Effectiveness of antimicrobial photodynamic therapy in the treatment of peri-implantitis: systematic review and meta-analysis.

The purpose of this study was to evaluate the current scientific evidence on the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to mechanical debridement in the treatment of peri-implantitis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022361684). The search was carried out in seven databases, with no restrictions regarding language or year of publication. Our work included studies that compared clinical periodontal parameters between individuals treated with mechanical debridement associated with aPDT and a control group of patients who had undergone mechanical debridement alone. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. The mean difference (MD) and a 95% confidence interval (CI) were provided. Four hundred and seven-four studies were identified, of which five studies were included. The meta-analysis demonstrated that aPDT adjunctive to mechanical debridement in subjects with peri-implantitis resulted in greater reduction in probing depth 3 months after treatment than among subjects receiving treatment with mechanical debridement. Most of the included studies exhibit a low risk of bias. Adjunctive aPDT to mechanical debridement contributes to the improvement of peri-implant clinical parameters in individuals with peri-implantitis, in particular probing depth.

Prevalence and predictors for clinical attachment loss in adolescents in Latin America: cross-sectional study.

AIM: To describe the prevalence, severity and extension of clinical attachment loss (CAL) and to study the predictors in 15- to 19-year-old adolescents from high schools in the Latin America. MATERIALS AND METHODS: A cross-sectional, epidemiological study was performed. The sample included 1070 high school adolescents 15-19 years of age from Santiago de Chile (Chile), Buenos Aires, Córdoba, Mendoza (Argentina), Montevideo (Uruguay), Quito (Ecuador) and Medellín (Colombia). Calibrated examiners performed full mouth, six sites per tooth clinical examination. RESULTS: There was a response rate of 100%. The prevalence of CAL ≥3 mm in ≥1 site was 32.6%, probing pocket depth ≥4 mm was 59.3% and bleeding on probing (BoP) ≥25% was 28.6%. The logistic regression analysis adjusted for cities revealed that smoking (OR = 1.6), attending public school (OR = 2.3) and having a BoP ≥25% (OR = 4.2) were positively associated with CAL ≥3 mm in ≥ 1 site. CONCLUSION: Clinical attachment loss was prevalent in Latin America adolescents and it is associated with smoking, attendance public school and BoP.

Periodontitis prevalence and associated factors: a comparison of two examination protocols.

The fact that there are different epidemiological definitions of periodontitis and different evaluation protocols affects the estimate of periodontitis prevalence and of the influence of associated factors. The gold standard for periodontal examination is full-mouth record assessing CAL and PD. However, there are not always sufficient human and financial resources available to apply such assessment for epidemiological surveillance systems. AIM: This study was conducted to compare different protocols and definitions of periodontitis for assessing prevalence and the impact of related factors in adult patients who requested care at the School of Dentistry, UdelaR. MATERIALS AND METHOD: This was a cross-sectional study of 410 subjects with a high burden of disease in terms of NCDs and periodontitis. Clinical examination evaluated PD in all teeth and CAL in the CPI sextants (WHO 2013). Four periodontitis criteria were defined based on two examination protocols (WHO 2013 and WHO 1997) and two definitions of epidemiological case. Comparisons were made taking the 2013 WHO protocol as a reference. RESULTS: Comparison of the two examination protocols showed that prevalence was underestimated when the WHO 1997 protocol was used to define moderate-severe and severe periodontitis, by 20% and 60%, respectively. CONCLUSIONS: When the severity of periodontitis was not considered, the WHO 2013 protocol did not provide more information on what factors increase the chance of periodontitis. However, when severity was considered, the associated factors were different. Consequently, in a small population, it would be worth using the WHO 2013 protocol, which is the closest to the full-mouth gold standard criterion.

