Clinical, immunological, and microbiological analysis of the association between periodontitis and COVID-19: a case-control study.

PURPOSE: Periodontitis and coronavirus disease (COVID-19) share risk factors and activate similar immunopathological pathways, intensifying systemic inflammation. This study investigated the clinical, immunological and microbiological parameters in individuals with COVID-19 and controls, exploring whether periodontitis-driven inflammation contributes to worsening COVID-19 endpoints. METHODS: Case (positive RT-PCR for SARS-CoV-2) and control (negative RT-PCR) individuals underwent clinical and periodontal assessments. Salivary levels of TNF-α, IL-6, IL-1ß, IL-10, OPG, RANKL, neutrophil extracellular traps, and subgingival biofilm were analyzed at two timepoints. Data on COVID-19-related outcomes and comorbidity information were evaluated from medical records. RESULTS: Ninety-nine cases of COVID-19 and 182 controls were included for analysis. Periodontitis was associated with more hospitalization (p = 0.009), more days in the intensive care unit (ICU) (p = 0.042), admission to the semi-ICU (p = 0.047), and greater need for oxygen therapy (p = 0.042). After adjustment for confounders, periodontitis resulted in a 1.13-fold increase in the chance of hospitalization. Salivary IL-6 levels (p = 0.010) were increased in individuals with COVID-19 and periodontitis. Periodontitis was associated with increased RANKL and IL-1ß after COVID-19. No significant changes were observed in the bacterial loads of the periodontopathogens Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, and Treponema denticola. CONCLUSIONS: Periodontitis was associated with worse COVID-19 outcomes, suggesting the relevance of periodontal care to reduce the burden of overall inflammation. Understanding the crosstalk between SARS-CoV-2 infection and chronic conditions such as periodontitis that can influence disease outcome is important to potentially prevent complications of COVID-19.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users.

We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Parâmetros clínicos, periodontais, nutricionais e imaginológicos em pacientes em uso de inibidores de aromatase / Clinical, periodontal, nutritional and imaginological parameters in patients using aromatase inhibitors

A osteoporose é uma doença sistêmica multifatorial, caracterizada pela redução da massa óssea. A osteoporose pode ser primária ou secundária ao uso de medicamentos como os inibidores de aromatase. Estes medicamentos interferem com a conversão de andrógenos a estrogênios, reduzindo a produção destes e sendo indicados para tratamento do câncer de mama dependente de estrógeno. O diagnóstico da osteoporose é baseado em critérios densitométricos da Organização Mundial de Saúde com referência na classificação do T-score, realizada pela técnica de absorciometria de energia dupla de raios X (DXA). Por se tratar de uma doença sistêmica, a osteoporose também afeta os ossos maxilares. Entretanto, a ocorrência e extensão de perda de estrutura do osso alveolar na osteoporose, bem como o risco destes pacientes à doença periodontal e perdas dentárias não estão claramente definidos. Este estudo teve como objetivo identificar os parâmetros clínicos, periodontais, nutricionais e bioquímicos envolvidos na perda óssea em pacientes em uso de inibidores de aromatase. A perda óssea foi avaliada por absorciometria dupla de raios-X (DXA). Foram coletados dados sobre estado nutricional, antropométrico, bucal e periodontal e qualidade de vida relacionada à saúde bucal (OHRQoL). Citocinas e adipocinas foram quantificadas na saliva e soro. Foi realizado um estudo transversal do tipo caso-controle, com um grupo de comparação, no serviço de densitometria óssea do Hospital Mater Dei, no período de 2018 a 2021. A amostra foi constituída por 72 mulheres divididas em dois grupos: em uso de inibidores de aromatase (IAs) (n=40) e pacientes sem uso de inibidores de aromatase (controle) (n=32). Do total da amostra, 39 pacientes (57,4%) foram diagnosticados com perda de massa óssea. Os resultados mostraram que as mulheres idosas em uso de inibidores de aromatase (p=0,009) e fumantes (p=0,034) apresentaram maior perda óssea. Não houve diferença significativa entre os grupos considerando-se as comorbidades analisadas. A análise antropométrica demonstrou que os indivíduos em uso de inibidores de aromatase com perda óssea apresentaram menor peso (p=0,028). O modelo de regressão revelou que a única variável que explica a perda óssea é o uso de antirreabsortivos sendo a perda óssea significativamente reduzida nos indivíduos que usaram esse medicamento (p=0,022). Embora a frequência de periodontite tenha sido semelhante comparando todos os grupos, maiores valores de IL-6 (p=0,004); IL-1ß (p=0,002) e IL-33 (p=0,006) na saliva foram relacionados à pior condição periodontal. Indivíduos que usaram inibidores de aromatase foram 1,18 mais propensos a relatar uma melhor qualidade de vida relacionada à saúde bucal (OHRQoL) do que os controles. Conclusão: Enquanto idade avançada, tabagismo e menor peso são fatores associados à perda óssea, o uso de antirreabsortivos foi fator protetor em indivíduos em uso de inibidores de aromatase.

