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    Periodontal inflamed surface area: quantifying inflammatory burden. Nesse Willem,Abbas Frank,van der Ploeg Ids,Spijkervet Frederik Karst Lucien,Dijkstra Pieter Ubele,Vissink Arjan Journal of clinical periodontology BACKGROUND:Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis. AIM:To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied. MATERIAL AND METHODS:A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP). RESULTS:The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA. CONCLUSION:PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied. 10.1111/j.1600-051X.2008.01249.x
    Platelet indices (mean platelet volume and platelet distribution width) have correlations with periodontal inflamed surface area in coronary artery disease patients: A pilot study. Temelli Başak,Yetkin Ay Zuhal,Aksoy Fatih,Büyükbayram Halil İbrahim,Kumbul Doğuç Duygu,Uskun Ersin,Varol Ercan Journal of periodontology BACKGROUND:The plausible mechanisms regarding the relationship between periodontitis and coronary artery disease (CAD) has long been the focus of studies. This study aimed to test the hypothesis that higher periodontal inflamed surface area (PISA) values have positive correlations with increased complete blood parameters in patients with CAD. METHODS:Patients who underwent coronary angiography with a suspicion of CAD between the ages 30 to 75 years were included. Clinical periodontal parameters (probing depth [PD], clinical attachment loss, bleeding on probing) were recorded, and the participants were divided into four groups after the coronary angiography: group 1: CAD (+) with periodontitis (n = 20), group 2: CAD (+) without periodontitis (n = 20), group 3: CAD (-) with periodontitis (n = 21), group 4: CAD (-) without periodontitis (n = 16). Complete blood counts were analyzed regarding the differences and correlations between the investigated parameters. RESULTS:CAD (+) P (+) individuals had significantly higher platelet distribution width (PDW) values than the other groups (P < 0.0125). Positive lower correlations were found between PISA scores and mean platelet volume (MPV, P = 0.021, rho = 0.264), PISA and PDW (P = 0.240, rho = 0.036) in the whole study group; and moderate correlation between PD and red blood cell distribution width (RDW, P = 0.049, rho = 0.445) in CAD (-) groups with/without periodontitis were found. Age was found to predict CAD with o lower OR (1.17, P < 0.01). CONCLUSION:The results of the present study highlight some blood parameters (PDW, RDW, and MPV) in CAD patients with/without periodontitis in terms of the relationship between inflammatory diseases and their significant low and moderate correlations with PISA values. 10.1002/JPER.17-0684
    Periodontal inflamed surface area as a novel numerical variable describing periodontal conditions. Park Shin-Young,Ahn Soyeon,Lee Jung-Tae,Yun Pil-Young,Lee Yun Jong,Lee Joo Youn,Song Yeong Wook,Chang Yoon-Seok,Lee Hyo-Jung Journal of periodontal & implant science PURPOSE:A novel index, the periodontal inflamed surface area (PISA), represents the sum of the periodontal pocket depth of bleeding on probing (BOP)-positive sites. In the present study, we evaluated correlations between PISA and periodontal classifications, and examined PISA as an index integrating the discrete conventional periodontal indexes. METHODS:This study was a cross-sectional subgroup analysis of data from a prospective cohort study investigating the association between chronic periodontitis and the clinical features of ankylosing spondylitis. Data from 84 patients without systemic diseases (the control group in the previous study) were analyzed in the present study. RESULTS:PISA values were positively correlated with conventional periodontal classifications (Spearman correlation coefficient=0.52; <0.01) and with periodontal indexes, such as BOP and the plaque index (PI) (=0.94; <0.01 and =0.60; <0.01, respectively; Pearson correlation test). () expression and the presence of serum antibodies were significant factors affecting PISA values in a simple linear regression analysis, together with periodontal classification, PI, bleeding index, and smoking, but not in the multivariate analysis. In the multivariate linear regression analysis, PISA values were positively correlated with the quantity of current smoking, PI, and severity of periodontal disease. CONCLUSIONS:PISA integrates multiple periodontal indexes, such as probing pocket depth, BOP, and PI into a numerical variable. PISA is advantageous for quantifying periodontal inflammation and plaque accumulation. 10.5051/jpis.2017.47.5.328
