Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth ...loss impacting negatively upon speech, nutrition, quality of life and self‐esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high‐risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis.
Aim
The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self‐administered plaque control regimes; 2) the efficacy of self‐administered inter‐dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti‐inflammatory (sole or adjunctive) approaches.
Methods
Two meta‐reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti‐inflammatory agents) formed the basis of this consensus.
Results
Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re‐chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter‐dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti‐inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter‐dental cleaning devices. In patients with gingivitis once daily inter‐dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.
Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship.
To update the evidence for their epidemiological and ...mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C).
There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes.
Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression.
Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27–0.48% after 3 months, although studies involving longer-term follow-up are inconclusive.
The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
Background and Aims
The scope of this working group was to review (1) ecological interactions at the dental biofilm in health and disease, (2) the role of microbial communities in the pathogenesis of ...periodontitis and caries, and (3) the innate host response in caries and periodontal diseases.
Results and Conclusions
A health‐associated biofilm includes genera such as Neisseria, Streptococcus, Actinomyces, Veillonella and Granulicatella. Microorganisms associated with both caries and periodontal diseases are metabolically highly specialized and organized as multispecies microbial biofilms. Progression of these diseases involves multiple microbial interactions driven by different stressors. In caries, the exposure of dental biofilms to dietary sugars and their fermentation to organic acids results in increasing proportions of acidogenic and aciduric species. In gingivitis, plaque accumulation at the gingival margin leads to inflammation and increasing proportions of proteolytic and often obligately anaerobic species. The natural mucosal barriers and saliva are the main innate defence mechanisms against soft tissue bacterial invasion. Similarly, enamel and dentin are important hard tissue barriers to the caries process. Given that the present state of knowledge suggests that the aetiologies of caries and periodontal diseases are mutually independent, the elements of innate immunity that appear to contribute to resistance to both are somewhat coincidental.
Aim
The aim of this systematic review was to evaluate the efficacy of anti‐plaque chemical formulations for managing gingivitis, in 6‐month, home‐use, randomised clinical trials (RCTs).
Material and ...Methods
A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand‐searches identified relevant papers, which were screened and evaluated for inclusion. Full‐papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences (WMD) and 95% confidence intervals.
Results
After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index (n = 23, −0.415), gingivitis severity index (n = 26, −14.939%) or bleeding index (n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe (n = 26, −0.109), and plaque severity (n = 12, −23.4%) indices, with significant heterogeneity.
Conclusion
Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices.
Objective
To critically evaluate the existing literature on acute lesions occurring in the periodontium (periodontal abscesses PA, necrotizing periodontal diseases NPD, and endo‐periodontal lesions ...EPL) to determine the weight of evidence for the existence of specific clinical conditions that may be grouped together according to common features. The ultimate goal is to support an objective classification system.
Importance
Although PA, NPD, and EPL occur with relatively low frequency, these lesions are of clinical relevance, because they require immediate management and might severely compromise the prognosis of the tooth.
Findings
In general, the evidence available to define these three conditions was considered limited. PA and EPL are normally associated with deep periodontal pockets, bleeding on probing, suppuration, and almost invariably, with pain. EPL are also associated with endodontic pathology. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla. The available data suggested that the prognosis of PA and EPL are worse in periodontitis than in nonperiodontitis patients. Lesions associated with root damage, such as fractures and perforations, had the worst prognosis. NPD progression, extent and severity mainly depended on host‐related factors predisposing to these diseases.
Conclusions
PA should be classified according to the etiological factors involved, with the most frequent being those occurring in pre‐existing periodontal pockets. NPD are clearly associated with the host immune response, which should be considered in the classification system for these lesions. EPLs should be classified according to signs and symptoms that have direct impact on their prognosis and treatment, such as presence or absence of fractures and perforations, and presence or absence of periodontitis.
Fair trade has been recognized as an effective way of eradicating poverty and sustainable development. It is a reality increasingly supported by consumers; in 2019, the entities that market fair
...trade products invoiced more than 138,5 million euros in Spain. This support has been encouraged
by greater social concern for global problems such as poverty or exploitation, and for education and
development cooperation actions and policies, among others. In this context, Spanish universities
have been working for more than a decade to bring fair trade closer to the university community.
Aware of their impact on the production and consumption model, 21 universities have positioned
themselves politically in favour of fair trade. This commitment has reached the Executive Committee
of CRUE-Internationalization and Cooperation, which approved its Declaration of Spanish Universities in favour of fair trade and responsible consumption in 2017, with the aim of contributing to
«guarantee sustainable consumption and production models». During all this time, the institutional
positioning has been accompanied by policies for the integration of ecological and fair trade criteria
in its purchases, the formation of work groups, the implementation of research and teaching actions,
the development of strategies for mainstreaming of sustainable consumption, and international
cooperation projects with producer groups, as well as the participation in interuniversity networks,
such as Fair Trade Universities, coordinated by the IDEAS cooperative at the state level, and which
has become a backbone, binder and enhancer of this commitment, together with the subgroup of
fair trade and responsible consumption of the CRUE.
