapeutic approach for the management of patients affected by periodontitis. Combining a stepwise approach for clinical phases with tailored oral hygiene instructions and motivational sessions offers a comprehensive strategy that may enhance outcomes for patients with periodontitis.

Aim: Lifestyle factors significantly influence the development of inflammatory diseases, and emerging evidence suggests they may also impact oral health. However, no studies have explored their role in apical periodontitis (AP) amongst adults. This study aimed to assess the association between adherence to the Mediterranean diet (MD), physical activity, perceived stress, and sleep quality with the periapical and caries status in a university‐based cohort.Methodology: A total of 149 periodontally healthy patients were included in the study. Clinical assessments and radiographic examinations [Orthopantomography (opt) and periapical radiographs] were conducted to evaluate the periapical status. Data on their periapical index (PAI) score and the decayed, missing and filled teeth (DMFT) index were recorded. Validated questionnaires were used to investigate patient's lifestyles. A final logistic regression model was performed for the multivariable analysis to evaluate the predictive ability of adherence to Mediterranean lifestyle on the presence of AP; other local, systemic and environmental factors were included as independent factors in the model.Results: Significant associations were observed between AP and high/low adherence to the MD (p = .00), high/low‐moderate physical activity (p = .00), high/low sleep quality (p = .00) and high/low perceived stress (p = .00). The final multivariable regression model showed that low adherence to MD (OR = 3.68; 95% confidence interval [CI]: 1.24–10.83; p = . 01) and reduced sleep quality (OR = 3.04; 95% CI: 1.42–6.50; p = .00) were identified as potential risk factors for AP development. On the other hand, the DMFT index showed no significant association with lifestyle factors (OR = 1.0; CI: 1.01–1.14; p = .02) but was correlated with the development of AP (OR = 1.07; CI: 1.01–1.14; p = .02).Conclusion: Results from the present study suggest a potential association between low adherence to MD and reduced sleep quality with the development of AP. Individuals with low adherence to MD and inadequate sleep quality faced respectively 4‐fold and 3‐fold increased odds of developing periapical lesions. Further research is essential to elucidate the causal mechanisms underlying these associations and to determine whether lifestyle adjustments could improve endodontic success rate.