La variabilidad en la definición epidemiológica de la periodontitis y los protocolos de evaluación afectan la medición de la prevalencia y su asociación con ciertos factores. Si bien, el patrón oro para el examen periodontal es el registro de boca completa, que evalúa la pérdida de inserción (CAL, por sus siglas en inglés) y profundidad de sondaje (PS, por sus siglas en inglés), los recursos no siempre están disponibles para los sistemas de vigilancia epidemiológica. OBJETIVO: En este estudio se compararon diferentes protocolos y definiciones de periodontitis evaluando la prevalencia y la asociación de factores relacionados en pacientes adultos que solicitaron atención en la Facultad de Odontología de la UdelaR. Materiales y Método: Los datos provienen de un estudio transversal de 410 sujetos con una elevada carga de enfermedad en términos de ENT y periodontitis. Se utilizó un examen clínico registrando PD en todos los dientes y CAL en los sextantes CPI (WHO 2013). Se definieron cuatro criterios de periodontitis basados en dos protocolos de examen y dos definiciones epidemiológicas de caso. Las comparaciones se realizaron tomando como referencia el protocolo de la OMS de 2013. RESULTADOS: Al comparar los dos protocolos de examen, se verificó la subestimación de la prevalencia cuando se utilizó el protocolo de la OMS de 1997 para la definición de caso moderado-grave y para la periodontitis grave, siendo en el primer caso del 20% y en el segundo caso tres veces mayor que. CONCLUSIONES: Si no se considera la gravedad de la periodontitis, el uso del protocolo de la OMS 2013 no proporciona más información sobre qué factores aumentan la probabilidad de periodontitis. Sin embargo, al analizar la gravedad, los factores asociados fueron diferentes. En consecuencia, en una población pequeña estaría justificado el esfuerzo de utilizar el protocolo de la OMS de 2013, ya que el criterio de referencia es la boca completa.

Periodontal status in cannabis smokers. A systematic review.

Aims: To assess the periodontal status in cannabis smokers in comparison with non-cannabis smokers. Materials and methods: Electronic databases were searched as well as hand searches performed. Eligible studies followed the Population Exposure Comparison Outcome Study (PECOS) structure: P: dentate humans, E: cannabis smoking, C: non-cannabis smoking, O: Primary outcomes: periodontitis case definition, clinical attachment loss, probing depth; Secondary outcomes: bleeding on probing/ gingival inflammation, plaque index and calculus; S: observational studies. Qualitative analyses of the studies were done. The quality of cohort studies was assessed with the Newcastle-Ottawa scale and cross-sectional studies were assessed using a modified Newcastle-Ottawa scale. Results: 2661 records were screened, of which 14 articles were included. Data from a cohort study showed that highly exposed participants were at higher risk of clinical attachment loss progression. Six cross-sectional studies reported worse gingival or periodontal conditions in cannabis smokers. Nevertheless, one did not find such association, neither did three case series. Three studies were of high, two of moderate and six were of low quality. Conclusions: Based on the available data, frequent cannabis smoking could be detrimental for periodontal tissues and this could be dose-dependent. Studies including long-term cannabis smokers, and stratified for periodontal disease etiologic factors and risk factors/indicators are needed.

Self-reported periodontitis in cannabis club members in Montevideo, Uruguay. An exploratory study.

In 2013, the Oriental Republic of Uruguay enacted a law regulating the cannabis market, and since then, an increasing number of users has been registered. Previous reports based on data from other countries link cannabis smokers to worse periodontal health status. The aim of this study is to describe self-reported gingival and periodontal health status and estimate the prevalence of periodontitis among Uruguayan cannabis club members. A cross-sectional study was conducted on a convenience sample of cannabis club members in Uruguay. A survey was used to gather sociodemographic data and information on oral hygiene, use of cannabis and other drugs, and self-reported gingival and periodontal health status. Eight questions validated in Spanish were used to estimate the prevalence of total periodontitis and severe periodontitis, based on two previously implemented predictive models. The survey was completed by 50 people, of whom 68% were male and 78% were in the 20-40 year age range. Based on the first model, estimated prevalence was 12% for total periodontitis and 10% for severe periodontitis. Based on the second model, estimated prevalence was 36% for total periodontitis and 12% for severe periodontitis. These findings suggest that smoking cannabis could potentially have a detrimental effect on oral health status.

En 2013 se aprobó la ley que regula el mercado del cannabis en la República Oriental del Uruguay y desde entonces se ha registrado un creciente número de consumidores. Reportes previos a partir de datos de otros países vinculan un peor estado de salud periodontal en fumadores de cannabis. El objetivo de este estudio es describir el estado gingivo-periodontal auto-reportado y estimar la prevalencia de periodontitis en participantes de clubes cannábicos uruguayos. Se realizó un estudio transversal a partir de una muestra por conveniencia de integrantes de clubes cannábicos en Uruguay. Mediante una encuesta se recolectaron datos socio-demográficos, de higiene oral, de consumo de cannabis y otras drogas, así como de auto-reporte del estado de salud gingivo-periodontal. A partir de 8 preguntas validadas en español se estimó la prevalencia de periodontitis total y severa a través de dos modelos predictivos previamente implementados. Un total de 50 personas completaron la encuesta. El 68% eran hombres y el 78% estaba dentro del rango de 20 a 40 años de edad. Con el primer modelo la prevalencia estimada de periodontitis total fue 12% y de periodontitis severa 10%. Con el segundo modelo fue 36% para periodontitis total y 12% para periodontitis severa. Estos hallazgos sugieren que fumar cannabis podría tener un potencial efecto deletéreo sobre las condiciones de salud bucal.

New Xerophilic Species of Penicillium from Soil.

Soil is one of the main reservoirs of fungi. The aim of this study was to study the richness of ascomycetes in a set of soil samples from Mexico and Spain. Fungi were isolated after 2% w/v phenol treatment of samples. In that way, several strains of the genus Penicillium were recovered. A phylogenetic analysis based on internal transcribed spacer (ITS), beta-tubulin (BenA), calmodulin (CaM), and RNA polymerase II subunit 2 gene (rpb2) sequences showed that four of these strains had not been described before. Penicillium melanosporum produces monoverticillate conidiophores and brownish conidia covered by an ornate brown sheath. Penicillium michoacanense and Penicillium siccitolerans produce sclerotia, and their asexual morph is similar to species in the section Aspergilloides (despite all of them pertaining to section Lanata-Divaricata). P. michoacanense differs from P. siccitolerans in having thick-walled peridial cells (thin-walled in P. siccitolerans). Penicillium sexuale differs from Penicillium cryptum in the section Crypta because it does not produce an asexual morph. Its ascostromata have a peridium composed of thick-walled polygonal cells, and its ascospores are broadly lenticular with two equatorial ridges widely separated by a furrow. All four new species are xerophilic. Despite the genus Penicillium containing more than 480 known species, they are rarely reported as xerophilic.

A revision of malbranchea-like fungi from clinical specimens in the United States of America reveals unexpected novelty.

The fungi of the order Onygenales can cause important human infections; however, their taxonomy and worldwide occurrence is still little known. We have studied and identified a representative number of clinical fungi belonging to that order from a reference laboratory in the USA. A total of 22 strains isolated from respiratory tract (40%) and human skin and nails (27.2%) showed a malbranchea-like morphology. Six genera were phenotypically and molecularly identified, i.e. Auxarthron/Malbranchea (68.2%), Arachnomyces (9.1%), Spiromastigoides (9.1%), and Currahmyces (4.5%), and two newly proposed genera (4.5% each). Based on the results of the phylogenetic study, we synonymized Auxarthron with Malbranchea, and erected two new genera: Pseudoarthropsis and Pseudomalbranchea. New species proposed are: Arachnomyces bostrychodes, A. graciliformis, Currahmyces sparsispora, Malbranchea gymnoascoides, M. multiseptata, M. stricta, Pseudoarthropsis crassispora, Pseudomalbranchea gemmata, and Spiromastigoides geomycoides, along with a new combination for Malbranchea gypsea. The echinocandins showed the highest in vitro antifungal activity against the studied isolates, followed by terbinafine and posaconazole; in contrast, amphotericin B, fluconazole, itraconazole and 5-fluorocytosine were less active or lacked in vitro activity against these fungi.

Cost-effectiveness of the CFTR gene-sequencing test for asymptomatic carriers in the Colombian population / [Costo-efectividad de la prueba de secuenciación del gen CFTR para portadores asintomáticos en la población colombiana].

Introduction: Cystic fibrosis is an autosomal recessive genetic disease classified as a highcost orphan disease. Objective: To determine the cost-effectiveness ratio of the diagnostic test for the CFTR gene-sequencing in asymptomatic family carriers in the first, second, and third degree of consanguinity. Materials and methods: We conducted a systematic search evaluating operative characteristics of the diagnostic test and decision-tree models in cost-effectiveness studies. A decision-tree model was elaborated taking prevention of future conceptions as a unit of analysis. We obtained the costs of the disease from the high-cost report of the Ministerio de Salud y Protección Social. The costs of the test were referenced by national laboratories. We carried out a deterministic and probabilistic sensitivity analysis with a third-payer perspective and a one-year horizon. Results: An ICER of USD$ 5051.10 was obtained as the incremental cost for obtaining 10.89% more probability of avoiding the birth of a child with cystic fibrosis per screened couple. For family members in second and third degrees, the ICER was USD$ 19,380.94 and USD$ 55,913.53, respectively, evidenced when applying the GDP per capita. This technology was cost-effective in 39%, 61.18%, and 74.36% for 1, 2, and 3 GDP per capita in first degree of consanguinity relatives. Conclusions: The genetic test for the detection of CFTR gene carriers was cost-effective depending on the threshold of availability to pay and the assumptions and limitations established in the model.

Introducción. La fibrosis quística es una enfermedad genética de carácter autosómico recesivo clasificada como enfermedad huérfana de alto costo. Objetivo. Determinar la razón de costo-efectividad de la prueba diagnóstica de secuenciación del gen CFTR para los portadores asintomáticos familiares en primer, segundo y tercer grados de consanguinidad. Materiales y métodos. Se hizo una búsqueda sistemática sobre la evaluación de las características operativas de la prueba diagnóstica y los modelos de árbol de decisiones en estudios de costo-efectividad. Se elaboró un modelo de árbol de decisiones tomando como unidad de análisis la prevención de futuras concepciones. Los costos de la enfermedad se obtuvieron del reporte de alto costo del Ministerio de Salud de Colombia. Los costos de la prueba se obtuvieron de laboratorios nacionales. Se hizo un análisis de sensibilidad, determinístico y probabilístico, con la perspectiva del tercer pagador y horizonte a un año. Resultados. Se obtuvo una razón incremental de costo-efectividad (RICE) de USD$5.051,10 por obtener 10,89 % más de probabilidades de evitar el nacimiento de un niño enfermo con fibrosis quística por pareja. Para los familiares de segundo y tercer grados, se encontró una RICE de USD$ 19.380,94 y USD$ 55.913,53, respectivamente, al aplicar el PIB per cápita. Esta tecnología fue costo-efectiva en 39 %, 61,18 % y 74,36 % para 1, 2 y 3 PIB per cápita en familiares de primer grado de consanguinidad. Conclusiones. La prueba genética de detección de portadores del gen CFTR resultó costo-efectiva dependiendo del umbral de la disponibilidad de pagar, y de los supuestos y limitaciones establecidas en el modelo.

Fungal Diversity of Deteriorated Sparkling Wine and Cork Stoppers in Catalonia, Spain.

Filamentous fungi are rarely reported as responsible for spoiling wine. Cork taint was detected in sparkling wine; therefore, we investigated fungal contamination as a possible cause of organoleptic alteration. Spoiled wine was filtered and membranes were plated onto potato dextrose agar (PDA). The cork stoppers used for sealing bottles were cut and also plated onto PDA. Fungal strains were phenotypically characterized and molecularly identified by sequencing of a fragment of the 28S nrRNA gene (LSU) and (occasionally) by other additional molecular markers. Twenty-seven strains were isolated and sixteen species were identified, all of them belonging to the phylum Ascomycota. The fungi isolated from wine were three species of Aspergillus section Nidulantes, a species of Penicillium section Exicaulis and Beauveria bassiana. Candida patagonica was isolated from both sort of samples, and the fungi isolated from cork stoppers were Altenaria alternata and Cladosporium cladosporioides. Surprisingly, most of the taxa recovered from the cork stoppers and/or wine were new to the science: a new genus (Dactylodendron) and seven new species belonging to the genera Cladophialophora, Dactylodendron, Kirschsteiniothelia, Rasamsonia, and Talaromyces. Future studies could let us know if these fungi would be able to produce compounds responsible for cork taint.

Asociación entre lesiones periapicales y diabetes mellitus

Las lesiones periapicales son procesos inflamatorios que generan la reabsorción de los tejidos mineralizados. En pacientes diabéticos este proceso puede verse afectado. Este trabajo tiene como objetivo identificar la asociación entre la diabetes mellitus y las lesiones periapicales y conocer si los pacientes diabéticos presentan mayor prevalencia y severidad. Se realizó una revisión amplia de la literatura disponible, de tipo narrativa. Se consultaron las bases de datos PubMed (Medline) y SciELO y los recursos Timbó y Google Scholar. Los criterios de exclusión fueron: trabajos anteriores al año 2010 y reportes de caso Se incluyeron artículos anteriores a la fecha de exclusión por considerarse relevantes para el trabajo. A pesar que la evidencia científica continúa siendo insuficiente y el diseño de los estudios debe mejorarse, se demuestra asociación entre lesiones periapicales y diabetes mellitus. Esto implica que los pacientes diabéticos podrían presentar mayor prevalencia y severidad de lesiones.

As lesões periapicais são processos inflamatórios que geram a reabsorção de tecidos mineralizados. Em pacientes diabéticos este processo pode ser afetado. Este trabalho tem como objetivo identificar a associação entre diabetes mellitus e lesões periapicais e saber se os pacientes diabéticos apresentam maior prevalência e gravidade. Foi realizada uma revisão abrangente da literatura disponível, do tipo narrativa. Foram consultadas as bases de dados PubMed (Medline) e SciELO e os recursos Timbó e Google Acadêmico. Os critérios de exclusão foram: trabalhos anteriores ao ano de 2010 e relatos de casos.Os artigos anteriores à data de exclusão foram incluídos por serem considerados pertinentes ao trabalho. Apesar de as evidências científicas ainda serem insuficientes e o delineamento dos estudos precisar ser aprimorado, foi demonstrada uma associação entre lesões periapicais e diabetes mellitus. Isso implica que os pacientes diabéticos podem ter maior prevalência e gravidade das lesões.

Summary Periapical lesions are inflammatory processes that generate the resorption of mineralized tissues. In diabetic patients this process may be affected. This work aims to identify the association between diabetes mellitus and periapical lesions and to know if diabetic patients have a higher prevalence and severity. A comprehensive review of the available literature, of a narrative type, was carried out. The PubMed (Medline) and SciELO databases and the Timbó and Google Scholar resources were consulted. The exclusion criteria were: works prior to the year 2010 and case reports. Articles prior to the exclusion date were included, as they were considered relevant to the work. Despite the fact that the scientific evidence is still insufficient and the design of the studies should be improved, an association between periapical lesions and diabetes mellitus has been demonstrated. This implies that diabetic patients could have a higher prevalence and severity of lesions.

Auto-reporte de Periodontitis en diabéticos. Estudio transversal en Montevideo, Uruguay

Objetivo: Conocer la ocurrencia de periodontitis a partir de un cuestionario de auto-reporte en una población de diabéticos en Montevideo, Uruguay. Materiales y métodos: Fueron invitados los participantes del 1er Encuentro de Diabetes en Uruguay, con diagnóstico de diabetes según auto-reporte, con al menos 18 años de edad y que firmaron el consentimiento informado. En todos los casos, fue aplicado un cuestionario con ocho preguntas previamente validadas al español de forma de estimar la ocurrencia de la Periodontits además de identificar indicadores asociados. Resultados: Un total de 37 personas respondieron el cuestionario suministrado, en su mayoría correspondientes al sexo femenino y de 45 años de edad promedio. La ocurrencia de periodontits fue del 68% de los encuestados, no existiendo diferencias significativas para el tipo de diabetes y las franjas etarias consideradas. Sin embargo las personas que presentaban periodontits tuvieron menos dientes naturales (según auto-reporte) al ser comparados con quienes no tenían periodontitis (27.5 vs. 20.4, p=0.01). Conclusiones: Los resultados del estudio permiten apreciar una condición oral deficitaria en aquellos diabéticos con periodontitis auto-reportada debido a la ocurrencia elevada de la misma así como la menor cantidad de dientes naturales.

Objective: To determine the occurrence of periodontitis from a self-report questionnaire in a population of diabetics in Montevideo, Uruguay. Materials and methods: Participants of the 1st Diabetes Meeting in Uruguay, with a diagnosis of diabetes according to self-report, with at least 18 years of age and signed the informed consent, were invited. In all cases, a questionnaire with eight questions previously validated in Spanish was applied in order to estimate the occurrence of Periodontits in addition to identifying associated indicators. Results: A total of 37 people answered the supplied questionnaire, mostly corresponding to the female sex and an average age of 45 years. The occurrence of periodontitis was 68%, with no significant differences for the type of diabetes and the age groups considered. However, people with periodontitis had fewer natural teeth (according to self-report) when compared to those who did not have periodontitis (27.5 vs. 20.4, p = 0.01). Conclusions: The results of the study allow us to appreciate a poor oral condition in those diabetics with self-reported periodontitis due to its high occurrence as well as the lower number of natural teeth.

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Periodontitis prevalence and associated factors: a comparison of two examination protocols / Prevalencia y factores asociados a periodontitis: comparación de dos protocolos de examen WHO

ABSTRACT The fact that there are different epidemiological definitions of periodontitis and different evaluation protocols affects the estimate of periodontitis prevalence and of the influence of associated factors. The gold standard for periodontal examination is full-mouth record assessing CAL and PD. However, there are not always sufficient human and financial resources available to apply such assessment for epidemiological surveillance systems. Aim: This study was conducted to compare different protocols and definitions of periodontitis for assessing prevalence and the impact of related factors in adult patients who requested care at the School of Dentistry, UdelaR. Materials and Method: This was a cross-sectional study of 410 subjects with a high burden of disease in terms of NCDs and periodontitis. Clinical examination evaluated PD in all teeth and CAL in the CPI sextants (WHO 2013). Four periodontitis criteria were defined based on two examination protocols (WHO 2013 and WHO 1997) and two definitions of epidemiological case. Comparisons were made taking the 2013 WHO protocol as a reference. Results: Comparison of the two examination protocols showed that prevalence was underestimated when the WHO 1997 protocol was used to define moderate-severe and severe periodontitis, by 20% and 60%, respectively. Conclusions: When the severity of periodontitis was not considered, the WHO 2013 protocol did not provide more information on what factors increase the chance of periodontitis. However, when severity was considered, the associated factors were different. Consequently, in a small population, it would be worth using the WHO 2013 protocol, which is the closest to the full-mouth gold standard criterion.

RESUMEN La variabilidad en la definición epidemiológica de la periodontitis y los protocolos de evaluación afectan la medición de la prevalencia y su asociación con ciertos factores. Si bien, el patrón oro para el examen periodontal es el registro de boca completa, que evalúa la pérdida de inserción (CAL, por sus siglas en inglés) y profundidad de sondaje (PS, por sus siglas en inglés), los recursos no siempre están disponibles para los sistemas de vigilancia epidemiológica. Objetivo: En este estudio se compararon diferentes protocolos y definiciones de periodontitis evaluando la prevalencia y la asociación de factores relacionados en pacientes adultos que solicitaron atención en la Facultad de Odontología de la UdelaR. Materiales y Método: Los datos provienen de un estudio transversal de 410 sujetos con una elevada carga de enfermedad en términos de ENT y periodontitis. Se utilizó un examen clínico registrando PD en todos los dientes y CAL en los sextantes CPI (WHO 2013). Se definieron cuatro criterios de periodontitis basados en dos protocolos de examen y dos definiciones epidemiológicas de caso. Las comparaciones se realizaron tomando como referencia el protocolo de la OMS de 2013. Resultados: Al comparar los dos protocolos de examen, se verificó la subestimación de la prevalencia cuando se utilizó el protocolo de la OMS de 1997 para la definición de caso moderado-grave y para la periodontitis grave, siendo en el primer caso del 20% y en el segundo caso tres veces mayor que. Conclusiones: Si no se considera la gravedad de la periodontitis, el uso del protocolo de la OMS 2013 no proporciona más información sobre qué factores aumentan la probabilidad de periodontitis. Sin embargo, al analizar la gravedad, los factores asociados fueron diferentes. En consecuencia, en una población pequeña estaría justificado el esfuerzo de utilizar el protocolo de la OMS de 2013, ya que el criterio de referencia es la boca completa.

Efectos psicosociales de la enfermedad periodontal en la calidad de vida de pacientes de la Facultad de Odontologia (UdelaR) Un estudio cuali-cuantitativo / Efeitos psicossociais da doença periodontal na qualidade de vida de pacientes da Faculdade de Odontologia (UdelaR). Um estudo qualitativo-quantitativo / Psychosocial impact of periodontal disease on the quality of life of patients of the school of dentistry (Udelar). A qualitative-quantitative study

Resumen Objetivos: Identificar los aspectos psicosociales de la enfermedad periodontal y su incidencia en la calidad de vida de las personas que la padecen. Métodos: Se realizó un estudio mixto cuanti-cualitativo en pacientes de la facultad de odontología UdelaR. Los instrumentos utilizados fueron: entrevista (semiestructurada) con base en la teoría fundamentada y la aplicación del cuestionario OHIP-14 (Oral Health Impact Profile) que mide el grado de afectación en la calidad de vida (modelo teórico de Locker). Resultado: Se identifican los factores psicosociales que presenta esta población, así como la afectación emocional y a nivel social que provoca el diagnóstico de enfermedad periodontal. Los resultados muestran una afectación en la calidad de vida de la población de 1,46 en una escala de 0-4, donde 4 es la máxima afectación. Las participantes femeninas mostraron mayor nivel de afectación en la calidad de vida (1,54) en comparación con los hombres (1,36). A mayor grado de instrucción más afectación en la calidad de vida. Conclusiones: Existe una limitación en el enfoque biomédico en la atención de pacientes odontológicos, y por tanto la necesidad de realizar un abordaje integral en pacientes con enfermedad periodontal. Los profesionales odontólogos deben tener un enfoque biopsicosocial en la atención debido a la complejidad que presenta la enfermedad periodontal.

