{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:10:14Z","timestamp":1789168214757,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["75N92021D00001"],"award-info":[{"award-number":["75N92021D00001"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["75N92021D00002"],"award-info":[{"award-number":["75N92021D00002"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["75N92021D00003"],"award-info":[{"award-number":["75N92021D00003"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["75N92021D00004"],"award-info":[{"award-number":["75N92021D00004"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["75N92021D00005"],"award-info":[{"award-number":["75N92021D00005"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The periodontal inflamed surface area (PISA) estimates the area of inflammatory burden of periodontal disease. This methodological study accessed PISA and its constituents, and systemic C\u2010reactive protein correlations in an attempt to define different tools to investigate the periodontal\u2010systemic interface.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the Buffalo OsteoPerio cross\u2010sectional study (1997\u20132001) were used. The full\u2010mouth periodontal probing depth (PPD) and clinical attachment loss (CAL) at six sites per tooth, and marginal bleeding (MB) at three sites per tooth from 713 post\u2010menopausal women were included. Fasting blood and saliva log\u2010transformed C\u2010reactive protein values were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant increase of MB (30\u00a0\u00b1\u00a020\/43\u00a0\u00b1\u00a026), CAL (1.8\u00a0\u00b1\u00a00.3\/3.1\u00a0\u00b1\u00a00.8), PPD (1.7\u00a0\u00b1\u00a00.2 \/2.3\u00a0\u00b1\u00a00.4), PISA (220.5\u00a0\u00b1\u00a0162.5\/472.1\u00a0\u00b1\u00a0324.6), and C\u2010reactive protein (medians in mg\/L), for saliva (0.43\/0.67) and serum (2810\/3882), was observed with increasing severity of periodontitis. Overall, the highest intercorrelations occurred for indices based on similar periodontal measures, as observed for PPD of whole mouth and of sites measured for bleeding (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.960). Correlations between PISA and C\u2010reactive protein were weak for saliva [maximum of 0.088 (0.015, 0.161) and serum (maximum 0.048 (\u22120.027, 0.123)]. MB presented a consistent pattern of correlations with C\u2010reactive protein, even weak [maximum of 0.254 (0.085, 0.409) for severe periodontitis]. For serum C\u2010reactive protein, no significant correlations were found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The extent of MB consistently correlated to C\u2010reactive protein, while a higher correlation with PISA could not be determined. The results of the present investigation do not support the use of PISA as a clinical tool in place of, or adjuvant to, the extent of gingival bleeding present when exploring periodontal inflammation and its potential interface with systemic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>The diagnosis of periodontal disease may be performed using different tools. In this study, the authors tested a tool that evaluates the area of inflamed periodontium (PISA), and its components to evaluate the periodontal\u2010systemic interface, using C\u2010reactive protein as a marker of systemic inflammation. Interestingly, the percentage of sites positive for bleeding showed higher correlations with C\u2010reactive protein than PISA. Although PISA has gained some followers, our results showed that its calculation may not be needed for evaluating the periodontal\u2010systemic interface.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.70151","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:19:25Z","timestamp":1782926365000},"page":"2013-2019","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periodontal inflamed surface area (PISA) system and components: Potential for exploring the periodontal systemic interface"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0102-9043","authenticated-orcid":false,"given":"Sabrina C.","family":"Gomes","sequence":"first","affiliation":[{"name":"Department of Periodontology, Dental School Federal University of Rio Grande do Sul  Rio Grande do Sul Brazil"},{"name":"Department of Periodontics &amp; Endodontics School of Dental Medicine University at Buffalo \u2013 SUNY  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6335-760X","authenticated-orcid":false,"given":"Kathleen","family":"Hovey","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo \u2013 SUNY Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6669-5242","authenticated-orcid":false,"given":"Michael","family":"LaMonte","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo \u2013 SUNY Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-9595","authenticated-orcid":false,"given":"Jean","family":"Wactawski\u2010Wende","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo \u2013 SUNY Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3512-8587","authenticated-orcid":false,"given":"Marcelo W. B.","family":"Araujo","sequence":"additional","affiliation":[{"name":"Department of Periodontics &amp; Endodontics School of Dental Medicine University at Buffalo \u2013 SUNY  Buffalo New York USA"},{"name":"Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo \u2013 SUNY Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12398"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12344"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2008.01249.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.20\u20100200"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.62389"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13195904"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0280333"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13216"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102018\u2010024263"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2012.110664"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17\u20100721"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0059498"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41371\u2010020\u201000422\u20102"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.2002.7.1.79"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.14048"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010011\u20100621\u20100"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13702"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10040723"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-63700-6"}],"container-title":["Journal of Periodontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jper.70151","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jper.70151","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jper.70151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:23:53Z","timestamp":1789165433000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/jper.70151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/jper.70151"],"URL":"https:\/\/doi.org\/10.1002\/jper.70151","archive":["Portico"],"relation":{},"ISSN":["0022-3492","1943-3670"],"issn-type":[{"value":"0022-3492","type":"print"},{"value":"1943-3670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2025-09-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}