DT South Asia No. 2, 2024

Rise of minimally invasive techniques for soft tissue augmentation – A tale of promise and pitfalls / News / Periodontitis can disrupt gut microbiota by inducing dysbiosis

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The World‘s Dental Newspaper
South Asia Edition
Published in India

www.dental-tribune.com

AI TOOLS

New generative AI tools in dentistry

Vol. 2, No. 2

ORAL HEALTH

PERIODONTITIS

Daily reminders to enhance oral
health: Guest editorial

Periodontitis
can
disrupt
gut
microbiota by inducing dysbiosis

Page 04

Page 06

Page 03

Rise of minimally invasive techniques for
soft tissue augmentation – A tale of promise
and pitfalls
the procedure much less invasive.
These involve the Tunnelling
technique (Allen 1994), Modified
Tunnelling
Technique
(Mahn
2001), VISTA (Zadeh 2011), and The
Pinhole technique (Chao 2012).
The techniques used to harvest
the connective tissue graft have
also evolved towards procedures
that do not involve healing by
secondary intention and minus
vertical incisions. The various
procedures are the trap door
technique with vertical incisions
(Edel 1974), The double incision
technique ( Langer and Calagna,
1982) The envelope technique
(Raetzke, 1985) (Langer and Lager
1985), and the single incision
technique (Hurzler and Weng,
1999). The de-epithelized Free
gingival graft ( Zucchelli et al.,
2003) remains the only modern
technique that has gone against
the flow and involves healing by
secondary intention.
Fig.1 Minimally invasive techniques for soft tissue augmentation in periodontal and implant surgeries are becoming popular. (Image: Bianca Nazareth-Arya)

By Dr Bianca Nazareth-Arya
In the realm of periodontal
soft tissue surgery, a revolutionary
wave is cresting: minimally invasive
surgery. By promising precision
and extraordinary results while
minimising patient discomfort and
post-operative care, it appears to
be the final frontier towards which
every soft tissue surgeon is
headed.

www.dental-tribune.com

Periodontal plastic surgery,
periodontal soft tissue surgery, or
mucogingival surgery as it is
sometimes referred to was
originally the playground of only
accomplished and dedicated
periodontal
surgeons
who
thought beyond pocket depths
and bone loss. However, with the
passing of decades, the spotlight
has shifted to aesthetics in
dentistry, and aesthetics in the
mouth cannot be achieved without
tending the gingiva. The advent
and mainstreaming of dental
implants brought with it another
set of conundrums with regard to
the gingiva and the realization
that implant longevity and health
depended not just on bone but
most often on 1-2 mm of healthy
keratinised soft tissue. This
automatically made soft tissue
surgeries the norm rather than the
exception catapulting it into the
limelight where the focus has now

shifted how to achieve the best
results with minimal trauma.
Over the past decades, we
have traversed through the free
gingival graft technique, the
coronally advanced flap, The
coronally advanced flap in
combination with a connective
tissue graft, the semilunar
technique and the Multiple

coronally advanced flap amongst
others. The coronally advanced
flap combined with a connective
tissue graft still remains the gold
standard for gingival recession
coverage. However, the focus
definitely seems to have shifted to
procedures that do not involve
vertical incisions and separation of
the papilla which in theory make

Fig. 2: Pouch preparation in the
central incisor region.

Fig. 3: De-epithelized free gingival
graft.

Advantages: Minimally invasive techniques for soft tissue augmentation offer several advantages over traditional approaches,
including:
1. Reduced patient discomfort:
Minimally invasive techniques
typically involve smaller and fewer
incisions resulting in less trauma
to the surrounding tissues.

Fig. 4: Tunnel preparation in lower
incisor region.

