Publications by authors named "C Pink"

41 Publications

Preparation of Methyltriazolo[1,4]benzodiazepine via Oxidative Activation of a Thiolactam for the Synthesis of BET Inhibitor Molibresib.

J Org Chem 2021 Apr 20. Epub 2021 Apr 20.

Product Development and Supply, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States.

A novel oxidative activation of a thiolactam was developed for the preparation of methyltriazolo[1,4]benzodiazepine in a single step. A sulfenic acid (R-SOH) was proposed as the activated intermediate with the concurrent formation of acetylhydrazone from acethydrazide and cyclocondensation to the triazole. A version of the method with 35% peracetic acid was scaled up to 40 kg as a part of the new route for the synthesis of BET inhibitor molibresib (GSK525762). The thiolactam was prepared from commercially available (2-amino-5-methoxyphenyl)(4-chlorophenyl)methanone in two steps in 66% yield. The concise four-step synthesis delivered 52 kg of molibresib of >99.9% ee in an overall 41% yield from the ketone. The condition for the methyltriazole was mild and free of racemization of the sensitive stereocenter. The oxidative method, with several advantages to the known methods, should be applicable to the synthesis of alkyltriazoles from other thiolactams and acylhydrazines.
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http://dx.doi.org/10.1021/acs.joc.1c00563DOI Listing
April 2021

Polypharmacy and saliva volumes in the northeast of Germany - The Study of Health in Pomerania.

Community Dent Oral Epidemiol 2021 Apr 7. Epub 2021 Apr 7.

Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

Objectives: Associations between saliva volumes or salivary flow rates and potentially xerogenic medication are rarely evaluated in cohorts with a wide age range. This cross-sectional cohort study investigated possible relationships between the regular consumption of potentially xerogenic medication and stimulated saliva volumes.

Methods: Data from the German Studies of Health in Pomerania (SHIP-2 and SHIP-Trend-0) were pooled. Potentially xerogenic medications were identified using the Workshop on Oral Medicine VI criteria. Stimulated saliva was sampled using Salivette®, and saliva volumes expressed as μl/min were determined. Applying linear mixed models with adjustment for time point of saliva collection, associations of (a) age and sex with regularly consumed medication, (b) age and sex with saliva volumes, and (c) the number of regularly consumed xerogenic medications with saliva volumes were evaluated.

Results: Six thousand seven hundred and fifty-three participants aged 20-83 years (mean 53.4 ± 14.9) were included. The average number of medications did not differ markedly between females (2.21 ± 2.46) and males (2.24 ± 2.83). Males took more potentially xerogenic medication (1.0 ± 1.3) than did females (0.9 ± 1.3). Also, males took more potentially xerogenic cardiovascular medications than did females (0.9 ± 1.2 versus 0.7 ± 1.1), while females were prescribed a higher number of potentially xerogenic medications affecting the nervous system (0.2 ± 0.5 versus 0.1 ± 0.4). The average stimulated saliva volume was 967.0 ± 433.3 µL/min. Regularly consumed and potentially xerogenic medications were associated with lower saliva volumes. Older age correlated not only with a higher number of total medications and a higher number of xerogenic medications affecting either the cardiovascular (in males) or the nervous system (in females), but also with lower saliva volumes.

Conclusions: Ageing was associated with polypharmacy, especially with the intake of potentially xerogenic medication, and lower average saliva volumes. With regard to complications of dry mouth, anamnesis of medication consumption is of high importance.
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http://dx.doi.org/10.1111/cdoe.12644DOI Listing
April 2021

At which bone level are implants explanted?

Clin Oral Implants Res 2021 Mar 23. Epub 2021 Mar 23.

Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Greifswald, Germany.

Objectives: Clear guidelines when to remove an implant are missing. The aim of this study was to evaluate the amount of peri-implant bone loss at explantation by specialists.

Material And Methods: Implantology specialists were asked to provide implants explanted due to peri-implantitis with related clinical information. Early failures (survival time <12 months) were analyzed separately. Questionnaires inquired age, sex, smoking, implant location, usage of bone substitutes, and implant brand. Explants were measured and bone loss was assessed using radiographs. Covariate-adjusted mixed-effects models were evaluated for bone loss and survival time.

Results: Twelve dental offices provided 192 explants from 161 patients with 99 related radiographs. Thirty-three (17.2%) explants were early failures. Excluding early failures, average survival time was 9.5 ± 5.8 years with absolute and relative bone loss of 7.0 ± 2.7 mm and 66.2 ± 23.7%, respectively. Late failures were removed at mean bone loss of 57.7% in the maxilla and 73.7% in the mandible irrespective of survival time. In fully adjusted mixed-effects models, only age at implantation (B = -0.19; 95% CI: -0.27, -0.10) remained a significant factor for survival time. Implants exhibited significantly more relative bone loss if they were positioned in the mandible (B = 17.3; 95% CI: 3.91, 30.72) or if they were shorter (B = -2.79; 95% CI: -5.50, -0.08).

Conclusions: Though the mean bone loss (66.2%) at which implants were explanted was in accordance with the literature, its wide variation and differentiation between jaws showed that the profession has no universally accepted threshold beyond which an implant cannot be preserved.
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http://dx.doi.org/10.1111/clr.13747DOI Listing
March 2021

Enzymatic biofilm destabilisation to support mechanical cleansing of inserted dental implant surfaces: an in-vitro pilot study.

Odontology 2021 Mar 19. Epub 2021 Mar 19.

Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Dental School, University Medicine, Greifswald Rotgerberstr. 8, 17475, Greifswald, Germany.