Resumo Objetivos: Identificar os aspectos psicossociais da doença periodontal e sua incidência na qualidade de vida das pessoas que sofrem com a doença. Métodos: Foi realizado um estudo quantitativo e qualitativo misto. Os instrumentos utilizados foram: entrevista (semiestruturada), fundamentada na teoria fundamentada em dados, e aplicação do questionário OHIP-14 (Perfil de Impacto na Saúde Oral), que mede o grau de comprometimento da qualidade de vida (modelo teórico de Locker). Resultado: são identificados os fatores psicossociais que essa população apresenta, bem como a afetação emocional e social que causa o diagnóstico de doença periodontal. Os resultados mostram uma afetação na qualidade de vida da população de 1,46 em uma escala de 0-4, onde 4 é a afetação máxima. As participantes do sexo feminino apresentaram maior nível de comprometimento da qualidade de vida (1,54) em comparação aos homens (1,36). Quanto maior o grau de escolaridade, mais a qualidade de vida será afetada. Conclusões: A limitação da abordagem biomédica no cuidado de pacientes odontológicos e a necessidade de realizar uma abordagem abrangente em pacientes com doença periodontal são evidentes. Os profissionais de odontologia devem ter uma abordagem biopsicossocial ao atendimento devido à complexidade da doença periodontal.

Abstract Objectives: To identify the psychosocial factors of periodontal disease and their impact on the quality of life of patients. Methods: A mixed quantitative and qualitative study was conducted at the School of Dentistry, UdelaR. The instruments used were a semi-structured interview based on grounded theory and the application of the OHIP-14 (Oral Health Impact Profile) questionnaire that measures the degree of impairment of quality of life (Locker's theoretical model). Results: This population's psychosocial factors are identified, as well as the emotional and social effects of periodontal disease diagnosis. The results show a 1.46 impact on people's quality of life on a scale of 0-4, where 4 is the maximum impact. Women showed a higher level of impairment in quality of life (1.54) than men (1.36). The higher the educational level, the more the quality of life is affected. Conclusions The limitations of the biomedical approach to dental patient care and the need for a comprehensive approach in periodontal disease patients are clear. Dental professionals need a biopsychosocial care approach given the complexity of periodontal disease.

Self-reported periodontitis in cannabis club members in Montevideo, Uruguay. An exploratory study

In 2013, the Oriental Republic of Uruguay enacted a law regulating the cannabis market, and since then, an increasing number of users has been registered. Previous reports based on data from other countries link cannabis smokers to worse periodontal health status. The aim of this study is to describe self-reported gingival and periodontal health status and estimate the prevalence of periodontitis among Uruguayan cannabis club members. A cross-sectional study was conducted on a convenience sample of cannabis club members in Uruguay. A survey was used to gather sociodemographic data and information on oral hygiene, use of cannabis and other drugs, and self-reported gingival and periodontal health status. Eight questions validated in Spanish were used to estimate the prevalence of total periodontitis and severe periodontitis, based on two previously implemented predictive models. The survey was completed by 50 people, of whom 68% were male and 78% were in the 20-40 year age range. Based on the first model, estimated prevalence was 12% for total periodontitis and 10% for severe periodontitis. Based on the second model, estimated prevalence was 36% for total periodontitis and 12% for severe periodontitis. These findings suggest that smoking cannabis could potentially have a detrimental effect on oral health status.

En 2013 se aprobó la ley que regula el mercado del cannabis en la República Oriental del Uruguay y desde entonces se ha registrado un creciente número de consumidores. Reportes previos a partir de datos de otros países vinculan un peor estado de salud periodontal en fumadores de cannabis. El objetivo de este estudio es describir el estado gingivo-periodontal auto-reportado y estimar la prevalencia de periodontitis en participantes de clubes cannábicos uruguayos. Se realizó un estudio transversal a partir de una muestra por conveniencia de integrantes de clubes cannábicos en Uruguay. Mediante una encuesta se recolectaron datos socio-demográficos, de higiene oral, de consumo de cannabis y otras drogas, así como de auto-reporte del estado de salud gingivo-periodontal. A partir de 8 preguntas validadas en español se estimó la prevalencia de periodontitis total y severa a través de dos modelos predictivos previamente implementados. Un total de 50 personas completaron la encuesta. El 68% eran hombres y el 78% estaba dentro del rango de 20 a 40 años de edad. Con el primer modelo la prevalencia estimada de periodontitis total fue 12% y de periodontitis severa 10%. Con el segundo modelo fue 36% para periodontitis total y 12% para periodontitis severa. Estos hallazgos sugieren que fumar cannabis podría tener un potencial efecto deletéreo sobre las condiciones de salud bucal.

Efficacy of a triclosan formula in controlling early subgingival biofilm formation: a randomized trial.

The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the test versus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.

Periodontal conditions and associated factors among adults and the elderly: findings from the first National Oral Health Survey in Uruguay.