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Dental Tribune South Asia Edition | 02/2024

2. Faster healing times: With
less tissue disruption, minimally
invasive procedures claim to
promote
quicker
healing
compared to traditional surgical
methods.
3.
Reduced
risk
of
complications: Minimally invasive
techniques minimize the risk of
complications such as excessive
bleeding, infection, and nerve
damage associated with more
invasive procedures. The reduced
trauma to the tissues also lowers
the likelihood of postoperative
swelling and bruising.
4.
Enhanced
aesthetic
outcomes: The lack of vertical
incisions precludes any scar
formations
resulting
in
aesthetically pleasing outcomes.
Disadvantages: The disadvantages must be discussed in as
much detail as the advantages:
1. Steep learning curve: There
is a steeper learning curve with
these techniques as visibility is
limited and the tunnel preparation
requires a great degree of control
and skill.
2. Investment: A specialised
armamentarium is required over

and above the microsurgical
blades and sutures already
mandatory for soft tissue surgeries.
3. Technique sensitive: Most
techniques are quite unforgiving.
The perforation of the flap during
tunneling would lead not only to
an abandonment of the current
procedure
undertaken
but
preclude
reverting
to
a
conventional technique like a
coronally advanced flap as well.
Complications such as tissue
ischemia, flap necrosis, and suture
dehiscence were inherent risks
associated with minimally invasive
procedures.
4. Anatomical variations:
Graft harvesting from the palate
via a single incision technique
requires a depth of tissue upwards
of 3 mm to get an adequate and
good quality connective tissue
graft.
Interestingly some studies
have shown that despite the
minimally invasive nature of
tunneling techniques the pain
perception postoperatively was
higher in the tunneling group+
Sub epithelial connective tissue
graft (SeCTG) in comparison to the
coronally advanced flap combined
with the SeCTG. Chair time was

also significantly higher in the
tunneling group.
Overall, we could conclude
that minimally invasive techniques
for soft tissue augmentation offer
a minimally traumatic, efficient,
and patient-friendly alternative to
traditional surgical methods. Even
the most cooperative and phobiafree patients prefer a comfortable
procedure and hence the quest to
develop a technique that marries
predictability to minimal morbidity
is not without merit however
practicality, reproducibility, and
flexibility must not be sacrificed at
the altar of comfort.
The surgical technique must
be accommodative of a surgeon’s
skill set and learning potential. By
embracing a balanced perspective,
and honing our skills in multiple
techniques we will be better suited
to provide our patients with better
care – thereby maximizing the
benefits of each technique while
minimizing their risks.

2. Puri K, Kumar A, Khatri M,
Bansal M, Rehan M, Siddeshappa
ST. 44-year journey of palatal
connective tissue graft harvest: A
narrative review. J Indian Soc
Periodontol.
2019
SepOct;23(5):395-408. doi: 10.4103/
jisp.jisp_288_18. PMID: 31543611;
PMCID: PMC6737854.
3. Gobbato L, Nart J, Bressan
E, Mazzocco F, Paniz G, Lops D.
Patient morbidity and root
coverage outcomes after the
application of a subepithelial
connective
tissue
graft
in
combination with a coronally
advanced flap or via a tunneling
technique:
a
randomized
controlled clinical trial. Clin Oral
Invest. 2016 Jan 27;1–14.

About

Dr. Bianca Nazareth-Arya, MDS is
the editor of Periodontics section
of Dental Tribune South Asia

References
1. Zucchelli G, Mounssif I.
Periodontal
plastic
surgery.
Periodontology
2000.
2015
Jun;68(1):333-68.

