The Impact of Heavy Metal Contamination in Humans and Periodontitis: A Scoping Review.

Periodontal disease, one of the most prevalent diseases worldwide, is a chronic inflammatory disease caused by dysbiotic dental biofilms that trigger the host's immune response. Periodontitis is a type of periodontal disease characterized by the destruction of tissues that support the teeth. The disease is influenced by various systemic and environmental risk factors. As heavy metals have been associated with the development of chronic inflammatory diseases, the present scoping review aimed to determine the coverage of the literature on whether human contamination by heavy metals affects periodontitis, as well as their mechanisms of action. Eight studies were selected, and two reviewers evaluated them. Most studies were cross-sectional studies involving humans and one study was performed on rats. Our review revealed a significant correlation between periodontitis and bioaccumulation of lead and cadmium. Oxidative stress generated by trace metals, characterized by elevated levels of reactive oxygen species, causes tissue damage through lipid peroxidation, enzymatic oxidation, and stimulation of proinflammatory cytokines. In conclusion, heavy metals contamination may be a risk factor for the development of periodontitis. Oxidative stress factors seem to increase the extent of the inflammatory response.

Photodynamic therapy as an adjunctive treatment for Grade C periodontitis in molar teeth: a preliminary trial.

OBJECTIVE: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for Grade C periodontitis in molars teeth. METHOD AND MATERIALS: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis. RESULTS: Both groups exhibited improvement in the clinical parameters (P < .001). However, the reductions in bleeding on probing and probing depth were greater in the test group (P < .001). There were no significant differences in the other clinical parameters between groups (P ≥ .130). CONCLUSIONS: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planing. aPDT may be used as adjunctive treatment for Grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement.

[Recommendation of tooth extraction and associated factors: cross-sectional study in the Kiriri indigenous population]. / Indicação de exodontias e fatores associados: estudo transversal na população indígena Kiriri.

The scope of this cross-sectional study was to evaluate the prevalence and the associated factors of the recommendation of dental extraction in the adult Kiriri Indigenous population of northeastern Brazil. A total of 225 natives (≥19 years) were evaluated. The extraction criteria were teeth with clinical attachment loss ≥50% in at least 3 sites, and residual roots. Statistical models were used to evaluate associations between the need for dental extraction and selected variables. The percentage of teeth recommended for dental extraction was 4.98%, characterizing a mean of 1.24 tooth per individual. A regression analysis showed that age ≥35 years (OR=2.24, 95%CI: 1.13-4.43, p=0.02), income

O objetivo deste artigo foi avaliar a prevalência e os fatores associados à indicação de exodontia em uma população adulta de índios Kiriri do Nordeste do Brasil. 225 indígenas (≥19 anos) foram avaliados. Os critérios de indicação de exodontia adotados foram: dentes com perda de inserção clínica ≥50%, em pelo menos 3 sítios, e, também, raízes residuais. Modelos estatísticos foram utilizados para avaliar associações entre necessidade de exodontia e as variáveis selecionadas. A porcentagem de dentes com indicação de exodontia foi de 4,98%, caracterizando uma média de 1,24 dente por indivíduo. A análise de regressão mostrou associação positiva entre indicação de exodontia e idade ≥35 anos (OR=2,24, 95%IC: 1,13-4,43, p=0,02), renda

Indicação de exodontias e fatores associados: estudo transversal na população indígena Kiriri / Recommendation of tooth extraction and associated factors: cross-sectional study in the Kiriri indigenous population

Resumo O objetivo deste artigo foi avaliar a prevalência e os fatores associados à indicação de exodontia em uma população adulta de índios Kiriri do Nordeste do Brasil. 225 indígenas (≥19 anos) foram avaliados. Os critérios de indicação de exodontia adotados foram: dentes com perda de inserção clínica ≥50%, em pelo menos 3 sítios, e, também, raízes residuais. Modelos estatísticos foram utilizados para avaliar associações entre necessidade de exodontia e as variáveis selecionadas. A porcentagem de dentes com indicação de exodontia foi de 4,98%, caracterizando uma média de 1,24 dente por indivíduo. A análise de regressão mostrou associação positiva entre indicação de exodontia e idade ≥35 anos (OR=2,24, 95%IC: 1,13-4,43, p=0,02), renda <R$ 570,00 (OR=3,34, 95%IC: 1,19-9,37, p=0,02) e índice de placa ≥40% (OR=2,38, 95%IC: 1,24-4,56, p=0,01). Uma prevalência de 33% de indivíduos com indicação de um ou mais dentes para exodontia está, principalmente, relacionada aos fatores de risco: idade maior que 35 anos, índice de placa ≥40% e renda inferior a um salário mínimo. Esse estudo reflete tanto a importância da priorização da prevenção em saúde bucal, como a necessidade de ampliação do acesso aos serviços de maior complexidade.