Osteoporosis is a multifactorial systemic disease characterized by reduced bone mass. Osteoporosis can be primary or secondary to the use of drugs such as aromatase inhibitors. These drugs interfere with the conversion of androgens to estrogens, reducing their production and are indicated for the treatment of estrogen-dependent breast cancer. The diagnosis of osteoporosis is based on densitometric criteria of the World Health Organization with reference to the T-score classification, performed by the technique of dual energy x-ray absorptiometry (DXA). Because it is a systemic disease, osteoporosis also affects the jaw bones. However, the occurrence and extent of loss of alveolar bone structure in osteoporosis, as well as the risk of these patients for periodontal disease and tooth loss, are not clearly defined. This study aimed to identify clinical, periodontal, nutritional and biochemical determinants involved with bone loss in patients using aromatase inhibitors. Bone loss was assessed by dual X- ray absorptiometry (DXA). Data on nutritional, anthropometric, oral and periodontal status and oral health-related quality of life (OHRQoL) were collected. Cytokines and adipokines were quantified in saliva and serum. A cross-sectional case-control type study, with a comparison group, was conducted at the bone densitometry service of Hospital Mater Dei from 2018 to 2021. The sample consisted of 72 women divided into two groups: using aromatase inhibitors (AIs) (n=40) and patients not using aromatase inhibitors (control) (n=32). Of the total sample, 39 patients (57.4%) were diagnosed with bone loss. The results showed that elderly women using aromatase inhibitors (p=0.009) and smokers (p=0.034) had greater bone loss. There was no significant difference between the groups considering the analyzed comorbidities. Anthropometric analysis showed that individuals using aromatase inhibitors with bone loss had lower weight (p=0.028). The regression model revealed that the only variable that explains bone loss is the use of antiresorptive drugs, with bone loss significantly reduced in individuals who used this medication (p=0.022). Although the frequency of periodontitis was similar comparing all groups, higher values of IL-6 (p=0.004); IL-1ß (p=0.002) and IL-33 (p=0.006) in saliva were related to worse periodontal status. Subjects who used aromatase inhibitors were 1.18 times more likely to report a better oral health-related quality of life (OHRQoL) than controls. Conclusion: While advanced age, smoking and lower weight are factors associated with bone loss, the use of antiresorptives was a protective factor in individuals using aromatase inhibitors.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service.

The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Prophylactic photobiomodulation therapy using 660 nm diode laser for oral mucositis in paediatric patients under chemotherapy: 5-year experience from a Brazilian referral service.

The use of photobiomodulation therapy (PBMT) in the prevention of oral mucositis (OM) in paediatric care has increased. In this article, we report data of paediatric oncology/haematopoietic stem cell transplantation (HSCT) patients treated with PBMT to prevent chemotherapy-induced OM. A retrospective study was conducted at a Brazilian referral service. Prophylactic PBMT was used in children and adolescents (≤ 17 years) following the protocol: InGaAIP, 660 nm, 100 mW, 2 J, 3.33 W/cm2, and 20 s per point. Demographic data and OM severity scores were assessed. A regression model tested the association between OM with prophylactic PBMT and antineoplastic therapy. A total of 148 individuals who had undergone 358 chemotherapy cycles were analysed. A higher occurrence of OM was observed in HSCT and osteosarcoma (OS) patients. Except for HSCT, OM was associated with methotrexate (MTX) use in all disease groups. PBMT significantly reduced OM severity in acute lymphoblastic leukaemia (ALL) and OS patients. OM grade was 3.16 and 5.45 times higher among individuals with ALL and OS, who had not undergone prophylactic PBMT compared with those who had undergone prophylactic PBMT (p < 0.001). PBMT prevented chemotherapy-induced OM. Individuals who used MTX and did not undergo prophylactic PBMT were at increased risk of OM.