    Periodontal inflamed surface area is associated with hs-CRP in septuagenarian Japanese adults in cross-sectional findings from the SONIC study. Miki Koji,Kitamura Masahiro,Hatta Kodai,Kamide Kei,Gondo Yasuyuki,Yamashita Motozo,Takedachi Masahide,Nozaki Takenori,Fujihara Chiharu,Kashiwagi Yoichiro,Iwayama Tomoaki,Takahashi Toshihito,Sato Hitomi,Murotani Yuki,Kabayama Mai,Takeya Yasushi,Takami Yoichi,Akasaka Hiroshi,Yamamoto Koichi,Sugimoto Ken,Ishizaki Tatsuro,Masui Yukie,Rakugi Hiromi,Ikebe Kazunori,Murakami Shinya Scientific reports Periodontal disease is a chronic inflammatory condition that affects various peripheral organs. The periodontal inflamed surface area (PISA) quantifies periodontitis severity and the spread of inflammatory wounds. This study aimed to investigate the association between PISA and high-sensitivity C-reactive protein (hs-CRP), a systemic inflammation marker. This study included 250 community-dwelling septuagenarians (69-71 years). We collected information on their medical (e.g., diabetes and dyslipidemia) and dental examinations (e.g., measurement of the probing pocket depth). Generalized linear model analysis was used to explore the association between PISA and hs-CRP levels. There was a significant difference in hs-CRP levels between groups with PISA ≥ 500 and < 500 (p = 0.017). Moreover, the generalized linear model analysis revealed a significant association between PISA and hs-CRP levels (risk ratio = 1.77; p = 0.033) even after adjusting other factors. Further, we found a correlation between PISA and hs-CRP (Spearman's rank correlation coefficient, rs = 0.181; p = 0.023). Our findings suggest that PISA is an effective index for estimating the effect of periodontitis on the whole body, enabling medical-dental cooperation. 10.1038/s41598-021-93872-8
    C-reactive protein levels are associated with periodontitis and periodontal inflamed surface area in adults with end-stage renal disease. Schöffer Caroline,Oliveira Leandro Machado,Santi Samantha Simoni,Antoniazzi Raquel Pippi,Zanatta Fabricio Batistin Journal of periodontology BACKGROUND:Several studies have shown the relationship between periodontal disease and chronic kidney disease, but there is little evidence to assess the impact of the amount of inflamed periodontal tissue on the levels of systemic inflammatory markers. So the aim of this study is determine the association between high-sensitivity C-reactive protein (hsCRP) and both periodontitis and periodontal inflamed surface area (PISA) in adults with end-stage renal disease (ESRD). METHODS:Cross-sectional study was conducted with 176 adults with ESRD on regular hemodialysis. The participants were submitted to a full-mouth periodontal examination to determine the occurrence of periodontitis and PISA. Regression analysis was performed to test the independent association between periodontal conditions and serum hsCRP levels. RESULTS:A total of 98.9% of the participants had periodontitis, with stages III and IV found in 26.1% and 52.9%, respectively. Mean hsCRP and PISA was 6.57 (SD: 6.03) mg/L and 217.15 (SD: 271.50), respectively. In the adjusted analysis, mean serum hsCRP levels were significantly higher in patients with stage III and IV generalized periodontitis compared with no/localized/generalized stages I-II (7.67 mg/L versus 5.72 mg/L, P = 0.028). After adjustments for confounding variables, individuals with PISA >490.56 mm (85th percentile) had a 3.26-fold greater chance of having hsCRP above 5 mg/L than their counterparts (OR = 3.26; 95% CI: 1.25 to 8.49). CONCLUSION:The inflammatory burden imposed by periodontitis can increase serum hsCRP levels in adults with end-stage renal disease. 10.1002/JPER.20-0200
    Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing. Pietropaoli Davide,Del Pinto Rita,Ferri Claudio,Marzo Giuseppe,Giannoni Mario,Ortu Eleonora,Monaco Annalisa Journal of clinical periodontology AIM:Periodontitis is a relapsing-remitting disease. Compared with bleeding on probing (BoP), expression of disease activity, periodontal inflamed surface area (PISA), incorporates chronic disease parameters. We tested the association of PISA and BoP with blood pressure (BP) in NHANES III. MATERIALS AND METHODS:A total of 8,614 subjects (≥30 years) with complete periodontal and BP examinations were enrolled. PISA was derived from periodontal probing depth and BoP. The association of PISA and BoP with high/uncontrolled BP was examined by multiple-adjusted models. Inflammatory markers were tested as possible mediators. A machine learning (ML) approach was used to define the relative importance of PISA and BoP and estimate the power of BP status prediction. RESULTS:Compared to no inflammation, severe PISA and BoP were associated with 43% (p < .001) and 32% (p = .006) higher odds of high/uncontrolled BP (≥130/80 mmHg), and with higher systolic BP by ≈4 (p < .001) and 5 (p < .001) mmHg, respectively. Inflammatory markers appeared to mediate this association with various extents, without threshold effect. BoP predicted high/uncontrolled BP more efficiently than PISA using ML. CONCLUSION:PISA and BoP describe the association of periodontal inflammation and hypertension with subtle differences. The contribution of local inflammation to the global inflammatory burden might explain the observed findings. 10.1111/jcpe.13216
    The periodontal inflamed surface area is associated with the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a retrospective study. Yamashita Moe,Kobayashi Tetsuo,Ito Satoshi,Kaneko Chihiro,Murasawa Akira,Ishikawa Hajime,Tabeta Koichi Modern rheumatology We evaluated whether the periodontal inflamed surface area (PISA), a measure of the inflammatory burden posed by periodontitis, is associated with the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). We conducted a retrospective study that collected rheumatologic and periodontal data from 54 patients with RA who had received corticosteroid, conventional synthetic DMARDs, or non-steroidal anti-inflammatory drugs before (baseline) and after 6 months of bDMARD therapy. After the patients were divided into two groups based on high or low PISA according to the median measurements at baseline, the rheumatologic condition was compared between the groups. The patients with a low PISA showed significantly lower values for the Clinical Disease Activity Index (CDAI) ( = .008), swollen joint count ( = .02), and patient's and evaluator's global assessment ( = .01 and  = .03) and significantly greater decreases in changes in the CDAI from baseline to 6 months than the patients with a high PISA ( = .01), although these values were comparable at baseline. Both univariate and multivariate analyses revealed a significantly positive correlation between the baseline PISA and changes in the CDAI ( = .04 and  < .001). The PISA is associated with the clinical response to bDMARDs in patients with RA. 10.1080/14397595.2019.1680100
    Periodontal inflamed surface area and periodontal case definition classification. Leira Yago,Martín-Lancharro Pablo,Blanco Juan Acta odontologica Scandinavica OBJECTIVE:To assess whether a higher periodontal inflamed surface area (PISA) may reflect more severe periodontitis, and if so, to calculate which cut-off point should be used to classify a patient as suffering from periodontitis. MATERIAL AND METHODS:Eighty subjects were selected based on their periodontal status and were divided into 4 groups of 20 each; periodontally healthy, mild periodontitis, moderate periodontitis and severe periodontitis. In addition, demographic data, smoking status and socioeconomic status were also recorded. RESULTS:The highest mean PISA value was obtained for the severe periodontitis group (2309.42 ± 587.69 mm) and the least for the periodontally healthy (34.30 ± 16.48 mm). The PISA values corresponding to the three categories of periodontitis severity were significantly higher than the periodontally healthy group. When receiver operating characteristic (ROC) analysis was performed, a PISA value ≥130.33 mm predicted the presence of periodontitis with a sensitivity of 98% and a specificity of 100%. CONCLUSIONS:PISA is a periodontal parameter that may be used in conjunction with the Centers for Disease Control and Prevention - American Academy of Periodontology case definition classification in periodontal medicine research. 10.1080/00016357.2017.1401659