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Dental Tribune South Asia Edition | 02/2024

New generative AI tools in dentistry
By Dr Rewant Chauhan
The healthcare industry is experiencing a transformative shift
from a rigid, one-size-fits-all system to a personalized healthcare
system guided by generative artificial intelligence (GAI).
With GAI, the possibilities for
revolutionizing healthcare are
endless, from dental care to drug
discovery. Moreover, the only GAI
that we are aware of are ChatGPT
(1)
and Google Gemini (2) which are
transforming various industries.
GAI’s capabilities are impressive, this article will discuss the GAI
models available and their true
potential which can be used in
dentistry and healthcare.
1. StyleGAN:
Models like Generative Adversarial Networks (GAN) for treatment planning leverage specific
data and disease progression to
develop individualized treatment
plans, minimizing side effects and
maximizing efficacy. A study conducted at the University of Osaka,
Japan suggests that StyleGAN2 (3)
can generate and reconstruct panoramic radiographs and thus may
be applied to the anonymization
and data compression of medical
images to craft personalized 3D
models of teeth, allowing dentists
to create custom-fit implants,
bridges, and dentures that feel like
an extension of oneself.
GAI’s reach extends beyond
mere aesthetics, as tools like
DeepCare (4) analyze data to predict CBCT Segmentation which is a
laborious task, but with GAI, this
company has achieved CBCT segmentation for treatment planning
in a mere fraction of seconds for
diagnosing potential dental issues, empowering patients to take
proactive measures to prevent future dental issues. Platforms like
Smile Design AI (5) also generate
personalized simulations of potential transformations, enabling
informed decisions before the first
cosmetic touch.
2. CycleGAN:
Data scarcity often obscures
crucial details in medical images,
hindering accurate diagnosis. GAI
steps in as a skilled sculptor with
tools like CycleGAN, (6) which generates synthetic medical images,
providing AI models with abundant training data, leading to more
accurate diagnoses, especially in
areas like cancer detection. GAI’s
Deep Denoising techniques allow
for clearer, noise-free scans, enabling doctors to see finer details
and make informed decisions. CycleGAN for sharper dental diagnostics: There is research that explores the potential of CycleGAN,
a type of deep learning algorithm,
to enhance the resolution of medical images, specifically chest
X-rays. While the study focuses on
lung pathologies,(4) the underlying
principles hold promise for signif-

icant advancements in dental diagnostics.
Here’s how CycleGAN could
transform dentistry:
a. Improved caries detection:
By enhancing the clarity of dental
X-rays, CycleGAN could enable
dentists to identify early-stage
cavities often missed by traditional methods, leading to earlier
intervention and potentially preventing extensive procedures. Enhanced fracture visualization: Subtle fractures, particularly in complex root structures, can be challenging
to
diagnose
on
conventional X-rays. CycleGAN’s
ability to sharpen images could
improve fracture detection, leading to more accurate diagnosis
and treatment planning.
b. Reduced need for repeat
imaging: With sharper images,
dentists might require fewer repeat X-rays for confirmation or to
monitor treatment progress, minimizing radiation exposure for patients. It’s important to note that
this is an early-stage exploration,
and further research is needed to
validate its efficacy in clinical settings. However, the potential benefits of CycleGAN for improved
dental diagnostics and patient
care are undeniable. This technology could pave the way for a future where precise diagnoses and
minimally invasive treatments become the norm in dentistry. Personalized simulations are possible
with GAI, such as realistic 3D models of organs incorporating unique
data, enabling patient-specific
surgical planning and treatment
optimization – a significant leap
forward in personalized medicine.
3. AlphaFold for drug discovery:
Drug discovery is a slow and
arduous process, but GAI provides
a portal to a faster, more efficient
future. Tools like AlphaFold (7) design novel drug candidates with
desired properties, potentially
leading to the development of
life-saving medications in record
time. Models like Transformers analyze complex biological data,
identifying potential drug targets,
and offering new avenues for therapeutic development. Platforms
like drug repurposing with generative models unlock new uses for
existing drugs, optimizing resources and potentially expanding
treatment options. AlphaFold is a
new method for predicting protein
structures with high accuracy even
when no similar structure is known.
This is a breakthrough in protein
science, as knowing a protein’s
structure is crucial for understanding its function and developing
drugs that target it.
AlphaFold in dentistry:
Many dental problems involve
proteins, such as enzymes involved in tooth decay or proteins
forming the building blocks of
teeth and bones. By accurately