Peri-implantitis is caused by microbial contamination and biofilm formation on the implant surface. To achieve re-osseointegration, the microbes must be completely removed from the surface. Adjunctive to mechanical cleaning, chemical treatment with enzymes or other substances could optimise the treatment outcome. Therefore, we investigated the efficacy of different enzymes, a surfactant, and a chelator in destabilising dental polymicrobial biofilm. The biofilm destabilising effect of the glycosidases α-amylase, dextranase, DispersinB, and lysozyme, as well as the proteinase subtilisin A, and the nuclease Benzonase, the chelator EDTA, and the surfactant cocamidopropyl betaine were investigated on biofilms, inoculated with plaque on rough titanium discs. The test and the control solutions were incubated for 15 min at 36 °C on biofilms, and loosened biofilm mass was removed by shear stress with a shaker. Fluorescence-stained biofilms were microscopically analysed. Acceptable cell tolerability concentrations of test substances were determined by the MTT (tetrazolium dye) assay on the MG-63 cell line. A statistically significant biofilm destabilising effect of 10% was shown with lysozyme (2500 µg/ml).
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http://dx.doi.org/10.1007/s10266-021-00599-zDOI Listing
March 2021

Is Continuous Eruption Related to Periodontal Changes? A 16-Year Follow-up.

J Dent Res 2021 Mar 3:22034521999363. Epub 2021 Mar 3.

Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, University Medicine Greifswald, Greifswald, Germany.

The aims of this study were to 1) determine if continuous eruption occurs in the maxillary teeth, 2) assess the magnitude of the continuous eruption, and 3) evaluate the effects of continuous eruption on the different periodontal parameters by using data from the population-based cohort of the Study of Health in Pomerania (SHIP). The jaw casts of 140 participants from the baseline (SHIP-0) and 16-y follow-up (SHIP-3) were digitized as 3-dimensional models. Robust reference points were set to match the tooth eruption stage at SHIP-0 and SHIP-3. Reference points were set on the occlusal surface of the contralateral premolar and molar teeth, the palatal fossa of an incisor, and the rugae of the hard palate. Reference points were combined to represent 3 virtual occlusal planes. Continuous eruption was measured as the mean height difference between the 3 planes and rugae fix points at SHIP-0 and SHIP-3. Probing depth, clinical attachment levels, gingiva above the cementoenamel junction (gingival height), and number of missing teeth were clinically assessed in the maxilla. Changes in periodontal variables were regressed onto changes in continuous eruption after adjustment for age, sex, number of filled teeth, and education or tooth wear. Continuous tooth eruption >1 mm over the 16 y was found in 4 of 140 adults and averaged to 0.33 mm, equaling 0.021 mm/y. In the total sample, an increase in continuous eruption was significantly associated with decreases in mean gingival height ( = -0.34; 95% CI, -0.65 to -0.03). In a subsample of participants without tooth loss, continuous eruption was negatively associated with PD. This study confirmed that continuous eruption is clearly detectable and may contribute to lower gingival heights in the maxilla.
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http://dx.doi.org/10.1177/0022034521999363DOI Listing
March 2021

Towards establishing no observed adverse effect levels (NOAEL) for different sources of dietary phosphorus in feline adult diets: results from a 7-month feeding study.

Br J Nutr 2021 Feb 8:1-16. Epub 2021 Feb 8.

Waltham Petcare Science Institute, Melton Mowbray, LeicestershireLE14 4RT, UK.

High dietary phosphorus (P), particularly soluble salts, may contribute to chronic kidney disease development in cats. The aim of the present study was to assess the safety of P supplied at 1 g/1000 kcal (4184kJ) from a highly soluble P salt in P-rich dry format feline diets. Seventy-five healthy adult cats (n 25/group) were fed either a low P control (1·4 g/1000 kcal [4184kJ]; Ca:P ratio 0·97) or one of two test diets with 4 g/1000 kcal (4184 kJ); Ca:P 1·04 or 5 g/1000 kcal (4184kJ); Ca:P 1·27, both incorporating 1 g/1000 kcal (4184 kJ) sodium tripolyphosphate (STPP) - for a period of 30 weeks in a randomised parallel-group study. Health markers in blood and urine, glomerular filtration rate, renal ultrasound and bone density were assessed at baseline and at regular time points. At the end of the test period, responses following transition to a commercial diet (total P - 2·34 g/1000 kcal [4184kJ], Ca:P 1·3) for a 4-week washout period were also assessed. No adverse effects on general, kidney or bone (skeletal) function and health were observed. P and Ca balance, some serum biochemistry parameters and regulatory hormones were increased in cats fed test diets from week 2 onwards (P ≤ 0·05). Data from the washout period suggest that increased serum creatinine and urea values observed in the two test diet groups were influenced by dietary differences during the test period, and not indicative of changes in renal function. The present data suggest no observed adverse effect level for feline diets containing 1 g P/1000 kcal (4184 kJ) from STPP and total P level of up to 5 g/1000 kcal (4184 kJ) when fed for 30 weeks.
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http://dx.doi.org/10.1017/S0007114521000477DOI Listing
February 2021

Identifying Data Sharing and Reuse with Scholix: Potentials and Limitations.

Patterns (N Y) 2020 Apr 10;1(1):100007. Epub 2020 Apr 10.

Statistical Cybermetrics Research Group, University of Wolverhampton, Wolverhampton WV1 1LY, UK.

The Scholexplorer API, based on the Scholix (Scholarly Link eXchange) framework, aims to identify links between articles and supporting data. This quantitative case study demonstrates that the API vastly expanded the number of datasets previously known to be affiliated with University of Bath outputs, allowing improved monitoring of compliance with funder mandates by identifying peer-reviewed articles linked to at least one unique dataset. Availability of author names for research outputs increased from 2.4% to 89.2%, which enabled identification of ten articles reusing non-Bath-affiliated datasets published in external repositories in the first phase, giving valuable evidence of data reuse and impact for data producers. Of these, only three were formally cited in the references. Further enhancement of the Scholix schema and enrichment of Scholexplorer metadata using controlled vocabularies would be beneficial. The adoption of standardized data citations by journals will be critical to creating links in a more systematic manner.
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http://dx.doi.org/10.1016/j.patter.2020.100007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660440PMC
April 2020

Effects of cold atmospheric pressure plasma and disinfecting agents on Candida albicans in root canals of extracted human teeth.