    Proportion and severity of periodontitis and correlation of periodontal inflamed surface area with glycemic status in patients with type 2 diabetic neuropathy with and without diabetic foot. Journal of periodontology BACKGROUND:The association between diabetic neuropathy with and without diabetic foot and periodontitis remains unaddressed in the literature. The present study was conducted to evaluate the frequency of patients with periodontitis and its severity, and to correlate clinical attachment loss (AL) and periodontal inflamed surface area (PISA) with HbA1c in Type 2 Diabetic Neuropathy (T2DN) patients with and without diabetic foot. METHODS:In this cross-sectional study 310 patients with type 2 diabetic neuropathy (T2DN) were randomly selected, and the study comprised of 120 patients with T2DN with diabetic foot and 155 patients with T2DN without diabetic foot. All patients were assessed for periodontal parameters (bleeding on probing, probing depth, clinical AL, oral hygiene index-simplified), plaque index, and PISA) and systemic parameters (HbA1c, fasting blood glucose, post prandial blood glucose, urinary albumin creatine ratio, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein).Unpaired t-test and Chi-Square test were used to analyze quantitative data and qualitative data, respectively. RESULTS:The frequency of patients with periodontitis in patients with T2DN with and without diabetic foot was 91.7% and 88.4%, respectively. The severity of periodontitis, PISA, and clinical AL were higher in the diabetic foot group. Clinical AL and PISA were significantly related with HbA1c in patients with T2DN with and without diabetic foot. CONCLUSIONS:Percentage of patients with periodontitis and the severity of periodontal destruction were high in type 2 diabetic neuropathy with diabetic foot. A significant correlation of PISA, clinical AL with glycemic status was found in patients with T2DN with and without diabetic foot. 10.1002/JPER.21-0174
    Periodontal Inflamed Surface Area Is Associated With Increased Gestational Blood Pressure and Uric Acid Levels Among Pregnant Women From Rural North China. Hu Shaonan,Yu Feifan,Jiang Hong,Shang Wei,Miao Hui,Li Simin,Zhao Jianjiang,Xiao Hui Frontiers in cardiovascular medicine Background:Periodontal disease has been associated with gestational complications and both conditions have a high prevalence in rural populations from developing regions. A cross-sectional study was carried out to explore the relationship between periodontal inflamed surface area (PISA), blood pressure (BP), and, serum uric acid levels (UA) in a group of rural North Chinese pregnant women in the third trimester of pregnancy. Methods:Three hundred and thirty-five rural women aged 20-34 years, with normal body mass index (BMI) were examined in a cross-sectional study during their third trimester of gestation. Exclusion criteria were history of pregnancy complications, multiple pregnancy, smoking habits, diabetes, hypertension or any known infectious disease. Socio-demographic variables, including age and socioeconomic status (SES), systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings, serum UA levels, and PISA values were recorded. A structural equation model was implemented with two constructed latent variables including "Dem" (comprising of age and SES category to represent unobserved demographic variables) and, "BP" (comprising of SBP and DBP to account for measurement error and lack of multiple BP readings). The model accounted for co-variance of BP and UA, and implemented simultaneous regressions for BP and UA as outcomes, upon Dem and PISA values as exogenous variables. Results:The median PISA score was 1,081.7 (IQR = 835.01), reflecting high levels of periodontal inflammation in the sample. SEM showed a significant association of PISA with BP (estimate = 0.011, 95% CI = 0.009-0.012 < 0.001) and UA (estimate = 0.001, 95% CI = 0.001-0.001, < 0.001). Conclusion:Higher PISA values were significantly associated with higher blood pressure and uric acid levels among rural pregnant women in a cross-sectional sample from a center in North China after accounting for a latent demographic construct derived from age and SES. 10.3389/fcvm.2022.830732