Generative AI is transforming healthcare in general, and dentistry in particular. (Image: Canva)

predicting protein structures, AlphaFold could: Lead to the development of new drugs and therapies: For example, designing drugs
that target specific enzymes involved in tooth decay or developing new materials for dental implants based on the structure of
natural bone proteins. Improve diagnosis and treatment planning:
By understanding the structure of
proteins associated with certain
dental diseases, dentists could diagnose them more accurately and
personalize treatment plans. Aid in
regenerative dentistry: By understanding how proteins interact to
form teeth and bones, researchers
could develop new methods for
regenerating damaged tissues.
4. DeepCE:
GAI enables the delivery of
personalized medicine like never
before, with tools like DeepCE (8)
using GAI for personalized genomics and disease risk prediction.
a. Predicting drug action:
DeepCE is an AI tool that uses
a technique called “phenotype-based compound screening”
and predicts how a drug might affect a cell based on its overall characteristics (phenotype) rather than
just its chemical structure. By analyzing gene expression changes,
DeepCE can identify existing drugs
that could be repurposed for new
uses, like treating COVID-19.
b. Drug discovery and repurposing:
DeepCE could be used to find
existing drugs approved for other
conditions that might be effective
against oral diseases like periodontitis, caries, or oral cancer.
This could save time and resources
compared to developing entirely
new drugs.
c. Personalized medicine:
By analyzing individual patient
data, DeepCE could help predict
which existing drugs might be
most effective for their specific
dental needs. Understanding disease mechanisms: DeepCE could
be used to study how different
drugs affect the gene expression
of oral cells, providing insights

into the mechanisms of dental diseases.
5. GAN-medEHR and Clinical
trials:
Clinical trials are stepping
stones to new drugs, but challenges like participant recruitment
and lengthy processes often hinder progress. GAI offers a helping
hand, with tools like GANs for synthetic Electronic Health Records
(9)
(GAN-medEHR)
generating
large-scale anonymized datasets
for clinical trial simulations, potentially reducing the need for real-world participants, and accelerating the development process.
Models like Bayesian Optimization
for clinical trial design identify
promising drug candidates and
optimize trial protocols, leading to
faster and more efficient development of effective therapies.

Conclusion
The future: a balancing act of
innovation and ethics
While GAI holds immense potential to transform healthcare, it
is crucial to tread cautiously, ensuring responsible development
and ethical implementation. Data
privacy, bias, fairness, explainability and interpretability of models,
and robust regulatory frameworks
are crucial aspects that need careful consideration. By addressing
these challenges responsibly, GAI
can become the tool that unlocks
a healthier future for all.
Remember, GAI is not a cureall but a powerful tool that can
revolutionize healthcare. Let us
harness its technology responsibly, ensuring that this leads to a future where everyone has access to
personalized,
effective,
and
life-saving care.

References
1. T. Wu et al., “A Brief Overview
of ChatGPT: The History, Status
Quo and Potential Future Development,” in IEEE/CAA Journal of
Automatica Sinica, vol. 10, no. 5,

pp. 1122-1136, May 2023, doi:
10.1109/JAS.2023.123618.
2. Saeidnia, Hamid Reza.
(2023). Welcome to the Gemini era:
Google DeepMind and the Information Industry. Library Hi Tech
News.
https://doi.org/10.1108/
LHTN-12-2023-0214.
3. Kokomoto, K., Okawa, R.,
Nakano, K., & Nozaki, K. (2021). Intraoral image generation by progressive growing of generative
adversarial network and evaluation of generated image quality by
dentists. Scientific reports, 11(1),
18517.
https://doi.org/10.1038/
s41598-021-98043-3
4. DeepCare Diagnosis System.
Offers second opinion for multimodal dental image analysis. Dental AI 2.0: AI-Collaborative https://
www.deepcare.com/solutions
5. Kurian, N., Sudharson, N. A.,
& Varghese, K. G. (2024). AI-driven
smile designing. British dental
journal, 236(3), 146. https://doi.
org/10.1038/s41415-024-7087-3
6. Liang, Z., Huang, J. X., & Antani, S. (2022). Image Translation
by Ad CycleGAN for COVID-19
X-Ray Images: A New Approach
for Controllable GAN. Sensors
(Basel, Switzerland), 22(24), 9628.
h t t p s : //d o i . o r g / 10 . 3 3 9 0 /
s22249628
7. Jumper, J., Evans, R., Pritzel,
A., Green, T., Et al (2021). Highly accurate protein structure prediction
with AlphaFold. Nature, 596(7873),
583–589. https://doi.org/10.1038/
s41586-021-03819-2
8. Novel ai tool takes a deepce
dive into potential drugs for covid19. Drug Target Review.
9. Baowaly, M. K., Lin, C. C., Liu,
C. L., & Chen, K. T. (2019). Synthesizing electronic health records
using improved generative adversarial networks. Journal of the
American Medical Informatics Association : JAMIA, 26(3), 228–241.
ht tps://doi.org/10.1093/jamia/
ocy142.

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Dental Tribune South Asia Edition | 02/2024

Daily reminders to enhance oral
health: Guest editorial

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User Toothbrushes with oral health-promoting foods imprinted on them can be a great daily reminder in this fast-paced world. (Image: Prakash Vaithyanathan)

By Prakash Vaithyanathan
In today’s fast-paced world,
where stress often leads to forgetting even life’s essential health
practices, simple and recurrent reminders are imperative. To aid
children and their parents in retaining this information throughout their lives, images of oral
health-promoting foods could be
imprinted on toothbrushes, serving as a daily reminder both consciously and subconsciously. Likewise, for individuals managing diabetes, heart conditions, or respiratory ailments, toothbrushes
could feature images of foods that
specifically contribute positively to
their health, offering continual reinforcement. Such a simple mnemonic could greatly benefit the
global population.
The journey to maintaining
optimal dental health encompasses more than just brushing
and flossing. A well-balanced diet
plays a crucial role in nurturing
healthy teeth and gums.
Among the plethora of nutritious foods available, water-rich
fruits and nuts stand out for their
exceptional benefits in promoting
oral hygiene. In this article, we
delve into the advantages of incorporating these natural delights
into one’s diet, particularly for children, and how parents can facilitate better oral health through
smart nutritional choices.
Teaching children proper oral
hygiene practices from a young
age lays the foundation for a lifetime of healthy smiles. Dentists
recommend brushing teeth twice
daily with fluoride toothpaste,

flossing regularly, and scheduling
routine dental check-ups.
Additionally, limiting sugary
snacks and beverages helps prevent tooth decay and gum disease.
Encouraging children to adopt
these habits early on sets the
stage for maintaining optimal oral
health throughout their lives.
Parents play a pivotal role in
shaping their children’s dietary
habits and overall health. By incorporating a variety of water-rich
fruits and nutrient-rich nuts into
their meals and snacks, parents
can provide essential vitamins and
minerals necessary for strong
teeth and gums. Some key components to include in their diet are:
1.

Water-Rich Fruits: Fruits such
as pears and apples are not
only hydrating but also stimulate saliva production, which
helps wash away food particles and neutralize acids in the
mouth. Vitamin-C-rich strawberries contribute to gum
health and strengthen tooth
enamel.
2. Nuts: Nuts, such as almonds
and Brazil nuts, are rich in calcium and phosphorus, minerals crucial for maintaining
strong teeth and bones. Chewing nuts also stimulate saliva
production, promoting a
cleaner mouth environment.
3. Dairy Foods: Cheese, milk, and
yogurt are excellent sources of
calcium and phosphorus, essential nutrients for healthy
teeth and bones. Cheese helps
neutralize acids in the mouth
and
remineralize
tooth
enamel, reducing the risk of
cavities.

4. Cranberries, Kiwis, and Broccoli: These foods are rich in vitamins C and K, which are
beneficial for gum health and
collagen production.

benefit the global population.
Straightforward ideas will get
deeply ingrained in the thoughts
of individuals and will never fail to
motivate them to seek benefits.

Incorporating them into the
diet adds variety and ensures a
well-rounded intake of essential
nutrients for optimal oral health.

Throughout my thirty-year career as a teacher, I spent a lot of
time looking for straightforward
approaches to help me get my
point across. The concept of imprinting helpful diet-related information to encourage oral hygiene
on toothbrush handles was
deemed to be patent-worthy, and
all the necessary steps were done
with the assistance of my pupils,
for whom I will be eternally grateful.

Incorporating water-rich fruits
into children’s diets can be both
simple and enjoyable. Parents can
offer sliced apples or pear slices as
a snack, blend strawberries into
smoothies, or add kiwi slices to
yogurt parfait. Including nuts can
be equally convenient by adding
them to trail mix, sprinkling them
over salads, or enjoying them as a
standalone snack.
However, in today’s fast-paced
world, where stress often leads to
forgetting even life’s essential
health practices, simple and recurrent serious reminders for stressed
minds are imperative. To aid children and their parents in retaining
this information throughout their
lives, images of these oral
health-promoting foods as recommended by International
Dental Associations could be
imprinted on toothbrushes as
shown in the representative
image below. This will serve as a
daily reminder both consciously
and subconsciously for the
stressed adults.
Likewise, for individuals managing diabetes, heart conditions,
or respiratory ailments, toothbrushes could feature images of
foods that specifically contribute
positively to their health, offering
continual reinforcement. Such a
simple mnemonic could greatly

Author

All rights reserved. © 2024 Dental
Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the
prior written permission of Dental
Tribune International GmbH is expressly prohibited.
Dental Tribune International GmbH
makes every effort to report clinical
information and manufacturers’ product news accurately but cannot assume responsibility for the validity of
product claims or for typographical
errors. The publisher also does not
assume responsibility for product
names, claims or statements made
by advertisers. Opinions expressed
by authors are their own and may
not reflect those of Dental Tribune
International GmbH

DENTAL TRIBUNE SOUTH ASIA
EDITION

PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA

CLINICAL EDITOR
Dr. Dilip DESHPANDE

RESEARCH EDITOR
Dr. Shobha DESHPANDE

ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI

Dr Prakash Vaithyanathan

ASSISTANT EXECUTIVE EDITOR
Dr. Riddhi D. TELISARA
DESIGNER
Anil LAHANE

PRINTER
Mehernosh MISTRY
Burzin MISTRY
Ampersand, Mumbai, India

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Dental Tribune South Asia Edition | 02/2024

Global Dental Leaders to Convene at
6th AAID and 12th WCOI Conference in
New Delhi
The 6th Global American
Academy of Implant Dentistry
(AAID) & 12th World Congress of
Oral Implantology (WCOI) Conference, alongside the 28th WCOI
Japan Annual Scientific Conference, is scheduled to take place
from November 8-10, 2024, at the

Leela Ambience Convention Hotel
in New Delhi.
This prestigious global gathering will bring together dental professionals and experts from
around the world to explore the
latest advancements, techniques,
and research in implant dentistry.

Attendees will have a unique opportunity to expand their knowledge and skills in this rapidly
evolving field.
The
conference,
themed
“Shaping the Future: Trends & Insights in Dental Implants from Vision to Reality,” aims to create a

dynamic platform for discussion
and interaction. It will provide an
environment where leading international and national dental practitioners and exhibitors can elevate the practice of implant dentistry to new heights.

With a comprehensive program featuring keynote speakers,
workshops, and ample networking
opportunities, this event promises
to inspire and educate. It is poised
to make a significant impact on the
global standards of care in implant
dentistry.
Advertisement

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Dental Tribune South Asia Edition | 02/2024

Periodontitis can disrupt gut microbiota by
inducing dysbiosis

Recent studies have shown that periodontitis may disrupt the homeostasis of gut microbiota by inducing dysbiosis (Image: Canva)

By Dr Geetpriya Kaur
Periodontitis is a chronic oral
inflammatory condition, commenced by the accumulation of
pathogenic dental plaque biofilm
above and below the gingival margin. Microbial dysbiosis may result
in a chronic non-resolving and destructive inflammatory response
which is characterized by the destruction of tooth-supporting tissues, such as the alveolar bone
and periodontal ligament, and
further leading to tooth loss. Recent studies suggest that periodontitis can disrupt the homeostasis of the healthy gut microbiota.
Potential pathways of gut
translocation of oral pathobionts
The oral bacteria from the oral
cavity can be translocated to the
gut mucosa through the following
two potential routes:
1. Hematogenous spread
• Oral bacteria can spread systemically through a hematogenous route.
• Mechanical injuries in the oral
cavity can result in the dissemination of oral bacteria into the
systemic circulation.
• Hematogenously
inoculated
Fusobacteria strains are more
thriving in colonization in the
gut tumor than gavaged strains,
implying the circulatory system
plays a major route in oral bacteria dissemination.
• Oral bacteria can seize and remain inside dendritic cells and
macrophages, indicating the
hijacking of host immune cells
to serve as Trojan horses for the

spread of bacteria from the oral
to the gut mucosa.
2. Enteral dissemination
• An individual can swallow
around 600 times a day and
synthesize ~1.5 L of saliva containing 1.5x10^12 oral bacteria.
• More than half of the oral bacterial species have been detected in the gut, indicating
oral–gut translocation of oral
bacteria even in healthy people.
• Generally, oral bacteria poorly
colonize in the healthy gastrointestinal tract (GIT) because of
the multiple barriers conferred
by the healthy gut.
• Gastric acidity is the first barrier
against the translocation of
oral bacteria to the gut mucosa.
• Oral bacteria translocation can
also be observed in patients
who have gastric achlorhydria,
gastroesophageal reflux disease, and gastritis after gastric
surgery.
• Various types of oral pathogens, like P. gingivalis, can survive in the acidic environment
of the stomach and pass
through the gut barrier.
• Thus, the prevention of the enteral transmission of oral
pathogens is the primary defense mechanism.
• Secondly, maintaining the gut’s
harmonious microbial structure is crucial for avoiding ectopic colonization by ingested
oral bacteria, since the gut resident microbiota confers resistance to colonization.
• Factors responsible for gut microbiota dysbiosis include gut
inflammation, artificial sweet-

eners, diets, and antibiotic
treatment.
Microbial routes of direct gut colonization by oral pathogens
Multiple oral pathogens that
colonize the gut may induce abnormal immune responses in GIT,
thus leading to intestinal inflammation. Following oral bacteria are
majorly responsible for gut inflammation:
1. Fusobacterium spp.
• The role of Fusobacterium spp.
is still debatable in gut inflammation.
• F. varium and F. nucleatum can
permeate the intestinal epithelium and induce the synthesis
of proinflammatory cytokines.
• F. nucleatum can invade intestinal epithelial cells and promote
the expression of proinflammatory cytokines.
• Additionally, F. nucleatum can
disrupt the integrity of the epithelial barrier.
2. Porphyromonas Gingivalis
• P. gingivalis is the main periodontopathic bacteria involved
in the pathogenesis of periodontitis.
• Studies showed that the orogastric administration of P. gingivalis to mice can disrupt the
integrity of the gut epithelium.
• Continuous administration of P.
gingivalis to mice leads to endotoxemia, reduced gene expression of tight junction proteins, and increased proinflammatory cytokines in the gut.
3. Staphylococcus aureus
• S. aureus is observed to adhere
to intestinal epithelial cells.

• Oral administration of S. aureus
strain RN8098 into antibiotic–
penetrated mice produces epithelial damage in the small intestine.
4. Klebsiella spp. and Enterobacter spp.
• Klebsiella spp. and Enterobacter spp. colonization have
been isolated from the saliva of
patients with Crohn’s disease,
resulting in potent Th1 cell differentiation in the gut of gnotobic animals.
• Oral
inflammation
fosters
blooms of Enterobacteriaceae,
including Klebsiella spp. and
Enterobacter spp., in genetically susceptible mice, leading
to exacerbation of intestinal inflammation.

Conclusion
Over the last decade, the research area of intestinal inflammation and oral microorganisms has
widely expanded by studies that
have mainly focused on the effect
of direct colonization of oral
pathobionts in the gut. Moreover,
the usage of murine models
showed the novel aspects of the
complicated intermucosal connection between the gut and the
oral cavity.

References
1. Kistler JO, Booth V, Bradshaw DJ, Wade WG. Bacterial community development in experimental gingivitis. PLOS ONE 8(8),
e71227 (2013).
2. Bao J, Li L, Zhang Y, Wang M,
Chen F, Ge S, Chen B, Yan F. Peri-

odontitis may induce gut microbiota dysbiosis via salivary microbiota. International Journal of Oral
Science 2022; 14:32.
3. Kitamoto S, Kamada N. Periodontal connection with intestinal
inflammation: Microbiological and
immunological mechanisms. Periodontology 2000. 2022; 89: 142153.
4. Nakajima M, Arimatsu K,
Kato T, et al. Oral administration of
P gingivalis induces dysbiosis of
gut microbiota and impaired barrier function leading to dissemination of enterobacteria to the liver.
PLoS One. 2015;10(7):e0134234.
5. Arimatsu K, Yamada H, Miyazawa H, et al. Oral pathobiont
induces systemic inflammation
and metabolic changes associated
with alteration of gut microbiota.
Sci Rep. 2014; 4:4828.
6. Atarashi K, Suda W, Luo C, et
al. Ectopic colonization of oral
bacteria in the intestine drives TH1
cell induction and inflammation.
Science. 2017;358(6361):359-365.
7. Kitamoto S, Nagao-Kitamoto H, Jiao Y, et al. The intermucosal connection between the
mouth and gut in commensal
pathobiont-driven colitis. Cell.
2020;182(2):447-62 e14.

[7] =>

For more informaon or to order any of the products in this brochure, please contact:
LifeCare Devices Private Limited
New Jubilee Building, Office no. 1, Laxmiben Chheda Road, Nalasopara West, Palghar 401 203.
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| Customer Service : +91 99304 50170 | Customer Service WhatsApp : +91 99304 50169
| Management WhatsApp : +91 99304 50163/+91 99997 86275

[8] =>

Amelotech
Synahealth Singapore Pte. Ltd.
16 Raffles Quay
#41-01 Hong Leong Building
Singapore 048581

LifeCare Devices Private Limited
New Jubilee Building, Office no. 1, Laxmiben Chheda Road,
Nalasopara West, Palghar 401 203. Mumbai Metropolitan Region,
Maharashtra, INDIA. | E: info@lifecare.in | Website: www.lifecare.in
| Customer Service : +91 99304 50170
| Customer Service WhatsApp : +91 99304 50169
| Management WhatsApp : +91 99304 50163/+91 99997 86275

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[cover] => DT South Asia No. 2, 2024

[toc] => Array ( [0] => Array ( [title] => Rise of minimally invasive techniques for soft tissue augmentation – A tale of promise and pitfalls [page] => 1 ) [1] => Array ( [title] => News [page] => 3 ) [2] => Array ( [title] => Periodontitis can disrupt gut microbiota by inducing dysbiosis [page] => 6 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

Rise of minimally invasive techniques for soft tissue augmentation – A tale of promise and pitfalls / News / Periodontitis can disrupt gut microbiota by inducing dysbiosis

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