J Biophotonics 2020 12 30;13(12):e202000221. Epub 2020 Sep 30.

Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Greifswald, Germany.

Reinfection in endodontically treated teeth is linked to the complexity of the root canal system, which is problematic to reach with conventional disinfection methods. As plasma is expected to have the ability to sanitize narrow areas, the aim of this study was to analyze the effect of cold atmospheric pressure plasma (CAP) on Candida albicans in root canals of extracted human teeth. CAP was applied as mono treatment and in combination with standard endodontic disinfectants (sodium hypochlorite, chlorhexidine and octenidine). Disinfection efficiency was evaluated as reduction of the logarithm of colony forming units per milliliter (log CFU/mL) supported by scanning electron microscopy as imaging technique. Plasma alone showed the highest reduction of log CFU, suggesting the best disinfection properties of all tested agents.
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http://dx.doi.org/10.1002/jbio.202000221DOI Listing
December 2020

Competing interplay between systemic and periodontal inflammation: obesity overrides the impact of oral periphery.

Clin Oral Investig 2021 Apr 22;25(4):2045-2053. Epub 2020 Aug 22.

Dental Clinics, Department of Periodontology, School of Dentistry, University Medicine Greifswald, Fleischmann-Strasse 42, D-17475, Greifswald, Germany.

Objectives: We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation.

Methods: From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes).

Results: The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations.

Conclusion: Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity.

Clinical Relevance: Keeping systemic inflammation low in order to prevent age-related disease sequelae.
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http://dx.doi.org/10.1007/s00784-020-03514-yDOI Listing
April 2021

Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany.

PLoS One 2019 22;14(11):e0225444. Epub 2019 Nov 22.

Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany.

Objectives: It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample.

Materials And Methods: Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex.

Results: Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028-1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913-0.996 and RR: 0.943; 95% confidence interval 0.894-0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed.

Conclusion: Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225444PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874347PMC
March 2020

Diabetes status affects long-term changes in coronal caries - The SHIP Study.

Sci Rep 2019 10 30;9(1):15685. Epub 2019 Oct 30.

Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.
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http://dx.doi.org/10.1038/s41598-019-51086-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821733PMC
October 2019

Construction of a Biological Age Score to Predict Tooth Loss over 10 Years.

J Dent Res 2019 09 29;98(10):1096-1102. Epub 2019 Jun 29.

1 Dental Clinics, Department of Periodontology, University Medicine Greifswald, Greifswald, Germany.

The aim of the present study was to construct a biological age score reflecting one's physiologic capability and aging condition with respect to tooth loss over 10 y. From the follow-up to the population-based Study of Health in Pomerania (i.e., SHIP-2), 2,049 participants were studied for their baseline biomarker measures 10 y before (i.e., in SHIP-0). Metabolic and periodontal data were regressed onto chronological age to construct a score designated as "biological age." For either sex separately, the impact of this individualized score was used to predict tooth loss in the follow-up cohort in comparison with each participant's chronological age. Outcome data after 10 y with respect to tooth loss, periodontitis, obesity, and inflammation were shown to be better for biologically younger subjects than as expected by their chronological age, whereas for the older subjects, data were worse. Especially for tooth loss, a striking increase was observed in subjects whose biological age at baseline appeared to be higher than their chronological age. Biological age produced significantly better tooth loss predictions than chronological age ( < 0.001). Areas under receiver operating characteristic curves for tooth loss of ≥3 teeth in men during follow-up were 0.811 and 0.745 for biological and chronological age, respectively. For women, these figures were 0.788 and 0.724. For total tooth loss, areas under the curve were 0.890 and 0.749 in men and 0.872 and 0.752 in women. Biological age combines various measures into a single score and allows identifying individuals at increased risk of tooth loss.
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http://dx.doi.org/10.1177/0022034519861037DOI Listing
September 2019

Long-term impact of powered toothbrush on oral health: 11-year cohort study.

J Clin Periodontol 2019 07 22;46(7):713-722. Epub 2019 May 22.

Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

Aims: This study aimed to assess 11-year longitudinal effects of powered toothbrush on periodontal health, caries and tooth loss in an adult population.

Materials And Methods: Participants of Study of Health in Pomerania (SHIP) cohort with dental examinations and interview data at SHIP-1, SHIP-2 or SHIP-3 examinations were included. Mixed-effects linear regression models were constructed between the exposure (manual versus powered toothbrush) and outcome variables (periodontal status using mean probing depth (PD) and mean clinical attachment loss (CAL), caries status using DMFS and DFS scores, and tooth loss), adjusting for potential baseline covariates.

Results: Final baseline (SHIP-1) study sample comprised of 2,819 participants. Powered toothbrush users increased from 18.3% (SHIP-1) to 36.9% (SHIP-3); were younger; had significantly less mean PD [β: -0.09 (95% CI: -0.16; -0.02)] and mean CAL [β: -0.19 (95% CI: -0.32; -0.07)] progressions; and had 17.7% less DMFS progression and 19.5% more teeth retained than the manual toothbrushers.

Conclusions: In the long-term, powered toothbrush seems to be effective in reducing mean PD and mean CAL progressions, besides increasing the number of teeth retained.
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http://dx.doi.org/10.1111/jcpe.13126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619286PMC
July 2019

The Saliva Metabolome in Association to Oral Health Status.

J Dent Res 2019 06 26;98(6):642-651. Epub 2019 Apr 26.

8 Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.