El comercio justo ha sido reconocido como una forma eficaz de erradicación de la pobreza y de desarrollo sostenible*. Es una realidad cada vez más apoyada por los consumidores; en 2019, las entidades que comercializaban productos de comercio justo facturaron en España más de 138,5 millones
de euros. Este apoyo ha sido alentado por una mayor preocupación social por problemas globales
como la pobreza, la explotación o la salud, y por acciones y políticas de educación y cooperación para
el desarrollo, entre otras. En este contexto, las universidades españolas llevan trabajando desde
hace más de una década en acercar el comercio justo a la comunidad universitaria. Conscientes
de su incidencia en el modelo productivo y de consumo, 21 universidades se han posicionado políticamente a favor de un comercio justo. Dicho compromiso ha llegado hasta la Comisión Ejecutiva
de CRUE-Internacionalización y Cooperación, la cual aprobó su Declaración de las Universidades
Españolas en favor del Comercio Justo y el Consumo Responsable en 2017, con el objetivo de contribuir a «garantizar modelos de consumo y producción sostenibles». Durante todo este tiempo, el
posicionamiento institucional ha ido acompañado por políticas para la integración de criterios ecológicos y de comercio justo en sus compras, la conformación de grupos de trabajo, la implementación
de acciones de investigación y docencia, el desarrollo de estrategias para la transversalización del
consumo sostenible y proyectos de cooperación internacional con grupos productores, así como la
participación en redes interuniversitarias, tales como la de Universidades por el Comercio Justo,
que coordina a nivel estatal la cooperativa IDEAS, y que se ha convertido en un eje vertebrador,
aglutinador y potenciador de este compromiso, junto con el subgrupo de comercio justo y consumo
responsable de la CRUE.
Objective
The objective of this review was to perform a systematic evaluation of the literature reporting current scientific evidence for periodontal bacteria as contributors to atherosclerosis.
...Methods
Literature from epidemiological, clinical and experimental studies concerning periodontal bacteria and atherosclerosis were reviewed. Gathered data were categorized into seven “proofs” of evidence that periodontal bacteria: 1) disseminate from the oral cavity and reach systemic vascular tissues; 2) can be found in the affected tissues; 3) live within the affected site; 4) invade affected cell types in vitro; 5) induce atherosclerosis in animal models of disease; 6) non‐invasive mutants of periodontal bacteria cause significantly reduced pathology in vitro and in vivo; and 7) periodontal isolates from human atheromas can cause disease in animal models of infection.
Results
Substantial evidence for proofs 1 to 6 was found. However, proof 7 has not yet been fulfilled.
Conclusions
Despite the lack of evidence that periodontal bacteria obtained from human atheromas can cause atherosclerosis in animal models of infection, attainment of proofs 1 to 6 provides support that periodontal pathogens can contribute to atherosclerosis.
CTLA4 is an essential negative regulator of T-cell immune responses and a key checkpoint regulating autoimmunity and antitumor responses. Genetic mutations resulting in quantitative defects in the ...CTLA4 pathway are also associated with the development of immune dysregulation syndromes in humans. It has been proposed that CTLA4 functions to remove its ligands CD80 and CD86 from opposing cells by a process known as transendocytosis. A quantitative characterization of CTLA4 synthesis, endocytosis, degradation, and recycling and how these affect its function is currently lacking. In a combined in vitro and in silico study, we developed a mathematical model and identified these trafficking parameters. Our model predicts optimal ligand removal in an intermediate affinity range. The intracellular CTLA4 pool as well as fast internalization, recovery of free CTLA4 from internalized complexes, and recycling is critical for sustained functionality. CD80-CTLA4 interactions are predicted to dominate over CD86-CTLA4. Implications of these findings in the context of control of antigen-presenting cells by regulatory T cells and of pathologic genetic deficiencies are discussed. The presented mathematical model can be reused in the community beyond these questions to better understand other trafficking receptors and study the impact of CTLA4 targeting drugs.
•The method solves multi-order and variable coefficients RLFDE and CFD.•Theorem 3.1. transforms RLFI to a linear algebraic equation.•Corollary 3.1.1. transforms CFD to a linear algebraic ...equation.•Theorem 3.2. allows to find with for RLFDE.•Corollary 3.2.1. allows to find and for CFDE.
In this paper, a numerical method is developed to obtain a solution of Caputo’s and Riemann-Liouville’s Fractional Differential Equations (CFDE and RLFDE). Scientific literature review shows that some numerical methods solve CFDE and there is only one paper that numerically solves RLFDE. Nevertheless, their solution is limited or the Fractional Differential Equation (FDE) to be solved is not in the most general form. To be best of the author’s knowledge, the proposed method is presented as the first method that numerically solves RLFDE which includes multi-order fractional derivatives and variable coefficients. The method converts the RLFDE or CFDE to be solved into an algebraic equation. Each Riemann-Liouville’s or Caputo’s Fractional Derivative (RLFD and CFD), derived from the RLFDE or CFDE respectively, is conveniently written as a set of substitution functions and an integral equation. The algebraic equation, the sets of substitution functions and the integral equations are discretized; and then solved using arrays. Some examples are provided for comparing the obtained numerical results with the results of other papers (when available) and exact solutions. It is demonstrated that the method is accurate and easy to implement, being presented as a powerful tool to solve not only FDE but also a wide range of differential and integral equations.
Human rights education (HRE) is an urgent historically and globally recognized challenge for societies. However, it has not been sufficiently addressed by empirical and theoretical research in ...education. Based on the UN Declaration on Human Rights Education and Training (UNDHRET), there is wide agreement that HRE should include education about, through, and for human rights. We argue that a situated deliberative pedagogy can offer these three dimensions to HRE. However, this is not without challenges for teachers and students. One way to deal with these challenges and support this pedagogical innovation is to design curriculum material that supports teachers. To contribute to this, we conducted a design-based research (DBR) aimed at participative designing of educative curriculum material for human rights deliberative education. Four teachers participated in two phases of the study. Two participated in refining the material's structure and its controversies and the other two participated in discussing the dilemmas and activities relating to implementation of the material at school with their 11th- and 12th-grade students. The results show participatory educative curriculum material designed for holistic HRE: about, through, and for HR. The implications and problems of the design process associated with a deliberative curriculum for HRE are discussed.
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