Abstract The scope of this cross-sectional study was to evaluate the prevalence and the associated factors of the recommendation of dental extraction in the adult Kiriri Indigenous population of northeastern Brazil. A total of 225 natives (≥19 years) were evaluated. The extraction criteria were teeth with clinical attachment loss ≥50% in at least 3 sites, and residual roots. Statistical models were used to evaluate associations between the need for dental extraction and selected variables. The percentage of teeth recommended for dental extraction was 4.98%, characterizing a mean of 1.24 tooth per individual. A regression analysis showed that age ≥35 years (OR=2.24, 95%CI: 1.13-4.43, p=0.02), income <R$ 570.00 (OR=3.34, 95%CI: 1.19-9.37, p=0.02) and plaque index ≥40% (OR=2.38, 95%CI: 1.24-4.56, p=0,01) were significantly associated with indication for dental extraction. A prevalence of 33% of subjects with dental extraction recommendation were associated with age older than 35 years, plaque index ≥40% and income less than a minimum wage were related with the recommendation for extraction. This study reflects the importance of prioritizing oral health prevention, as well as the need to expand complex dental services.

Evaluation of the Association of Early Implant Failure With Local, Environmental, and Systemic Factors: A Retrospective Study.

PURPOSE: This study aimed to assess the association of early implant failure (EIF) with demographic, local, environmental, and systemic factors. METHODS: Clinical charts of 594 individuals with 2,537 dental implants were assessed. EIF was characterized by implant loss before and up to the abutment connection. Logistic regression analysis was used to verify the association between EIF and local, environmental, and systemic factors at the individual and implant levels. The chosen level of significance was 5%. RESULTS: EIF occurred in 144 implants (5.68%) and in 97 individuals (16.3%). At the individual level, smoking habits (odds ratio [OR] = 2.54; 95% confidence interval [CI] = 1.00 to 6.47; P = .05), absence of postoperative antibiotic therapy (OR = 2.73; CI = 1.22 to 6.13; P = .02), and bone augmentation (OR = 1.83; CI = 1.17 to 2.85; P = .01) were significantly associated with EIF. At the implant level, smoking habits (OR = 2.90; CI = 1.60 to 5.26, P < .001), absence of postoperative antibiotic therapy (OR = 2.77; CI = 1.36 to 5.63, P = .005), postoperative complications (OR = 28.35; CI = 6.79 to 118.45, P < .001), implant length ≤8.5 mm (OR = 1.79; CI = 1.07 to 2.99; P = .03), and diameter <3.75 mm (OR = 1.65; CI = 1.08 to 2.52, P = .02) were associated with EIF. Age, sex, alcohol abuse, diabetes, hypertension, and long-term medication use were not associated with EIF at both individual and implant levels (P ≥ .12). CONCLUSIONS: Smoking habits, absence of antibiotic therapy, bone augmentation, postoperative complications, implant diameter <3.75 mm, and implant length ≤8.5 mm were associated with EIF. Clinicians should be aware of these associations that should be controlled for when feasible. Future cohort studies are required to confirm the risk factors.

The effect of dental plaque level and self-performed oral hygiene on periodontal status: a cross-sectional study in Brazilian Indigenous / O efeito do nível da placa dentária e da higiene bucal autorrealizada no estado periodontal: um estudo transversal em indígenas brasileiros

Objective: This study evaluated the associations of periodontal status with dental plaque index and frequency of toothbrushing and flossing in Kiriri Brazilian Indigenous people. Methods: Gingival bleeding, periodontal clinical attachment level, and dental plaque index were clinically evaluated in 204 adult Brazilian indigenous. They were categorized as healthy, gingivitis, or periodontitis. Sociodemographic data and oral hygiene habits were registered. Bivariate and logistic regression analyses were performed (p≤0.05). Results: Gingivitis [odds ratio (OR): 2.83; 95% confidence interval (CI), 1.52­5.25; p=0.001] and periodontitis (OR: 6.88; 95%CI, 1.44­32.78; p=0.02) were associated with plaque index level, but not with toothbrushing or flossing frequency (p ≥0.55). Conclusion: Gingivitis and periodontitis were associated with higher plaque index, but not with the frequency of toothbrushing and flossing. To enhance this population's periodontal health, a prevention program focused on improving the quality of self-performed oral hygiene should be planned and implemented.

Objetivo: avaliar as associações do estado periodontal com o índice de placa dentária, a frequência de escovação e o uso do fio dental em Indígenas Brasileiros Kiriri. Métodos: sangramento gengival, nível de inserção clínica periodontal e índice de placa dentária foram avaliados, clinicamente, em 204 indígenas brasileiros adultos. Eles foram classificados como saudáveis, com gengivite ou periodontite. Dados sociodemográficos e hábitos de higiene bucal foram registrados. Foram realizadas análises bivariadas e de regressão logística (p≤0,05). Resultados: gengivite [Odds Ratio (OR): 2,83; Intervalo de confiança de 95% (IC), 1,52-5,25; p = 0,001] e periodontite (OR: 6,88; IC 95%, 1,44­32,78; p = 0,02) foram associados ao nível de índice de placa, mas não à frequência de escovação ou uso do fio dental (p ≥0,55). Conclusão: gengivite e periodontite foram associados a maior índice de placa, mas não com frequência de escovação e uso do fio dental. Para melhorar a saúde periodontal dessa população, um programa de prevenção com foco na melhoria da qualidade da higiene bucal autorrealizada deve ser planejado e implantado.