Periodontitis is one of the most prevalent oral diseases worldwide and is caused by multifactorial interactions between host and oral bacteria. Altered cellular metabolism of host and microbes releases a number of intermediary end products known as metabolites. There is an increasing interest in identifying metabolites from oral fluids such as saliva to widen the understanding of the complex pathogenesis of periodontitis. It is believed that some metabolites might serve as indicators toward early detection and screening of periodontitis and perhaps even for monitoring its prognosis in the future. Because contemporary periodontal screening methods are deficient, there is an urgent need for novel approaches in periodontal screening procedures. To this end, we associated oral parameters (clinical attachment level, periodontal probing depth, supragingival plaque, supragingival calculus, number of missing teeth, and removable denture) with a large set of salivary metabolites ( n = 284) obtained by mass spectrometry among a subsample ( n = 909) of nondiabetic participants from the Study of Health in Pomerania (SHIP-Trend-0). Linear regression analyses were performed in age-stratified groups and adjusted for potential confounders. A multifaceted image of associated metabolites ( n = 107) was revealed with considerable differences according to age groups. In the young (20 to 39 y) and middle-aged (40 to 59 y) groups, metabolites were predominantly associated with periodontal variables, whereas among the older subjects (≥60 y), tooth loss was strongly associated with metabolite levels. Metabolites associated with periodontal variables were clearly linked to tissue destruction, host defense mechanisms, and bacterial metabolism. Across all age groups, the bacterial metabolite phenylacetate was significantly associated with periodontal variables. Our results revealed alterations of the salivary metabolome in association with age and oral health status. Among our comprehensive panel of metabolites, periodontitis was significantly associated with the bacterial metabolite phenylacetate, a promising substance for further biomarker research.
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http://dx.doi.org/10.1177/0022034519842853DOI Listing
June 2019

Long-term Association of Periodontitis With Decreased Kidney Function.

Am J Kidney Dis 2019 04 29;73(4):513-524. Epub 2019 Jan 29.

Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany. Electronic address:

Rationale & Objective: Previous studies have yielded inconclusive findings regarding the relationship between periodontitis and kidney function. We sought to investigate whether periodontitis is associated with subsequent decreases in kidney function (reductions in estimated glomerular filtration rate [eGFR] and increased urinary albumin-creatinine ratio [UACR]) in the general population.

Study Design: Population-based cohort study.

Setting & Participants: We used baseline and 11-year follow-up data from 2,297 and 1,512 adult participants, respectively, in the Study of Health in Pomerania (SHIP). Age range was limited to 20 to 59 years to avoid the potential influence of tooth loss.

Exposures: Periodontal status defined by periodontal pocket probing depth (PPD) and clinical attachment level. Mean levels and the percentage of sites ≥ 3mm was determined for either all sites (PPD) or interproximal sites (clinical attachment level). All PPDs≥4mm were summed to calculate the total PPD.

Outcomes: GFR estimated from serum creatinine and serum cystatin C (eGFR). Moderately increased albuminuria defined as UACR>30mg/g.

Analytical Approach: Adjusted linear and logistic mixed regression models.

Results: At baseline and follow-up, average eGFR was 118.3 and 105.0mL/min/1.73m, respectively. Using mixed models, no consistently significant associations between periodontitis variables and eGFR were detected. Long-term changes in UACR were inconsistently associated with periodontitis measures. After imputation of missing data, associations were either attenuated or no longer detectable.

Limitations: Because periodontal assessments were performed using a partial recording protocol, periodontal disease severity estimates might have been underestimated, resulting in attenuated effect estimates.

Conclusions: We found no consistent evidence for an association between periodontitis and decreased kidney function. In contrast to previous studies, these results do not support the hypothesis that periodontitis is an important risk factor for chronic kidney disease.
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http://dx.doi.org/10.1053/j.ajkd.2018.10.013DOI Listing
April 2019

Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge.

Periodontol 2000 2018 10;78(1):59-97

Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

This report provides a comprehensive overview of the adverse effects of hyperglycemia on the periodontium. It combines data from literature reviews of original data from two large, population-based epidemiologic studies with comprehensive periodontal health assessment. Emphasis is placed on the exploration of hitherto sparsely reported effects of prediabetes and poorly controlled (uncontrolled) diabetes, in contrast to the umbrella term "diabetes." This stems from the realization that it is not simply having a diagnosis of diabetes that may adversely affect periodontal health. Rather, it is the level (severity) of hyperglycemia that is the determining factor, not the case definition of the diagnosis of diabetes or the type of diabetes in question. Importantly, based on existing evidence this paper also attempts to estimate the improvements in periodontal probing depth and clinical attachment level that can be expected upon successful nonsurgical periodontal treatment in people with chronic periodontitis, with and without diabetes, respectively. This exploration includes the implentation of new systematic reviews and meta-analyses that allow comparison of such intervention outcomes between hyperglycemic and normoglycemic subjects. Based on both existing literature and original analyses of population-based studies, we try to answer questions such as: Is there a glycated hemoglobin concentration threshold for periodontitis risk? Does short-term periodontal probing depth reduction and clinical attachment level gain after scaling and root planing depend on glycemic control in type 2 diabetes? Are short-term scaling and root planing outcomes in people with hyperglycemia/diabetes inferior to those in people without diabetes? Do periodontitis patients with diabetes benefit more from the use of adjuvant antibiotics with nonsurgical periodontal treatment than people without diabetes? Does hyperglycemia lead to greater tooth loss in patients in long-term post-periodontal treatment maintenance programs? Throughout this review, we compare our new findings with previous data and report whether the results of these new analyses corroborate, or are in discord with, similar scientific reports in the literature. We also explore the potential role of dental health-care professionals in helping patients control the risk factors that are identical for periodontitis and diabetes. Finally, we suggest various topics that still need exploration in future research.
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http://dx.doi.org/10.1111/prd.12235DOI Listing
October 2018

Applicability of Computerized Planimetric Method in Estimating Plaque Accumulation and Efficacy of a Cleaning Method for Removable Dental Prostheses.

Int J Prosthodont 2018 Mar/Apr;31(2):152–157. Epub 2018 Feb 15.

