Clinical Trial Summary
The number of CF adults is increasing year after year (61.7% in 2021) confirming that
patients are living longer. These data do not leave aside the desire to see CF patients "age
well" considering of all the comorbidities linked to aging.
Among these comorbidities, the oral repercussions of cystic fibrosis and its treatments
remain to this day little investigated. We know, however, that oral health, and periodontal
health, is closely linked to general health. Indeed, the oral cavity presents one of the
richest microbiota in the body, made up of bacteria, viruses, yeasts and archae organized
into a biofilm at the interface of periodontal tissues. Periodontal diseases are partly
linked to an imbalance in and loss of diversity within the commensal periodontal flora,
aggravated by risk factors such as diabetes, which affects many CF adults. Early detection
and treatment of periodontal diseases are therefore of primary interest in patients at
increased risk of respiratory infections such as CF patients. This transversal research
project aims to study the oral repercussions, notably periodontal disease prevalence in
cystic fibrosis (CF) adult patients.
Thus, this program will allow, on the one hand, the acquisition of clinical and biological
data on periodontal and/or dental pathologies from which adult CF patients may suffer. These
data will be accessible through an oral and periodontal clinical examination that will allow
the identification of diagnostic clues. The quality of life related to oral health will also
be investigated using a self-administered questionnaire. Clinical and biological data
commonly recorded in the context of the medical follow-up of CF patients (ventilatory
capacity, glycemic status, cytobacteriological examination of sputum, etc.) will also be
taken into account in order to study any correlations with periodontal status.
On the other hand, on a more fundamental level, this work aims to investigate the impact of
CFTR protein dysfunction on the local immunity of the oral cavity and more particularly on
the expression of antimicrobial peptides at the level of the periodontium.
Thus this project is articulated around a strong axis which is "aging well" for adult CF
patients thanks to the improvement of knowledge and ultimately the prevention of
comorbidities linked to aging in CF adult patients and particularly those related to oral
health.
The main objective of this study is to determine the prevalence of periodontal disease in
adult CF subjects followed at CRCM of the CHU of Reims. Periodontal diseases (periodontitis
and gingivitis) will be diagnosed according to the international classification of
periodontal diseases (Chicago 2017). Periodontal examination will be performed with
periodontal probe PCP UNC15. The diagnosis of periodontal disease is defined from the
decision algorithm including measurement of interdental attachment loss (CAL), measurement of
gingival recession (REC) and depth of vestibular or lingual pocket (PPD) (Tonetti and Sanz
2019).The clinical indices noted will therefore include: pocket depth on probing, gingival
recession (Ramfjord 1959), periodontal attachment loss (CAL=PPD+REC) and bleeding index (BOP)
(Ainamo and Bay 1975).
The secondary objectives are:
1. To Investigate an association between the presence of periodontal disease and:
- the CFTR expression genotype (type of mutation)
- the ventilatory capacity (FEV1)
- the treatments administered and their mode of administration
- the value of glycated hemoglobin (Hba1c%)
2. To assess the prevalence of carious lesions in adult cystic fibrosis patients
3. To assess the impact of cystic fibrosis and its treatments on oral health-related
quality of life.
4. To look for an association between periodontal clinical indices and the level of
expression of genes encoding antimicrobial peptides