Systemic risk indicators for peri-implant diseases in individuals with implant-supported fixed prostheses: A cross-sectional study.

PURPOSE: The present study aimed to identify the systemic risk indicators associated with peri-implant mucositis and peri-implantitis in individuals with implant-supported fixed prostheses. MATERIALS AND METHODS: In this cross-sectional study, clinical evaluations of periodontal and peri-implant conditions were performed by a single examiner in a sample of 71 volunteers with 360 implants. Peri-implant mucositis was defined as the occurrence of bleeding on probing in association with redness and swelling or suppuration, without bone loss. Peri-implantitis was defined based on a radiograph of bone loss ≥ 3 mm and/or a probing depth ≥ 6 mm with bleeding and/or suppuration on probing. The systemic factors evaluated were obesity, hormone replacement therapy, osteopaenia and osteoporosis, high blood pressure and hypercholesterolaemia. Logistic models were applied to assess the associations between peri-implant diseases and systemic factors. RESULTS: Mucositis and peri-implantitis were found in 83.1% and 16.9% of the individuals, respectively. The regression analysis showed that obesity (prevalence ratio = 5.23; 95% confidence interval, 1.91 to 96.83; P = 0.01) and high systolic blood pressure (prevalence ratio = 4.23; 95% confidence interval, 1.66 to 12.87; P = 0.03) were associated with peri-implantitis at the individual and implant levels, respectively. No systemic factor was associated with peri-implant mucositis (P ≥ 0.06). CONCLUSION: Obesity and high systolic blood pressure were associated with peri-implantitis, whereas no systemic factor was associated with peri-implant mucositis. Future prospective studies are required to confirm these as true risk factors. Patients with obesity and/or high systolic blood pressure could be informed of the likely association with peri-implantitis, preferably before implant placement.

Efeito da cirurgia bariátrica em obesos na condição periodontal: uma revisão sistemática de literatura / Periodontal status in obeses submitted to bariatric surgery: a systematic literature review

Introdução: A cirurgia bariátrica é o procedimento de eleição para tratamento da obesidade mórbida. Além da satisfatória perda de peso, indivíduos submetidos a essa cirurgia também apresentam modificações da saúde sistêmica, incluindo a bucal. O objetivo desse estudo foi avaliar, através de uma revisão sistemática de literatura, os efeitos da cirurgia bariátrica na condição periodontal. Metodologia: Essa revisão utilizou como critérios de inclusão: artigos recentes (últimos 06 anos), redigidos no idioma inglês e publicados em revistas internacionais indexadas ao PUBMED. Seis artigos foram elegíveis para síntese qualitativa. Discussão: A cirurgia bariátrica teve impactos negativos na saúde periodontal, com aumento da profundidade de sondagem, do índice de sangramento e da severidade da doença periodontal. Muitos fatores como o desenvolvimento de problemas ósseos, vômitos, medicações, alterações psicológicas, entre outros foram considerados associados ao agravamento da doença periodontal. Conclusão: A análise desses estudos permite concluir que os indivíduos submetidos à cirurgia bariátrica apresentaram uma piora das condições periodontais nos primeiros meses após a cirurgia. O cirurgião-dentista deve ser inserido no grupo de abordagem ao paciente obeso e acompanhá-lo durante o pré e todas as fases do pós-operatório, com o objetivo de reduzir os possíveis danos ao periodonto. (AU)

Introduction: Bariatric surgery is the procedure of choice for patients with morbid obesity. In addition to satisfactory weight loss, individuals undergoing this surgery also present changes in systemic health, including oral modifications. The purpose of this study was to evaluate, through a systematic literature review, the effects of bariatric surgery on the periodontal condition. Methodology: This review used as inclusion criteria recent articles (last 06 years), written in English and published in international journals indexed to PUBMED. Six articles were eligible for qualitative synthesis. Discussion: Bariatric surgery had negative impacts on periodontal health, with increased probing depth, bleeding index and severity of periodontal disease. Many factors such as the development of bone problems, vomiting, medications and psychological changes, among others were considered causal for the worsening of periodontal disease. Conclusion: The analysis of these studies allows concluding that the individuals submitted to bariatric surgery presented periodontal compromise. The dentist should be included in the obese patient approach group and accompany him before and all phases after the postoperative period, in order to reduce possible damages to the periodontal and all oral health. (AU)