Purpose: To demonstrate how data collected using the computerized planimetric method (CPM) can be analyzed by providing an example in which the amount of plaque accumulation and the efficacy of the rotating needles device (RND) in cleaning specific parts of partial removable dental prostheses (PRDPs) were estimated.

Materials And Methods: Thirty-four participants wearing a total of 41 double-crown-retained PRDPs with veneered secondary crowns were included in this study. The PRDPs underwent the following steps: preparing the PRDP for photography, photography of the PRDP, cleaning the PRDP with the RND, and re-photography. One trained examiner used a tested CPM to analyze 98 images (49 before/49 after). Each participant was considered as a statistical unit; thus, if the participant had two PRDPs, one was randomly selected for analysis. Reliability was tested using intraclass correlation coefficients (ICCs), and nonparametric Wilcoxon signed rank test was used for all comparisons.

Results: The intraclass correlation coefficients (images before/after) for both the base and veneer were > 0.9. Wilcoxon signed rank test P value was < .001 for the comparison of plaque accumulation on the base and veneer, estimating the RND's efficacy on both PRDP parts (before/after) and comparing the RND's efficacy on the base and the RND's efficacy on the veneer.

Conclusions: There are different ways to analyze data collected via CPM; thus, it is advisable to provide an explanation for the choice of modeling. Plaque accumulation was significantly greater on the double-crown veneer than on the base. The RND efficacy in cleaning the veneer and the base is significant, but more substantial in cleaning the base.
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http://dx.doi.org/10.11607/ijp.5462DOI Listing
February 2018

Cross-sectional association between oral health and retinal microcirculation.

J Clin Periodontol 2018 04 9;45(4):404-412. Epub 2018 Mar 9.

Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany.

Aim: To investigate the relation between oral health status and microcirculation, we analysed the association between periodontitis and number of teeth with retinal vessel diameters in a population-based study.

Methods: We analysed data from the Study of Health in Pomerania-TREND (SHIP-TREND). All subjects (3,183 for number of teeth, 3,013 for mean probing depth and 2,894 for mean attachment level) underwent nonmydriatic funduscopy and dental examination. We measured central retinal arteriolar (CRAE), venular (CRVE) vessel diameters and calculated arterio-venous ratio (AVR) from static vessel analysis (SVA). Periodontal status was assessed using the case definition of the Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Data were analysed by linear (CRAE, CRVE, AVR) and logistic regression (AVR < 0.8) adjusted for age, sex, smoking status, alcohol consumption, body mass index, systolic blood pressure, hsCRP and type-2-diabetes mellitus.

Results: Only in men, significant associations were found between periodontal and retinal conditions. Severe periodontitis [β = -0.0120 (-0.0218; -0.0007 95%-CI)] and mean probing depth [β = -0.0054 (-0.0105; -0.0002 95%-CI)] were inversely associated with AVR; severe periodontitis [β = 3.80 (0.61; 6.98 95%-CI)], mean probing depth [β = 1.86 (0.23; 3.49 95%-CI)] and mean attachment level [β = 1.31 (0.34; 2.27 95%-CI)] with CRVE and mean attachment level with CRAE [β = 0.91 (0.14; 1.69 95%-CI)].

Conclusions: Our results point towards an association between periodontal conditions and AVR in men. Periodontitis may impact microvascular endothelium function. Improving oral health to reduce periodontitis might lead to reduced risk for other age-related diseases.
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http://dx.doi.org/10.1111/jcpe.12872DOI Listing
April 2018

Does periodontitis affect diabetes incidence and haemoglobin A1c change? An 11-year follow-up study.

Diabetes Metab 2018 Jun 22;44(3):243-249. Epub 2017 Nov 22.

Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr 42, 17475 Greifswald, Germany. Electronic address:

Aim: As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort.

Methods: Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20-81years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c≥6.5% or non-fasting blood glucose levels ≥11.1mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites≥3mm were calculated. In addition, all probing depths≥4mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time.

Results: Over a mean follow-up period of 11.1years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio=0.819, 95% confidence interval (CI): 0.489-1.370; P=0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β=-0.086, 95% CI: -0.187, -0.016; P=0.098). Sensitivity analyses using alternative exposure definitions confirmed these results.

Conclusion: Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change.
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http://dx.doi.org/10.1016/j.diabet.2017.11.003DOI Listing
June 2018

The effect of furcation involvement on tooth loss in a population without regular periodontal therapy.

J Clin Periodontol 2017 Aug 12;44(8):813-821. Epub 2017 Jul 12.

Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.

Aim: We aimed to assess the association between furcation involvement (FI) and tooth loss for subjects not undergoing regular periodontal treatment.

Materials And Methods: Data from 2333 subjects participating in the baseline and 11-year follow-up of the Study of Health in Pomerania (SHIP) were used. All subjects had half-mouth periodontal examinations, including FI in one upper and one lower molar, at baseline. A total of 1897 subjects and 3267 molars were included in the final analysis.

Results: In total, 375 subjects (19.8%) lost molars during the follow-up period. Respectively, 5.6%, 12.7%, 34.0% and 55.6% of molars without FI, degree I FI, degree II FI and degree III FI were lost. Initial probing pocket depth (PPD) and clinical attachment level (CAL) were associated with molar loss (p < .001). Baseline degree I FI was associated with a 1.73 IRR (incidence rate ratio) (95% CI=1.34-2.23, p < .001) of tooth loss while degree II-III was associated with a 3.88 IRR (95% CI=2.94-5.11, p < .001) of tooth loss compared to molars without FI at baseline.

Conclusion: This study provides evidence for an increased risk of molar loss affected by periodontal furcation involvement in a general population not undergoing regular periodontal care.
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http://dx.doi.org/10.1111/jcpe.12756DOI Listing
August 2017

Cross-Sectional Association of Salivary Proteins with Age, Sex, Body Mass Index, Smoking, and Education.