The aims of this study were to assess the prevalence of periodontal conditions in the Uruguayan adult and elderly population and its association with socioeconomic and behavioral characteristics. Data from adults (35-44, n = 358) and elderly (65-74, n = 411) who participated in the first National Oral Health Survey, Uruguay, 2011, were used. The survey included a household questionnaire addressing socioeconomic characteristics, and tobacco use. Bleeding on probing (BOP), periodontal pockets (CPI) and clinical attachment loss (CAL) were measured by clinical examination. A multivariable analysis was carried out. Considering both age groups, the prevalence of mild/severe periodontal disease was 21.8% and 9.12% for severe periodontal disease. Adjusted analyses revealed an association between high education and all outcomes. Attendance at dental services was negatively associated with BOP and mild to severe periodontitis. Periodontal outcomes were higher in disadvantaged socioeconomic groups. Tobacco consumption has a strong association with periodontal disease in the elderly.

Influencia del consumo de cannabis en la enfermedad periodontal: una Scoping Review / Influence of cannabis use on periodontal disease: a scoping review

Recientes publicaciones plantean la posible asociación del cannabis (Cannabis sativa) con el desarrollo de la periodontitis. Objetivo: Analizar la influencia del consumo de cannabis en la enfermedad periodontal, relevando la evidencia disponible e identificando las variables asociadas en los estudios . Material y método: se realizó una Scoping Review a partir de una búsqueda estructurada en PubMed/ MEDLINE, Science Direct, LILACS, SciELO hasta mayo de 2017 .Resultados: Estudios "In vivo" mostraron una mayor pérdida ósea en animales expuestos a Cannabis. Los casos clínicos muestran que el uso crónico de cannabis puede resultar en agrandamientos gingivales y periodontitis crónica severa localizada. Los estudios epidemiológicos demuestran una asociación estadística entre Cannabis y periodontitis. Conclusiones:El consumo del Cannabis parece estar asociado con una mayor presencia de periodontitis. Sin embargo, se desconoce el mecanismo específico por el cual actúa en los tejidos gingivales.

Recent publications suggest the possible association between cannabis (Cannabis sativa) and periodontitis. Objective: To analyze the possible influence of cannabis use on periodontal disease, highlighting the available evidence and identifying the associated variables in the studies. Materials and methods: We conducted a scoping review applying a structured search method in PubMed/MEDLINE, Science Direct, LILACS, SciELO including publications until May 2017. Results: In vivo studies showed greater bone loss in animals exposed to cannabis. Clinical cases show that chronic cannabis use may result in gingival enlargement (with clinical features similar to phenytoin induced enlargement) and localized severe chronic periodontitis. Most of the epidemiological studies confirmed the possible association between cannabis and periodontitis. Conclusions: The consumption of cannabis seems to be associated with a greater presence of periodontitis. However, the specific mechanism by which cannabis acts in the gingival tissues is unknown.

Fibrina Rica en Plaquetas y Leucocitos en el tratamiento de defectos intra-óseos: Revisión Narrativa / Leucocyte and Platelet Rich Fibrin in the treatment of intra-bony defects. Narrative Review

RESUMEN: Diferentes técnicas quirúrgicas periodontales han surgido a lo largo del tiempo con el objetivo de lograr una regeneración periodontal y mejorar su predictibilidad. La Fibrina Rica en Plaquetas y Leucocitos (L-PRF) se ha posicionado como una alternativa para cumplir este objetivo, debido a que no requiere anticoagulantes en su preparación y muestra liberación sostenida de factores de crecimiento durante por lo menos 7 días. El objetivo de esta revisión narrativa es describir la evidencia disponible sobre el uso de L-PRF en defectos intra-óseos. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane Library, exploración manual y páginas web. De un total de 494 artículos recuperados, fueron seleccionados 12 publicaciones para esta revisión. Los resultados sugieren que L-PRF muestra beneficios al ser utilizada en el tratamiento periodontal regenerativo de defectos intra-óseos. Sin embargo, son necesarios ensayos clínicos con diseño metodológico estandarizado que permitan comparar L-PRF con biomateriales habitualmente empleados en el tratamiento de estos defectos.

ABSTRACT: Periodontal surgical techniques have emerged over time with the aim of achieving periodontal regeneration and improving its predictability. Leukocyte and Platelet-Rich Fibrin (L-PRF) has been proposed as an alternative, for not requiring anticoagulants in its preparation and for performing sustained release of growth factors for at least 7 days. The aim of this narrative review is to describe the available evidence on the use of L-PRF in periodontal intra-bony defects. An electronic and hand search was conducted in MEDLINE and Cochrane Library databases. Of 494 papers retrieved, 12 were selected for this review. The results suggest that even if L-PRF shows benefits when used in regenerative periodontal treatment of intra-bony defects, clinical trials with standardized methodological design are necessary to compare L-PRF with biomaterials usually used in these defects.