    Estimation of the Periodontal Inflamed Surface Area by Simple Oral Examination. Nomura Yoshiaki,Morozumi Toshiya,Numabe Yukihiro,Ogata Yorimasa,Nakayama Yohei,Sugaya Tsutomu,Nakamura Toshiaki,Sato Soh,Takashiba Shogo,Sekino Satoshi,Yoshinari Nobuo,Hanada Nobuhiro,Sugano Naoyuki,Fukuda Mitsuo,Minabe Masato,Umeda Makoto,Tabeta Koichi,Takahashi Keiso,Noguchi Kazuyuki,Kobayashi Hiroaki,Takai Hideki,Nishimura Fusanori,Suzuki Fumihiko,Kakuta Erika,Yoshimura Atsutoshi,Saito Atsushi,Nakagawa Taneaki Journal of clinical medicine The periodontal inflamed surface area (PISA) is a useful index for clinical and epidemiological assessments, since it can represent the inflammation status of patients in one contentious variable. However, calculation of the PISA is difficult, requiring six point probing depth measurements with or without bleeding on probing on 28 teeth, followed by data input in a calculation program. More simple methods are essential for screening periodontal disease or in epidemiological studies. In this study, we tried to establish a convenient partial examination method to estimate PISA. Cross-sectional data of 254 subjects who completed active periodontal therapy were analyzed. Teeth that represent the PISA value were selected by an item response theory approach. The maxillary second molar, first premolar, and lateral incisor and the mandibular second molar and lateral incisor were selected. The sum of the PISAs of these teeth was significantly correlated with the patient's PISA (R = 0.938). More simply, the sum of the maximum values of probing pocket depth with bleeding for these teeth were also significantly correlated with the patient's PISA (R = 0.6457). The simple model presented in this study may be useful to estimate PISA. 10.3390/jcm10040723
    Prospective Longitudinal Changes in the Periodontal Inflamed Surface Area Following Active Periodontal Treatment for Chronic Periodontitis. Nomura Yoshiaki,Morozumi Toshiya,Saito Atsushi,Yoshimura Atsutoshi,Kakuta Erika,Suzuki Fumihiko,Nishimura Fusanori,Takai Hideki,Kobayashi Hiroaki,Noguchi Kazuyuki,Takahashi Keiso,Tabeta Koichi,Umeda Makoto,Minabe Masato,Fukuda Mitsuo,Sugano Naoyuki,Hanada Nobuhiro,Yoshinari Nobuo,Sekino Satoshi,Takashiba Shogo,Sato Soh,Nakamura Toshiaki,Sugaya Tsutomu,Nakayama Yohei,Ogata Yorimasa,Numabe Yukihiro,Nakagawa Taneaki Journal of clinical medicine Periodontal disease is a chronic inflammatory disease of the periodontal tissue. The periodontal inflamed surface area (PISA) is a proposed index for quantifying the inflammatory burden resulting from periodontitis lesions. This study aimed to investigate longitudinal changes in the periodontal status as evaluated by the PISA following the active periodontal treatment. To elucidate the prognostic factors of PISA, mixed-effect modeling was performed for clinical parameters, tooth-type, and levels of periodontal pathogens as independent variables. One-hundred-twenty-five patients with chronic periodontitis who completed the active periodontal treatment were followed-up for 24 months, with evaluations conducted at 6-month intervals. Five-times repeated measures of mean PISA values were 130+/-173, 161+/-276, 184+/-320, 175+/-417, and 209+/-469 mm. Changes in clinical parameters and salivary and subgingival periodontal pathogens were analyzed by mixed-effect modeling. Plaque index, clinical attachment level, and salivary levels of were associated with changes in PISA at the patient- and tooth-level. Subgingival levels of and were associated with changes in PISA at the sample site. For most patients, changes in PISA were within 10% of baseline during the 24-month follow-up. However, an increase in the number of bleeding sites in a tooth with a deep periodontal pocket increased the PISA value exponentially. 10.3390/jcm10061165
    Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus. Anil Krishna,Vadakkekuttical Rosamma Joseph,Radhakrishnan Chandni,Parambath Fairoz Cheriyalingal World journal of clinical cases BACKGROUND:The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications. AIM:To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications. METHODS:This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose). RESULTS:The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients ( = 0.393, < 0.001). The dose-response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm was associated with a 1.0% increase of HbA1c. CONCLUSION:High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications. 10.12998/wjcc.v9.i36.11300