J Proteome Res 2017 06 18;16(6):2273-2281. Epub 2017 May 18.

Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald , Friedrich-Ludwig-Jahn-Str. 15a, 17475 Greifswald, Germany.

Whole saliva is gaining more and more attention as a diagnostic tool to study disease-specific changes in human subjects. Prior to the actual disease-related analyses, it is important to understand the influence of various demographic variables and coupled phenotypes on salivary protein signatures. In a cross-sectional approach, we analyzed the influence of age, sex, body mass index (BMI), smoking, and education on salivary protein signatures in whole saliva samples of 187 individuals. Subjects were randomly selected from the population-based Study of Health in Pomerania (SHIP-Trend). Stimulated whole saliva was collected, and proteins were precipitated and proteolytically digested. Samples were analyzed by label-free tandem mass spectrometry. Of the 602 human proteins identified in at least 40% of the saliva samples, we used 304 proteins, which could be identified with at least two unique peptides, for statistical analyses. Univariate and multivariate linear models were used to reveal associations with the phenotypes. The largest number of proteins was associated with smoking status. Moreover, age had a distinct influence on the salivary protein composition. The study discloses the influence of common phenotypes on the salivary protein pattern of human subjects. These results should be considered when studying disease-related proteome signatures in saliva.
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http://dx.doi.org/10.1021/acs.jproteome.7b00133DOI Listing
June 2017

Mortality is associated with inflammation, anemia, specific diseases and treatments, and molecular markers.

PLoS One 2017 19;12(4):e0175909. Epub 2017 Apr 19.

Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center, Rostock, Germany.

Lifespan is a complex trait, and longitudinal data for humans are naturally scarce. We report the results of Cox regression and Pearson correlation analyses using data of the Study of Health in Pomerania (SHIP), with mortality data of 1518 participants (113 of which died), over a time span of more than 10 years. We found that in the Cox regression model based on the Bayesian information criterion, apart from chronological age of the participant, six baseline variables were considerably associated with higher mortality rates: smoking, mean attachment loss (i.e. loss of tooth supporting tissue), fibrinogen concentration, albumin/creatinine ratio, treated gastritis, and medication during the last 7 days. Except for smoking, the causative contribution of these variables to mortality was deemed inconclusive. In turn, four variables were found to be associated with decreased mortality rates: treatment of benign prostatic hypertrophy, treatment of dyslipidemia, IGF-1 and being female. Here, being female was an undisputed causative variable, the causal role of IFG-1 was deemed inconclusive, and the treatment effects were deemed protective to the degree that treated subjects feature better survival than respective controls. Using Cox modeling based on the Akaike information criterion, diabetes, mean corpuscular hemoglobin concentration, red blood cell count and serum calcium were also associated with mortality. The latter two, together with albumin and fibrinogen, aligned with an"integrated albunemia" model of aging proposed recently.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175909PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397036PMC
April 2017

Osteoblast growth, after cleaning of biofilm-covered titanium discs with air-polishing and cold plasma.

J Clin Periodontol 2017 Jun 16;44(6):672-680. Epub 2017 May 16.

Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, Dental School, University Medicine Greifswald, Greifswald, Germany.

Aim: To investigate the effects of a combined biofilm removal with an optimized air polishing and a cold plasma device on cells in vitro.

Materials And Methods: A 7-day-old biofilm was removed from rough titanium discs with an air-polishing device with erythritol powder (AP) or with a cold atmospheric pressure argon plasma (CAP) device or in combination of both (AP + CAP). The removal efficacy was evaluated by subsequent cell seeding of osteoblast-like cells (MG-63). The cell spreading was analysed after 5 days of incubation by scanning electron microscopy. Separately, the surface hydrophilicity was analysed by measuring the water contact angle (WCA) of the disc for each treatment method.

Results: The mechanical plaque removal with AP rendered specimen conducive for cell growth, 85% of the surface was covered with cells. An advantage of the combination of AP + CAP was not detectable compared to AP (cell coverage ranged from 57% up to 75%). After sole CAP treatment, microorganisms re-grew and destroyed all cells. The WCA was reduced by all treatment methods.

Conclusion: An AP treatment has the potential to remove biofilm from rough implant surfaces completely. In contrast to our hypothesis, the combination of plasma and AP treatment did not enhance osteoblast spreading.
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http://dx.doi.org/10.1111/jcpe.12720DOI Listing
June 2017

Estimating effects of craniofacial morphology on gingival recession and clinical attachment loss.

J Clin Periodontol 2017 Apr 18;44(4):363-371. Epub 2017 Feb 18.

Department of Prosthodontics, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany.

Objectives: Evidence on possible associations between facial morphology, attachment loss and gingival recession is lacking. We analysed whether the facial type, which can be described by the ratio of facial width and length (facial index), is related to periodontal loss of attachment, hypothesizing that a broad face might be associated with less gingival recession (GR) and less clinical attachment loss (CAL) than a long face.

Materials And Methods: Data from the 11-year follow-up of the population-based Study of Health in Pomerania were used. Periodontal loss of attachment was assessed by GR and CAL. Linear regression models, adjusted for age and gender, were used to assess associations between specific landmark based distances extracted from magnetic resonance imaging head scans and clinically assessed GR or CAL (N = 556).

Results: Analysing all teeth, a higher maximum cranial width was associated with a lower mean GR (B = -0.016, 95% CI: -0.030; -0.003, p = 0.02) and a lower mean CAL (B = -0.023, 95% CI: -0.040; -0.005, p = 0.01). Moreover, a long narrow face was significantly associated with increased mean GR and CAL (facial index, P for trend = 0.02 and p = 0.01, respectively). Observed associations were more pronounced for incisors and canines than for premolars and molars.

