The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis.

OBJECTIVE: To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease's daily activities compared to the non-psoriatic ones. MATERIALS & METHODS: 296 individuals with psoriatic disease (PSO n = 210, APS n = 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. RESULTS: The prevalence of PE was higher in PsA (57.0%; OR = 2.67 95%CI 1.65-4.32; p<0.001) than in PSO (34.3%; OR = 1.05 95% CI 0.73-1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). CONCLUSION: Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.

Long-term impact of patients' compliance to peri-implant maintenance therapy on the incidence of peri-implant diseases: An 11-year prospective follow-up clinical study.

OBJECTIVE: To prospectively evaluate the incidence of peri-implant diseases and the associated risk factors during 11 years of peri-implant maintenance therapy (PIMT). MATERIAL AND METHODS: A sample of 80 partially edentulous individuals rehabilitated with dental implants was invited to participate in a PIMT program (T1-prior to entering the PIMT program). After 11 years, 51 individuals remained regularly or irregularly adherent to PIMT (T2-last recall after 11 years) and were classified as regular (RC; n = 27) or irregular (IC; n = 24) compliers. Data of interest were analyzed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implant mucositis and peri-implantitis observed at T2 in the IC group (70.8% and 37.5%, respectively) were significantly higher than those observed in the RC group (37.0% and 11.1%, respectively). The incidence of peri-implant diseases was mostly attributable to potentially modifiable risk factors, as such: RC group-PM (p = 0.013); IC group-high plaque index (p < 0.001), irregular compliance (p < 0.001), the presence of PM (p = 0.015) and periodontitis (p < 0.039). CONCLUSION: Regular compliance during PIMT had a strong effect in minimizing the incidence of peri-implant diseases. Increasing regular dental visits and improving oral hygiene would provide benefits for preventing peri-implant diseases.

Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial.

This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis.

Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis / Os efeitos do tabagismo sobre a perda dentária em indivíduos em terapia periodontal de suporte: uma revisão sistemática e meta-análise / Los efectos del consumo de tabaco en la pérdida de dientes entre personas con una terapia de mantenimiento periodontal: un revisión sistemática y metaanálisis

Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Resumo: A perda dentária tem sido relatada em estudos longitudinais sobre terapia periodontal de suporte (TPS), mas houve menos investigação sobre o efeito independente do tabagismo sobre a perda dentária, ajustado por importantes variáveis de confusão. Esta revisão sistemática teve como objetivo avaliar e analisar o efeito isolado do tabagismo sobre perda dentária em indivíduos em TPS. A estratégia incluiu fontes eletrônicas, busca manual, literatura cinzenta e artigos recentes (publicados a partir de abril de 2018), sem restrição quanto ao idioma; as datas de publicação foram incluídas. Foram selecionados estudos clínico-epidemiológicos com dados sobre perda dentária entre tabagistas em TPS, comparado com grupos-controle de não-tabagistas. A qualidade metodológica foi avaliada com a Escala de Newcastle-Ottawa. Foi realizada uma meta-análise, assim como, I2 testes de heterogeneidade e de sensibilidade. A qualidade das evidências foi avaliada com a escala GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Onze artigos foram incluídos na revisão sistemática, sendo quatro estudos de casos e controles e sete estudos de coorte. Dez dos 11 estudos concluíram que o tabagismo é importante fator de risco para a ocorrência de perda dentária. De acordo com a meta-análise de quatro dos estudos de coorte, os tabagistas em TPS apresentavam risco 3,24 vezes maior de ocorrência de perda dentária quando comparados aos não tabagistas (IC95%: 1,33-7,90). O risco global de viés nos estudos foi baixo. A revisão mostrou qualidade moderada das evidências científicas de que os tabagistas em TPS apresentam risco maior de perda dentária do que os não-tabagistas.

Resumen: La mortalidad dental ha sido estudiada en estudios longitudinales acerca de la terapia de mantenimiento periodontal (TMP), pero el efecto independiente de fumar en la pérdida de dientes (PD), ajustado a variables de confusión importantes, se ha evaluado muy poco. Esta revisión sistemática tuvo como objetivo evaluar y analizar el efecto aislado de fumar en la PD con personas bajo TMP. Se investigó en medios electrónicos, manuales, literatura gris, y artículos recientes (desde abril 2018), sin restricciones respecto a la lengua; incluyendo sus respectivas fechas de publicación. Además, se seleccionaron estudios clínicos epidemiológicos que trabajaban sobre datos de PD entre fumadores que estaban bajo TMP, en comparación con grupos de control de no fumadores. La calidad metodológica se evaluó usando la Escala de Newcastle-Ottawa. Se realizó un metaanálisis, así como tests de heterogeneidad I2 y sensibilidad. La evidencia de calidad fue evaluada usando GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Se incluyeron once trabajos en la revisión sistemática (cuatro de caso-control y siete estudios de cohortes). Diez de los once estudios concluyeron que fumar era un factor de riesgo importante para la ocurrencia de PD. Los metaanálisis de cuatro de los estudios de cohorte descubrieron que los fumadores tenían 3,24 veces más la oportunidad de sufrir PD, en comparación con los no fumadores TMP (IC95%: 1,33-7,90). En general, el riesgo de sesgo en los estudios fue bajo. La calidad de la evidencia científica respaldó moderadamente que los fumadores bajo TMP contaban con más oportunidad de PD que los no fumadores.

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

Drogas promissoras na reparação óssea periodontal: sinvastatina, ranelato de estrôncio e alendronato de sódio / Promissing drugs for periodontal bone regeneration: simvastatin, strontium ranelate, and sodium alendronate

O tratamento de defeitos ósseos intrabucais tem sido um desafi o na área odontológica, e a pesquisa de novas drogas para otimizar os resultados cirúrgicos regenerativos é de extrema importância. Existem evidências de que algumas drogas, como o ranelato de estrôncio (RSr), a sinvastatina (SNV) e o alendronato de sódio (ALE), têm propriedades anabólicas no metabolismo ósseo. A proposta desta revisão foi apresentar o estado atual da arte sobre o emprego da SNV, do RSr e do ALE em terapias odontológicas. Foi realizada uma busca bibliográfica na base PubMed e incluídos estudos relevantes relacionados ao tema para síntese deste trabalho. Concluiu-se que a aplicação do ALE e da SIN são efetivos como coadjuvantes no tratamento mêcanico da doença periodontal e como indutores de neoformação óssea, entretanto, o RSr merece ser mais bem estudado para tal afirmação.

The treatment of intraoral bone defects has been a challenge in dentistry, in this way the development of new drugs in order to optimize surgical regenerative results are extreme important. There are evidences that drugs such as strontium ranelate (RSr), simvastatin (SNV) and sodium alendronate (ALE) have anabolic properties in bone metabolism and several studies have been performed aiming to improve therapeutic strategies in bone regeneration. Therefore, the purpose of this review is to present the current state of art about the usage of SNV, RSr and ALE in dental therapies, targeting better clinical outcomes in bone manipulation techniques. A literature research was performed in PubMed database and relevant studies between were included. Our study concluded that application of ALE and SNV are effective as adjuncts with mechanical therapy of periodontal disease and also induces bone formation. In the other hand, the application of RSr as a promising bone formation drug needs to be better elucidated.

Sense of coherence and periodontal health outcomes.

OBJECTIVE: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. MATERIALS AND METHODS: The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. RESULTS: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). CONCLUSIONS: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Impact of different settings in periodontitis prevalence / Impacto das diferentes definições na prevalência de periodontite

Methods: The sample consisted of 200 pregnant women from a database. A Medline search was conducted to identify studies that evaluated the association between periodontitis and gestational diabetes. Periodontitis case definitions used in the retrieved studies were applied in the sample. The frequency of periodontitis among the different diagnostic criteria was compared through the Chi-square test. Results: After conducting a search, analysis, and selection from the literature, nine studies were included in the present study. Three studies showed the same criteria. As a result, seven different periodontitis definitions were identified. The frequency of periodontitis in the sample ranged from 24.5% to 72.5%. Conclusion: The prevalence of periodontitis greatly varies when different diagnostic criteria are used. The standardization of periodontitis case definitions in epidemiological studies is crucial for a better comparison among the studies and improvement of the results.(AU)

Objetivo: O objetivo deste estudo foi avaliar o impacto de diferentes critérios de diagnóstico na prevalência de periodontite em mulheres grávidas. Métodos: A amostra foi composta por 200 mulheres grávidas de um banco de dados. Uma pesquisa na base de dados Medline foi realizada para identificar estudos que avaliaram a associação entre periodontite e diabetes gestacional. Os diferentes critérios de diagnóstico para periodontite utilizados nesses estudos foram aplicados em nossa amostra. A comparação da frequência de periodontite entre os diferentes critérios de diagnóstico foi realizada utilizando o teste quiquadrado. Resultados: Após pesquisa bibliográfica, análise e seleção 9 estudos foram incluídos no presente estudo. Três estudos apresentavam o mesmo critério e, portanto, 7 diferentes critérios para diagnóstico da periodontite foram identificados. A prevalência de periodontite na amostra variou de 24,5% a 72,5% dependendo do critério diagnóstico utilizado. Conclusão: Na mesma amostra a prevalência de periodontite pode variar quando diferentes critérios foram utilizados para o diagnóstico. A padronização da definição de periodontite em estudos epidemiológicos é crucial para melhor comparação entre os estudos e melhoria dos resultados.(AU)

Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study.

BACKGROUND AND OBJECTIVE: Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. MATERIALS AND METHODS: A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. RESULTS: Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. CONCLUSIONS: Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures.

Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines.

BACKGROUND: There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals not or occasionally using alcohol and those with alcohol dependence. The aim of this study is to determine the effect of alcohol consumption on the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]-1ß and tumor necrosis factor [TNF]-α) in the gingival fluid among individuals with and without periodontitis. METHODS: This observational analytic study includes 88 volunteers allocated in four groups (n = 22): individuals with alcohol dependence and periodontitis (ADP), individuals with alcohol dependence and without periodontitis (ADNP), individuals not or occasionally using alcohol with periodontitis (NAP), and individuals not or occasionally using alcohol without periodontitis (NANP). Levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum were determined by real-time polymerase chain reaction on the basis of the subgingival biofilm, and IL-1ß and TNF-α were quantified by enzyme-linked immunosorbent assay in gingival fluid samples. RESULTS: Individuals with alcohol dependence showed worse periodontal status and higher levels of P. intermedia, E. corrodens, F. nucleatum, and IL-1ß than non-users. No significant correlations between TNF-α and bacterial levels were observed. However, in the ADP group, higher levels of E. corrodens were correlated with higher levels of IL-1ß. CONCLUSION: A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies.

Avaliação do risco periodontal em terapia periodontal de manutenção / Periodontal risk assessment in maintenance therapy

Este estudo teve como objetivo fazer uma avaliação do risco em indivíduos cooperadores inseridos em um programa de terapia de manutenção periodontal (TMP), através do modelo ARP (avaliação do risco periodontal) proposto por um estudo prévio1. Metodologia: foram elegíveis para determinação do risco individual pelo modelo ARP, 150 indivíduos considerados cooperadores regulares, que finalizaram terapia periodontal ativa na Faculdade de Odontologia da Universidade Federal de Minas Gerais, Brasil. Resultados: a amostra total foi composta de dois indivíduos (1,3%) de baixo risco (BR), 83 (55,3%) de moderado risco (MR) e 65 (43,4%) de alto risco (AR) à periodontite. Na última rechamada, os 150 indivíduos tinham médias de sangramento a sondagem (SS) de 29,06%, sendo em BR=16,07; MR=24,21 e AR=35,65, e média de bolsas residuais (profundidade de sondagem ≥ 5 mm) =1,15 mm (BR sem bolsas; MR=0,58 e AR=1,91). A amostra tinha um total de 854 dentes perdidos, com média de perda dentária de 5,69 (BR=1,50; MR=4,54 e AR=7,29 dentes perdidos). O fator relação perda óssea por idade teve uma média de 1,00 (BR=0,54; MR=0,87 e AR=1,19). Conclusão: a adoção do modelo ARP contribui para a determinação do risco dos indivíduos, permitindo que estes escores sejam comparados ao longo do tempo. Assim, este instrumento pode ser válido para monitorar variáveis mutáveis de risco e auxiliar na estratégia de tratamento e cooperação nos programas de TMP.

Medidas de auto-retato para periodontite: avaliação de acurácia, validação discriminante e associação com o senso de coerência / Self-report measures for periodontitis: evaluation of accuracy, discriminant validation and association with the sense of coherence

O exame clínico, padrão ouro para avaliação da doença periodontal (DP), possui custo e logística complexos, tornando a pesquisa epidemiológica em periodontia difícil e onerosa. Uma alternativa é o uso de medidas de auto-relato para determinar a DP na população. O objetivo deste estudo foi avaliar a acurácia individual de medidas periodontais de auto-relato e modelos multivariados num conjunto de medidas; testar a validade interna e discriminante destas medidas e sua a associação com o senso de coerência (SOC). A amostra final foi 332 indivíduos de 18 a 60 anos, ambos os gêneros, grupo racial e nível socioeconômico heterogêneo. Foram registrados profundidade de sondagem, nível clínico de inserção, sangramento à sondagem, índice de placa visível e mobilidade. Diferentes pontos de corte para definição de DP e medidas contínuas de parâmetros periodontais foram usadas para determinar desfechos de saúde bucal. As medidas de auto-relato foram respondidas pelo questionário proposto (Cyrino et al., 2011) e o SOC, versão curta de 13 itens (Bonanato et al., 2009). Foram determinados os valores de sensibilidade (SS), especificidade (ES), área sob a curva ROC (AROC), para cada medida e modelos multivariados preditivos para periodontite através de análises de regressão logística. O conjunto de medidas de auto-relato foi submetido à análise fatorial onde verificou a confiabilidade interna e a análise discriminante canônica validou as dimensões encontradas. Adicionalmente, foram criados modelos de regressão logística e linear para avaliar a associação entre os desfechos de saúde bucal e variáveis biológicas, sócio-demográficas e o SOC. Os valores individuais de acurácia variaram consideravelmente. