Prevalence of orofacial alterations in sickle cell disease: a review of literature

AIM: To evaluate the manifestations of sickle cell disease on the orofacial complex through a review of current literature concerning prevalence of dental caries, periodontal disease, temporomandibular joint disorders and radiographic alterations of maxillofacial bones. METHODS: Full-text papers retrieved from MEDLINE and LILACS electronic databases were critically reviewed. RESULTS: Alterations of maxillofacial bones are well documented in the literature, but studies reporting caries, periodontal condition and temporomandibular joint alterations in are scarce and inconclusive. CONCLUSION: Further well-designed epidemiological studies are needed to indicate the real impact of this disease on the stomatognathic health, collaborating to improve public health policies.

Sickle cell disease does not predispose to caries or periodontal disease.

This study investigated the prevalence of dental caries and periodontal condition in a population with sickle cell disease (SCD), analyzing some associations with disease severity. The Decayed, Missing and Filled Teeth index (DMFT) and Community Periodontal Index (CPI) were recorded for 99 individuals with SCD and 91 matched controls. Socio-demographic status, oral health behaviors, and history of clinical severity of SCD were assessed. Statistical comparisons were performed between the group with SCD and the control group, as well as multivariate logistic regression analyses with DMFT index and CPI as the dependent variables. The mean number of decayed teeth was significantly higher in individuals with HbSS. Older age, female gender, and daily smoking were identified as risk factors for higher DMFT, while older age and absence of daily use of dental floss were risk factors for the development of periodontal disease. In conclusion, risk factors known to cause caries and periodontal disease had more influence on oral health than the direct impact of SCD.

Correlation between maxillofacial radiographic features and systemic severity as sickle cell disease severity predictor.

This study was conducted to investigate the relationship among radiographic features observed on panoramic radiographs of sickle cell disease patients and analyze their relationship with history of systemic severity of the disease. Panoramic radiographs of 71 subjects with sickle cell disease were evaluated for the presence of the following radiographic bony alterations: radiopaque areas, increased spacing of bony trabeculae, horizontal arrangement of bony trabeculae and corticalization of mandibular canal. History of clinical systemic severity was assessed through direct questioning about the frequency of vaso-occlusive crisis, history of stroke, clinical jaundice, femur head necrosis, and leg ulceration. Chi-square or Fisher's exact test were applied in order to analyze possible associations between radiographic features and history of complications, with p < 0.05 significance level. Increased spacing of bony trabeculae was statistically associated with absence of corticalization of mandibular canal (p < 0.01) and horizontal arrangement of bony trabeculae (p = 0.04). Statistically significant associations were demonstrated between history of clinical jaundice and presence of increased spacing of bony trabeculae (p = 0.02) and between history of stroke and presence of horizontal arrangement of bony trabeculae (p = 0.04). Based on the results of the current study, maxillofacial radiographic features may be associated with clinical parameters of systemic complications in sickle cell disease patients. The relationship between radiographic features and history of complications associated with clinical severity of sickle cell disease has not been demonstrated in the literature. Acknowledgment of such possible association may help establish prognosis and influence clinical treatment of systemic and oral complications.

Radiographic changes of the jaws in HbSS and HbSC genotypes of sickle cell disease.

This study used panoramic radiographs to evaluate the presence of radiographic changes in the jaws of a population who had sickle cell disease (SCD). The authors compared the frequency of findings between subjects with and without SCD. Panoramic radiographs of 71 subjects with SCD (36 with HbSS and 35 with HbSC) and 52 healthy controls (HbAA) were evaluated for the presence of the following radiographic alterations: radiopaque areas, increased spacing of bony trabeculae, horizontal arrangement of bony trabeculae, and absence of mandibular canal corticalization. The control group had a significantly smaller number of all the radiographic features evaluated. Differences were not statistically significant between the groups with HbSS and HbSC, except for more trabecular spacing in the molar region in the HbSS genotype, suggesting a possible correlation between radiographic findings and disease presentation.

Nova técnica para remoção de retentores intra-radiculares / New technique to intraradicular posts removal

A remoção de retentores intraradiculares constitui um procedimento difícil, arriscado e demorado, sendo, muitas vezes, um desafio para o cirurgião-dentista. A literatura descreve várias técnicas e aparelhos para a solução deste problema, como o em prego de ultra-som, o desgaste por meio de instrumentos rotatórios e a tração por alicates ou fórceps especiais. Este trabalho relata uma nova técnica para a remoção de retentores intra-radiculares metálicos fundidos, cimentados com fosfato de zinco.

Inflammatory cytokines activity in temporomandibular joint disorders: a review of literature

Cytokines are important polypeptides mediators of acute and chronic inflammation. These molecules act as a complex immunological network, in which there are pro-inflammatory cytokines, such as interleukin-1 (IL-1), IL-6 and tumor necrosis factor-a (TNF-a), and anti-inflammatory mediators like IL-10 and transforming growth factor-b. In spite of some controversial findings, in general high levels of pro-inflammatory cytokines have been correlated with signs and symptoms of temporomandibular disorders (TMD) such as internal derangement and osteoarthritis. These mediators promote degradation of cartilage and bone joint by inducing release of proteinases and other inflammatory molecules. Indeed, pro-inflammatory cytokines have been associated with temporomandibular joint (TMJ) tissue destruction. However, its mechanisms and pathophysiology have not been clearly delineated. In attempt to summarize the role of cytokines in TMD pathophysiology and its potential for medical intervention, the purpose of the current study was to review the literature concerning the analysis of these inflammatory mediators in TMJ fluid and tissues.

Interleukin-2 and interleukin-6 gene promoter polymorphisms, and early failure of dental implants.

Single nucleotide polymorphisms in the promoter region of the human interleukin (IL)-2 (T-330G) and IL-6 (G-174C) genes have modified the transcriptional activity of these cytokines and are associated with several diseases. The aim of this study was to investigate the possible relationship between these single nucleotide polymorphisms and early implant failure. A sample of 74 nonsmokers was divided into 2 groups: test group comprising 34 patients (mean age 49.3 years) with >or=1 implants that failed and control group consisting of 40 patients (mean age 43.8 years) with >or=1 healthy implants. Genomic deoxyribonucleic acid from oral mucosa was amplified by polymerase chain reaction and analyzed by restriction fragment length polymorphism. Monte Carlo simulations (P < 0.05) were used to assess differences in allele and genotypes frequencies of the single nucleotide polymorphisms between the 2 groups. No significant differences were observed in the allele and genotypes distribution of both polymorphisms when the 2 groups were compared. The results indicate that polymorphisms in the IL-2 (T-330G) and IL-6 (G-174C) genes are not associated with early implant failure, suggesting that the presence of those single nucleotide polymorphisms does not constitute a genetic risk factor for implant loss in the studied population.

Analysis of the transforming growth factor-beta 1 gene promoter polymorphisms in early osseointegrated implant failure.

Transforming growth factor-beta 1 is a multifunctional cytokine involved in extracellular matrix deposition, reduction of inflammation, and promotion of wound healing. Single nucleotide polymorphisms in the promoter region of human transforming growth factor-beta 1 gene, C-509T and G-800A, have been shown to increase the transcriptional activity of this cytokine and have been associated with a variety of diseases. The objective of this study was to investigate the possible association between these single nucleotide polymorphisms and the early implant failure. A sample of 68 nonsmoking patients was divided into two groups: a test group comprising 28 patients with one or more early failed implants and a control group consisting of 40 individuals with one or more healthy implants. Genomic DNA from oral mucosa was amplified by polymerase chain reaction and analyzed by restriction fragment length polymorphism. The significance of the differences in observed frequencies of single nucleotide polymorphisms was assessed using the chi square test and Fisher's exact test. The cited single nucleotide polymorphisms in transforming growth factor-beta 1 were analyzed in combination as haplotype using the computer program ARLEQUIN. The authors did not observe significant differences in the allele and genotypes to both single nucleotide polymorphisms of transforming growth factor-beta 1 gene (C-509T and G-800A) between control and early implant failure groups. The distribution of the haplotypes arranged as allele and genotypes were similar between control and test groups. These results indicate that C-509T and G-800A polymorphisms in the transforming growth factor-beta 1 gene are not associated separately or in haplotype combinations with early implant failure, suggesting that the presence of those single nucleotide polymorphisms alone do not constitute a genetic risk factor for early implant failure in the Brazilian population.

Early failure of dental implants and TNF-alpha (G-308A) gene polymorphism.

Tumor necrosis factor-alpha (TNF-alpha) is a potent inflammatory mediator with bone resorption activity. Polymorphisms in the promoter region of the human TNF-alpha gene have been shown to affect the levels of this cytokine and have been associated with a variety of diseases. The aim of this study was to investigate the possible relationship between early implant failure and a single nucleotide polymorphism (SNP) in the -308 promoter region of the TNF-alpha gene. A sample of 66 nonsmokers was divided into 2 groups: a test group comprising 28 patients (mean age, 52.7 years) with one or more early failed implants and a control group consisting of 38 individuals (mean age, 43.2 years) with one or more healthy implants. Genomic DNA from buccal mucosa was amplified by the polymerase chain reaction (PCR), analyzed by restriction fragment length polymorphism (RFLP), and submitted to polyacrylamide gel electrophoresis to distinguish allele G and allele A of the TNF-alpha (-308) gene polymorphism. Differences in the allele and genotype frequencies between control and test groups were assessed by chi-squared test (P <0.05). No significant difference was observed in the allele (P = 0.4635) and genotype (P = 0.4445) distribution of the polymorphism when control and failure groups were compared. The results indicate that the TNF-alpha (G-308A) gene polymorphism is not associated with early implant failure, suggesting that its presence alone does not constitute a genetic risk factor for implant loss in the Brazilian population.

Influência da interleucina: 1 Beta e de suas variaçöes genéticas na periodontite e periimplantite / The influence of interleukin - 1 Beta and their genetic variations on periodontitis and periimplantitis

As citocinas säo moléculas que possuem importante papel na regulaçäo da resposta inflamatória. Dentre elas, as interleucinas (IL) säo alvo de muitos estudos que tentam correlacioná-las com a doença periodontal. Este artigo tem o objetivo de realizar uma revisäo de literatura, abordando o papel da IL-1 na periodontite e na periimplantite, além de estabelecer a relaçäo de variaçöes genéticas associadas à produçäo desta citocina com a severidade da doença periodontal e com a perda de implantes osseointegráveis

Infecção do espaço submassetérico: relato de caso / Submasseteric space infection: a case report

As infecções odontogênicas são complicações frequentemente encontradas pelos cirurgiões-dentistas. Estas podem se disseminar, localizando-se em regiões distantes do seu sítio de origem, o que dificulta o estabelecimento do correto diagnóstico e terapia apropriada. Os espaços fasciais são potencialmente localizadores de secreções e constituem um trajeto pelo qual as infecções podem se disseminar com facilidade. O espaço submassetérico constitui o grupo dos espaços mastigatórios e pode ser sítio de infecções que normalmente se originam de pericoronarites associadas a terceiros molares mandibulares impactados. Este artigo aborda os aspectos da infecção do espaço submassetérico através de uma breve revisão de literatura e relato de caso clínico