Conclusion: This study revealed craniofacial morphology, specifically the cranial width and the facial index, as a putative risk factor for periodontal loss of attachment.
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http://dx.doi.org/10.1111/jcpe.12661DOI Listing
April 2017

Magnesium/Calcium Ratio in Serum Predicts Periodontitis and Tooth Loss in a 5-Year Follow-up.

JDR Clin Trans Res 2016 Oct;1(3):266-274

1 Dental Clinics, Unit of Periodontology, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.

In the cross-sectional Study of Health in Pomerania (SHIP-0), subjects with an adequate magnesium supply had a lower risk of periodontal disease and more teeth than those with low magnesium levels. The authors analyzed 5-y follow-up data (SHIP-1) to determine whether the baseline magnesium levels had a long-term effect on attachment level and number of teeth lost. Of the participants examined dentally in the baseline study, 3,300 (75%) were examined for progression or recession of periodontal attachment level after 5 y. For 2,432 subjects, the authors related the outcome variables of periodontal attachment level and tooth loss to baseline characteristics, especially serum magnesium and calcium concentrations, as well as systemic markers of inflammation. The progression of periodontitis was associated with the magnesium/calcium (Mg/Ca) ratio at baseline in a dose-dependent manner. Progression of mean attachment loss was prevented in the upper quartile of the Mg/Ca ratio ( P < 0.001) with antagonistic effects of magnesium and calcium irrespective of inflammatory state. With respect to tooth loss, Mg/Ca exerted dimorphic effects. In inflammatory states as indicated by high C-reactive protein (>3 mg/L), tooth loss was prevented in subjects with high Mg/Ca ratio (incidence rate ratio = 0.60, 95% confidence interval: 0.45 to 0.80, P = 0.001), but the contrary was observed in subjects with low C-reactive protein levels (incidence rate ratio = 1.14, 95% confidence interval: 0.97 to 1.34, NS). Similar results were observed with stratifying the regression on tooth loss by interleukin 6 or fibrinogen threshold. An adequate magnesium serum level and Mg/Ca balance may prevent progression of attachment level and tooth loss, especially in inflammatory states. Knowledge Transfer Statement: The results of this study present evidence that an adequate magnesium supply may be important in the prevention of periodontal diseases and future tooth loss. A diet high in magnesium could improve periodontal health, notwithstanding its beneficial effects on systemic disease. In populations with a high prevalence of hypomagnesemia, additional intake of supplements is advisable.
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http://dx.doi.org/10.1177/2380084416663458DOI Listing
October 2016

Association of Periodontal Destruction and Diabetes with Mortality.

J Dent Res 2017 Jan 1;96(1):56-63. Epub 2016 Oct 1.

1 Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

Current evidence indicates the effects of periodontitis on diabetes as well as mortality, for which diabetes itself represents a risk factor. However, the possible interaction of these 2 chronic conditions regarding mortality has not yet been investigated. Therefore, the purpose of this study was to evaluate whether periodontal destruction interacts with diabetes on all-cause and cardiovascular disease (CVD) mortality or if diabetes serves as a mediator in this association. The study sample comprised 3,327 participants aged 20 to 81 y from the Study of Health in Pomerania. Periodontal destruction was assessed via clinical attachment level (CAL) and the number of missing teeth. Information on mortality (date and ICD-10 code) was ascertained from death certificates. Directed acyclic graphs were used to identify potential confounders, and Cox proportional hazard models were applied. In 36,701 person-years of follow-up, 263 study participants deceased, 89 due to CVD. Fully adjusted main effect models resulted in hazard ratios of 1.01 (95% confidence interval [95% CI]: 1.002 to 1.01) for extent of CAL ≥3 mm, 1.10 (95% CI: 1.03 to 1.18) for mean CAL, and 1.03 (95% CI: 1.01 to 1.04) for the number of missing teeth regarding all-cause mortality. Analogous results were obtained for CVD mortality, with hazard ratios of 1.01 (95% CI: 0.99 to 1.02), 1.10 (95% CI: 0.98 to 1.23), and 1.02 (95% CI: 0.99 to 1.05) for extent of CAL, mean CAL, and the number of missing teeth, respectively. Findings did not indicate additive interaction of periodontal destruction and diabetes regarding all-cause and CVD mortality. Similarly, no substantial evidence was found to demonstrate the presence of multiplicative interaction or mediation. Besides adjustment for baseline covariates, time-varying covariates were also considered and led to comparable results. In summary, despite their reciprocal relationship, periodontal destruction and diabetes may be independent risk factors for all-cause and CVD mortality.
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http://dx.doi.org/10.1177/0022034516668839DOI Listing
January 2017

"Who's been a good dog?" - Owner perceptions and motivations for treat giving.

Prev Vet Med 2016 Sep 12;132:14-19. Epub 2016 Aug 12.

Centre for Applied Bioethics, School of Biosciences and School of Veterinary Medicine and Science, University of Nottingham, Loughborough, Leicestershire, LE12 5RD, UK.

Complex relationships commonly exist between owners and their companion animals, particularly around feeding behaviour with an owner's affection or love for their animal most pronounced through the provision of food. It is notable that the pet food market is experiencing strong year-on-year growth in sales of dog and cat treats. Recognising the impact of treat giving in pet nutrition, the objective of the study was to investigate owner attitudes and motivations towards feeding treats (shop bought and other) to their dogs. A researcher-mediated questionnaire consisting of both quantitative and qualitative questions was used to interview dog owners (n=280) at two locations: an out-of-town retail park and a country park in the East Midlands. Owners almost unanimously viewed the word 'treat' within a nutritional context, as opposed to a new toy or other pleasure. The majority (96%) of owners interviewed reported feeding treats to their dog, with 69% feeding shop-bought treats on a daily basis. A wide range of treats was reportedly given by owners and the majority of owners interviewed fed multiple treat types. No association was found between owner age and frequency of shop-bought treats fed (P=0.659) nor between owner age and frequency of food given to the dog from the owner's plate (P=0.083). A wide range of foods which would not be considered balanced for the animal's nutritional requirements was viewed as a treat by some dog owners. A range of positive and negative views around the feeding of treats were expressed by dog owners, with some citing beneficial effects while others were clearly aware of the association between treat feeding and potential weight gain/obesity. Owner views included themes around positive reinforcement and responsibility but also reflected relational aspects of the human-animal bond. The results of the study show that treat giving is commonplace in feeding regimes and that treats are embedded in the feeding behaviour of many dog owners. However, the different views expressed around the motivations for, and feeding of, dog treats, reinforce the need to better understand owner psychology linked to this area, and the role this may play in the growing pet obesity epidemic.
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http://dx.doi.org/10.1016/j.prevetmed.2016.08.002DOI Listing
September 2016

