Bleeding gums—a warning sign for the whole body?

Aim of the study: Von Willebrand disease (VWD) is not a rare inherited bleeding disorder. However, it is frequently underdiagnosed because early mucocutaneous bleeding manifestations are often attributed to local factors such as inflammation or anatomical abnormalities, leading to delayed recognition of the underlying systemic disease.

Results: This case highlights two important clinical messages. First, clinical practitioners, including dentists, can serve as key first responders in identifying systemic disorders by carefully evaluating bleeding and family histories rather than focusing solely on local oral conditions. Second, a comprehensive, patient-centered diagnostic approach is essential to avoid delayed diagnosis of inherited bleeding disorders such as VWD. This case report emphasizes the important role of non-hematology clinicians in the early diagnosis of rare VWD subtypes.

Aim of the study: On examination, the oral cavity may exhibit manifestations of underlying systemic disease and serve as an indicator of overall health. Systemic diseases with oral findings include autoimmune, hematologic, endocrine, and neoplastic processes.

Results: Patients with chronic diseases such as gastroesophageal reflux and eating disorders may present with dental erosions that cause oral pain or halitosis. In the pediatric population, oral changes can be related to rare cancers, such as Langerhans cell histiocytosis, or infectious etiologies, such as Kawasaki disease. In both adults and pediatric patients, poor oral health has been linked to poorer health outcomes overall. Thorough history taking and physical examination by dentists may aid in determining the underlying etiology of oral changes and allow for earlier intervention by medical colleagues.

Aim of the study: Objective More patients visit oral surgery outpatient clinics from evening to night to treat persistent gingival bleeding (PGB) related to periodontal disease (PD) (PD-PGB). Since there are few reports on PD-PGB, the present study performed a detailed characterisation of this disease.

Results: Patients in the PGB-RPD group showed a significantly higher percentage (57.1%) of taking anticoagulants and/or antiplatelets than the control group (24.2%) (P < 0.001). A significantly higher percentage of patients in the PGB-RPD group had hypertension (68.1%) than in the control group (34.1%) (P < 0.001). Bleeding is most frequently observed in molars, with pocket depths exceeding 4 mm. Conclusion: PD-PGB accompanied by deep pockets was more common in older patients and aggravated by taking anticoagulants and/or antiplatelets and antihypertensives. PD-PGB is not rare, and periodontal maintenance, such as regular dental checks, is an important preventive measure.

Aim of the study: This study aimed to verify whether blood pressure was higher in patients presenting to the dental out-of-hours clinic with post-extraction bleeding (PEB) and periodontal disease-related gingival bleeding (PDB) compared to those presenting for other conditions (Control (C) group). Additionally, we examined differences in the prevalence of hypertension, antithrombotic use, and diabetes mellitus among the PEB, PDB, and C groups.

Results: A total of 416 bleeding patients were included, comprising 216 patients with PEB, 119 with PDB, and 81 with other bleeding. Because of the limited number of cases in the Y and M-groups, multivariable logistic regression analyses were performed only in the O-group (≥ 60 years). According to that, antithrombotic use was independently associated with both PDB and PEB in males and females. Increased SBP was independently associated with PDB in both sexes and with PEB in males. Hypertension remained independently associated with PDB only in females, whereas diabetes mellitus was not independently associated with either bleeding condition. Particularly among the O-group (≥ 60 years), antithrombotic use was independently associated with both PDB and PEB, whereas increased systolic blood pressure was independently associated with PDB and, to a lesser extent, PEB.

Aim of the study: The present meta-analysis aimed to evaluate quantitively the recent scientific evidence regarding the association between obstructive sleep apnea (OSA) and periodontitis.

Results: Thirteen eligible studies comprising a total of 31,800 patients were included. The meta-analysis showed an increased prevalence of periodontitis in OSA populations compared to controls. Both PD and CAL were increased in OSA populations compared with controls. (Prevalence of periodontitis: OR 2.348; 95%CI 2.221-2.482; PD: SMD = 0.681, 95% CI: 0.062-1.301, Z = 2.61, P = 0.031; CAL: SMD = 0.694, 95% CI: 0.167-1.22, Z = 2.58, P = 0.01). The study also found significantly increased BOP in patients with OSA after heterogeneity was clarified. (SMD = 0.357, 95% CI: 0.079-0.635, Z = 2.52, P = 0.012). The findings suggest that OSA was associated with an increased prevalence of periodontitis.

Aim of the study: Crohn's disease (CD) is a chronic inflammatory disorder with systemic manifestations, including potential effects on oral health. Evidence regarding its association with periodontal disease remains inconsistent.

Results: Thirty-four studies, including 6482 CD patients and 9137 controls, were analyzed. CD was -associated with a higher risk of periodontitis (OR = 2.14, 95% confidence interval [CI]: 1.65-2.77). Clinical periodontal parameters were also significantly worse in CD patients: probing depth (SMD = 0.42), clinical attachment loss (CAL) (SMD = 0.50), bleeding on probing (SMD = 0.47), plaque index (SMD = 0.39), and gingival index (SMD = 0.31). Associations were stronger in European populations and in studies using CAL criteria. Sensitivity analyses confirmed the robustness of results. CD is associated with increased prevalence and severity of periodontal disease. These -findings support routine periodontal screening and integrated multidisciplinary management for CD patients, highlighting shared inflammatory pathways as potential therapeutic targets.

Aim of the study: Examination of the oral cavity can identify clinical signs indicative of underlying systemic disease. Key features to examine include the general appearance and number of the teeth, signs of inflammation of the mucosa or gingival tissues including bleeding of the gums and redness, swelling or hyperplasia.

Results: The aim of this narrative review is to outline both the impact of periodontitis and xerostomia on cardiometabolic disease and the impact of cardiometabolic health on these oral health conditions. Key features of periodontitis and xerostomia will be provided along with a brief discussion of current concepts in early prevention and management of these oral health conditions. The biological mechanisms linking cardiometabolic disease and periodontitis will be outlined and the evidence supporting the association between cardiometabolic disease and oral health conditions will be presented together with an identification of areas where further research is indicated. Last, guidance for general practitioners to assess and support early diagnosis and management of oral health conditions by raising awareness of the relationship between oral health and cardiometabolic disease, providing simple oral health advice and referring to a dental practitioner will be presented.

Aim of the study: Assessment of risk for periodontitis is still in its infancy. Nevertheless, a sufficient amount of dependable information exists to begin using risk assessment in the day to day practice of dentistry.

Results: Some risks such as pathogenic bacteria in the subgingival flora are strongly linked to causation of the disease while others such as bleeding on probing may indicate enhanced risk for future disease but are not known to be involved in causation and still others such as advancing age may be background factors that enhance susceptibility. While some risks such as cigarette smoking can be modified to lower the level of risk, others such as ageing are immutable and cannot be modified but need to be considered in overall risk assessment. A goal of periodontal diagnosis, treatment planning and therapy is to lower risk for future periodontal deterioration to the maximal extent. One approach to achieving this goal is described.

Aim of the study: Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting reproductive-aged women, characterised by metabolic abnormalities, polycystic ovaries, hyperandrogenism, and chronic anovulation. This pathology has been attributed to hormonal imbalances, including elevated levels of insulin, growth hormone (GH), ghrelin, LEAP-2, GnRH, LH/FSH ratio (>2:1), androgenic hormones, and estrogen.

Results: This case highlights that PCOS may contribute to or exacerbate gingival enlargement through hormonal and inflammatory alterations rather than being a direct etiological factor. Early interdisciplinary diagnosis and co-management between dental and medical professionals are crucial for optimizing both periodontal and systemic health outcomes in adolescent patients.

Aim of the study: Pregnancy increases susceptibility to gingival inflammation, and saliva may help characterize associated host-response profiles. This cross-sectional study compared nine salivary proteins and inflammatory mediators between pregnant women with high and low gingival bleeding burdens.

Results: Primary comparisons used ANCOVA adjusted for maternal age and total protein concentration, with additional adjustment for visible biofilm in sensitivity analyses. In the primary adjusted analyses, G1 showed higher RBP4 (FDR-adjusted p = 0.004; partial η2 = 0.466) and clusterin (FDR-adjusted p = 0.006; partial η2 = 0.413), and lower IL-10 (FDR-adjusted p = 0.032; partial η2 = 0.285). In the sensitivity analyses, significant group effects were observed for RBP4 (FDR-adjusted p = 0.026; partial η2 = 0.381) and IL-8 (FDR-adjusted p = 0.044; partial η2 = 0.303). These findings demonstrate associations between high gingival bleeding burden and a salivary profile involving inflammatory/chemotactic, regulatory, and stress-response signals.