• Changes in Periodontal Status after Pandemic-Related Interruptions to Care in a Fragile Cohort

      Young, Hannah; Applied Health Sciences Program
      Sanative therapy (ST) can be a highly effective first-line therapy for periodontal disease. However, even after successful ST, patients require life-long periodontal maintenance therapy (PMT) to maintain their periodontal health. As a result of the COVID-19 global pandemic, stay-at-home orders and other public health measures resulted in many patients missing or delaying their regularly scheduled PMT appointments. The primary objective of this study was to determine, at 5 to 10 years post-ST, if patients who delayed their appointments as a result of COVID-19 experienced significant changes in periodontal probing depth (PPD), bleeding on probing (BOP), and plaque index (PI) compared to patients without appointment delays. Additionally, lifestyle factors such as dietary intake, physical activity, and oral hygiene behaviors were hypothesized to have been altered because of the COVID-19 pandemic, and interview questions were used to capture these changes. The study was completed at a private periodontal clinic. Patient medical and dental history data was collected retrospectively from patient charts. Due to challenges with recruitment, a subset of the required sample size was studied with findings providing pilot data for a larger future study. Study participants (n = 12) were asked to complete two different physical activity questionnaires, a 24-hour dietary recall, and a supplement and tea questionnaire online. Furthermore, a short virtual interview was used to ask participants how they felt COVID-19 impacted several lifestyle factors. At 5 to 10 years post-ST, a short delay in PMT appointments of 2 – 6 months did not significantly affect PPD, BOP and PI. Most participants reported changes to physical activity (80%) and diet (80%), but no changes to oral hygiene behaviors (90%). Overall, physical activity, diet, and body mass index data in the study sample closely aligned with findings from larger studies that have assessed these aspects in the Canadian population. This pilot study should be used to design future studies aimed at investigating the relationship between periodontal health and behavioral changes resulting from the COVID-19 pandemic.
    • Flavonoid Intake and Periodontal Healing Outcomes Following Sanative Therapy

      Klok, Stephanie; Applied Health Sciences Program
      Diet has an important role in the maintenance of oral health. Periodontal disease is an inflammatory disease of the soft and hard tissues that support our teeth. Sanative therapy (ST) offers a first-line, cost-effective treatment for periodontal disease. Although ST improved clinical healing outcomes from baseline, it may not completely resolve inflammation associated with periodontal disease. Due to the high flavonoid content in tea and the anti-inflammatory and anti-oxidant properties of flavonoids, it was hypothesized that participants with higher daily intakes of tea and flavonoids would have improved healing outcomes, designated as greater reductions in probing depth (PD) ≥ 4 mm and salivary biomarker concentration levels (C-reactive protein, interleukin 1-beta, and interleukin-6) eight weeks after ST. The relationship between tea consumption or flavonoid intake and clinical outcomes following sanative therapy (ST) has not been investigated. Participants completed the 2014 Block food frequency questionnaire prior to ST and provided saliva samples via passive drool immediately prior to ST and eight weeks following ST. There were no significant associations between flavonoid intake and tea consumption with periodontal outcomes (percentage of PD sites post-ST ≥ 4 mm) or change in salivary biomarker concentrations pre- and post-ST. Although, salivary concentrations of IL-1ß were significantly lower post-ST (p < 0.05). Therefore, our results suggest that among our sample, no relationship exists between tea or flavonoid intake and clinical healing outcomes after ST.
    • Inulin Supplementation to Support Periodontal Health

      Zanatta, Carly; Zanatta, Carly; Applied Health Sciences Program
      Periodontal disease is a chronic state of inflammation that can destroy the supporting tissues around the teeth, leading to the resorption of alveolar bone. The initial strategy for treating periodontal disease is non-surgical sanative therapy (ST). Periodontal disease can also induce dysbiosis in the gut microbiota and contribute to low-grade inflammation. Prebiotic fibres, such as inulin, can selectively alter the intestinal microbiota and support homeostasis by improving gut barrier function, preventing systemic inflammation which may help local inflammation in the periodontal tissues. Providing an inulin supplement may benefit periodontal health while providing insight into the complex relationship between periodontal disease and the gut microbiota. The primary objective is to determine if a daily 10 g dose of inulin for 14 weeks is more effective than the placebo at improving clinical periodontal outcomes including probing depth (PD) and bleeding on probing (BOP). Secondary objectives include determining the effects of inulin supplementation pre and post ST on salivary markers of inflammation and periodontal-associated pathogens, as these outcomes reflect more rapid changes than clinical periodontal outcomes. This thesis has involved the design and registration of a single-center, randomized, double-blind, placebo-controlled study design in which 170 participants who are receiving ST to manage periodontal disease will be randomized to the intervention (inulin) or placebo (maltodextrin) group. The intervention period will begin 4 weeks before ST through to their follow up appointment at 10 weeks post ST. Clinical outcomes of periodontal disease including number of sites with PD ≥ 4 mm and the absence of BOP will be measured at baseline and post ST. Salivary markers of inflammation (interleukin-1beta, interleukin-6, c-reactive protein and matrix metalloproteinase-8), periodontal-associated pathogens (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Aggregatibacter actinomycetemcomitans), body mass index (BMI) and diet assessments will be measured at baseline, pre ST and post ST. Inulin is expected to enhance the positive effect of ST on the management of periodontal disease. The results of the study results will help to provide guidance regarding the use of prebiotics prior to and as a supportive adjunct to ST for periodontal health.