Reduced Bone Stiffness in Women Is Associated with Clinical Attachment and Tooth Loss: The Study of Health in Pomerania.

J Dent Res 2016 Dec 21;95(13):1464-1471. Epub 2016 Sep 21.

Department of Study of Health in Pomerania / Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.

The authors evaluated the association of reduced bone stiffness of the calcaneus with clinical attachment loss (CAL) and tooth loss. The authors analyzed data from 4,678 subjects (2,384 women), aged 20 to 88 y, from the second follow-up of the population-based Study of Health in Pomerania (SHIP-2) and the baseline examination of the SHIP-Trend cohort. Bone stiffness, characterized by the stiffness index (SI) and the osteoporotic fracture risk (OFR), was assessed by quantitative ultrasound of the heel. SI and OFR were significantly associated with the mean CAL in women. While 1) the SI showed a significant association with the mean CAL and 2) the OFR with the median number of teeth in just the postmenopausal women, the OFR showed a significant association with mean CAL for both pre- and postmenopausal women. In postmenopausal women, a 10-unit increase in the SI was associated with a decrease in the mean CAL of 0.05 mm (95% confidence interval [CI]: -0.10 to 0.00; P = 0.046). Moreover, the adjusted median number of teeth was 21.4 (95% CI: 20.9 to 21.9) among the postmenopausal women with a low OFR, while it was 19.1 (95% CI: 17.8 to 20.3; P = 0.001) among the postmenopausal women with a high OFR. For the premenopausal women with a low OFR, the mean CAL was 1.60 mm (95% CI: 1.53 to 1.66), while for the premenopausal women with a high OFR, it was 2.24 mm (95% CI: 1.78 to 2.69; P = 0.006). Reduced bone stiffness was associated with clinical attachment and tooth loss in women but not in men.
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http://dx.doi.org/10.1177/0022034516666491DOI Listing
December 2016

Cross-sectional association between physical strength, obesity, periodontitis and number of teeth in a general population.

J Clin Periodontol 2016 05 6;43(5):401-7. Epub 2016 Apr 6.

Department of Periodontology, University Medicine Greifswald, School of Dentistry, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.

Aim: Muscle strength declines and gums recede with increasing age across the life course. Possible associations exist between handgrip strength as an indicator of physical fitness and periodontitis and number of teeth.

Material And Methods: Handgrip strength (GS), anthropometric measures, clinical attachment loss, number of teeth, C-reactive protein and glycated haemoglobin were assessed in 2089 participants of the Study of Health in Pomerania (SHIP-2). Linear regression including interaction with age was used to estimate the association between clinical attachment level, number of teeth and GS.

Results: In multiple regression adjusted for age, body mass index (BMI) and waist-to-hip ratio (WHR) each mm of diminished periodontal attachment was associated with reduction in GS by 1.47 kg (95% CI -2.29 to -0.65) and 0.38 kg (-0.89 to 0.14) in men and women respectively. Correspondingly, each additional remaining tooth was significantly associated with higher GS. Using handgrip strength relative to BMI as outcome, these relationships become even more apparent. Indicators of obesity such as BMI and WHR associated with both GS and periodontitis modulate the relationship between GS and periodontitis with a different impact between the sexes.

Conclusion: Periodontitis is associated with GS modified mainly by anthropometric measures related to adiposity and inflammation. Putative mechanisms encompass interactions of factors declining with increasing age.
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http://dx.doi.org/10.1111/jcpe.12531DOI Listing
May 2016

Longitudinal effects of systemic inflammation markers on periodontitis.

J Clin Periodontol 2015 Nov 14;42(11):988-97. Epub 2015 Nov 14.

Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.

Aim: Systemic low-grade inflammation represents a central hallmark of chronic diseases and has been proposed as the underlying mechanism linking factors like obesity or diabetes with periodontitis. However, the impact of inflammatory markers on periodontitis has not yet been investigated.

Materials And Methods: The study population comprised 1784 subjects from the Study of Health in Pomerania with complete 11-year follow-up. Fibrinogen and white blood cell (WBC) counts were measured as markers of inflammation. Periodontitis was assessed by probing depth (PD), clinical attachment loss (CAL) and the CDC/AAP case definition.

Results: Multilevel regression analyses revealed significant coefficients for the impact of both inflammation markers on the percentage of sites with PD/CAL ≥ 3 mm. Increases in fibrinogen about 1 g/l were associated with 3.0% and 2.7% more sites with PD/CAL ≥ 3 mm respectively. Consistent associations were found using mean values of PD/CAL but not using missing teeth or caries. Regarding the CDC/AAP case definition, 11-year changes in fibrinogen and WBC counts were significantly associated with ≥1 category progression (OR: 1.36 and 1.11).

Conclusions: Fibrinogen levels and WBC counts showed consistent long-term associations with PD, CAL and the CDC/AAP case definition. Results indicate that systemic low-grade inflammation might indeed represent one possible pathway for effects of obesity, diabetes or other chronic inflammatory conditions on periodontitis.
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http://dx.doi.org/10.1111/jcpe.12473DOI Listing
November 2015