Bleeding assessment in oral surgery: A cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group.

Some prospective studies have been designed specifically to investigate perioperative bleeding in dental surgery. The quantitative assessment of intraoperative blood loss can be useful for indicating the real risk of bleeding complications, especially in medically compromised individuals. The aim of this study was to evaluate the pattern of bleeding in individuals under vitamin K antagonist (VKA) therapy and non-anticoagulated individuals submitted to dental extractions. Perioperative bleeding was evaluated by using a total collected bleeding corrected by absorbance reading (dental bleeding score). 138 procedures were performed. When the perioperative dental bleeding score was correlated with the number of extracted teeth, the quantity of bleeding was found to be directly proportional to the procedure. Extractions of two or more teeth presented higher scores than single extractions (p = 0.003). In a comparative analysis between the VKA and non-anticoagulated groups, no significant difference in the scores was found. The previous history of complications in dental procedures (p = 0.001) and the use of additional hemostatic measures were higher in the VKA group (p = 0.017). VKA therapy did not impact significantly the volume of blood lost during dental extractions. Perioperative bleeding assessment might be a useful parameter for evaluating patients under antithrombotic treatment.

Fabrication of a custom pediatric nasal mask for noninvasive ventilation using a maxillofacial elastomer: A straightforward technique.

The facial masks commercially available for noninvasive positive pressure ventilation therapy for children with clinical conditions of hypoventilation are limited by size and hardness. The present report describes a straightforward method of developing a nasal mask from a room-temperature vulcanizing silicone elastomer for daily contact with the nasal mucosa of babies during noninvasive positive pressure ventilation. The fabrication of the silicone mask with nasal tubes is based on maxillofacial prosthesis techniques, with retention with steel prongs and elastics.

Treatment of oral manifestations of toxic epidermal necrolysis with low-level laser therapy in a pediatric patient.

Drug-induced reactions are complications associated with high mortality and significant morbidity. Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9-year-old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. A drug-induced hypersensitivity reaction to antibiotics was suspected, and a diagnosis of TEN was made. The patient was managed with withdrawal of the suspected causative agent, and the oral lesions were treated with low-level laser therapy (LLLT) and oral hygiene. This case highlights that TEN requires interdisciplinary intervention with dental assistance and follow-up to improve symptoms, nutrition, systemic condition, and quality of life.

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

BACKGROUND: Infective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE. OBJECTIVE: To analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE. METHODS: We performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371). RESULTS: Of the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p < 0.003) and gender (p = 0.013) were significant risk factors for IE. There was a high demand for dental procedures in the group receiving dental preparation, with no significant differences between the patients with or without IE. Hemoculture indicated qualitative differences in comparing patients with and without dental treatment, especially in the frequency of Staphylococcus and Streptococcus. CONCLUSIONS: The results did not allow for the determination of the impact of dental treatment before CVS on IE outcomes. However, it was not possible to exclude the potential beneficial effects of dental treatment in the prevention of IE.

Identificação de condições de saúde bucal em pacientes submetidos à cirurgia cardíaca: monitoramento de prováveis fatores de risco para endocardite infecciosa

A endocardite infecciosa (EI) é uma doença grave que afeta a superfície do endocárdio. A disseminação de microrganismos a partir da cavidade bucal tem sido associada com a ocorrência de EI. Para analisar a possível associação causal com a condição de saúde bucal e ocorrência de EI em pacientes submetidos previamente à cirurgia cardíaca valvar, foi realizado um estudo retrospectivo de análise dos prontuários médico e odontológico de pacientes submetidos à cirurgia valvar, de 2004 a 2014. A amostra foi constituída de 482 pacientes submetidos à cirurgia valvar divididos em dois grupos: pacientes submetidos a tratamento odontológico previamente a cirurgia valvar (n=111) e pacientes submetidos a cirurgia valvar sem preparo odontológico prévio (n=371)...

Avaliação da implementação de novo protocolo de higiene bucal em um centro de terapia intensiva para prevenção de pneumonia associada à ventilação mecânica / Evaluation of the implementation of new protocol of oral hygiene in an intensive care center for prevention of pneumonia associated with mechanical ventilation

A pneumonia associada à ventilação mecânica (PAVM) é uma das infecções hospitalares mais prevalentes na Unidade de Tratamento Intensivo(UTI). Dentre os fatores de risco, destacam-se as microaspirações de microrganismos da orofaringe. A estratégia para prevenção da PAVM foia criação dobundleda ventilação. Nem todas as estratégias, porém, estão incluídas nobundle– por exemplo, a higiene bucal. O objetivo comeste trabalho foi avaliar os procedimentos de higiene bucal na prevenção da PAVM. Foram avaliados os dados secundários da comissão decontrole de infecção hospitalar entre 2008 e 2011, apresentados por frequência de ocorrência, bem como a percepção dos profissionais de saúdena UTI sobre a implantação do protocolo de higiene bucal. Após assinar o Termo de Consentimento Livre e Esclarecido (TCLE), foi aplicadoum questionário. A pneumonia foi a principal causa de infecção no CTI, de 2008 a 2010. Em 2011, após a implantação dobundle, a pneumoniadeixou de liderar como a mais frequente. Em números percentuais, a redução de pneumonia após a implantação dobundleaté a incorporaçãodo protocolo de higiene bucal variou de 33,3% para 3,5%. Sobre a percepção dos profissionais sobre a inserção da odontologia na UTI, 56profissionais responderam ao questionário, citando a higiene bucal como a segunda medida mais importante. Cem por cento dos profissionaisresponderam que eram favoráveis à inserção do dentista na UTI. A vasta literatura existente evidencia a eficiência do protocolo de higiene bucalna prevenção de PAVM. Recomenda-se, portanto, a inserção dessa medida nobundle.

Ventilator-associated pneumonia (VAP) is one of the most prevalent infections in hospital intensive care unit (ICU). Among the risk factors highlightthe microaspiration of oropharyngeal microorganisms. The strategy for prevention of VAP bundle was the creation of ventilation. However, notall strategies are included in the bundle, for example, the oral hygiene. This study aimed to assess the oral hygiene procedures to prevent VAP.We conducted a review of secondary data from the infection control committee of the hospital between 2008 to 2011 presented by frequency ofoccurrence. We also evaluated the perception of health professionals in the ICU on the implementation of the protocol of oral hygiene. After signingthe informed consent a questionnaire was administered. Pneumonia was the primary cause of infection in the ICU from 2008 to 2010. In 2011after deploying the bundle fails to lead to pneumonia as the most frequent. Percentage reduction in numbers of pneumonia after the deploymentbundle to the incorporation of oral hygiene protocol ranged from 33.3% to 3.5%. About the perception of professionals about the insertion of dentalprofessionals in the ICU 56 respondents, citing oral hygiene as the second most important measure. 100% of professionals said to be favorable tothe dentist’s inclusion in the ICU. The vast literature demonstrates the efficiency of the protocol of oral hygiene in the prevention of VAP, so it isrecommended the inclusion of this measure in the bundle.

La neumonía asociada a ventilación mecânica (NAVM) es una de las infecciones más prevalentes en unidades de cuidados intensivos (UCI). Entre los factores de riesgo se destacan la microaspiración de bacterias colonizantes de la orofaringe. La estratega para prevención de la NAV fue la creación del bundle de la ventilación. Sin embargo, no todas las estrategias se incluyen en el paquete de medidas como, por ejemplo, la higiene bucal. Este estudio tuvo como objetivo evaluar los procedimientos de higiene oral para prevenir la NAVM. Se realizó una revisión de datos secundarios de la comisión de control de infecciones del hospital entre 2008 a 2011 según la frecuencia de incidencia. También se evaluó la percepción de los profesionales de la salud en la UCI sobre la aplicación del protocolo de higiene bucal. Después de firmar el consentimiento informado se aplicó un cuestionario. La neumonía fue la principal causa de infecciones en la UCI desde 2008 hasta 2010. En 2011, después de implementar el paquete, la neumonía dejó de ser la más frecuente. En porcentaje, la reducción de la neumonía después de la puesta en práctica del bundle hasta la incorporación del protocolo de higiene bucal varió entre 33,3% y 3,5%. Acerca de la percepción de los profesionales de la inserción de la odontología en la UCI, 56 profesionales encuestados citaron la higiene bucal como la segunda medida más importante. El cien por ciento de los profesionales es favorable a la inclusión del dentista en la UCI. La vasta literatura demuestra la eficacia del protocolo de higiene bucal en la prevención de la NAVM. Se recomienda, entonces, la inclusión de esta medida en el paquete.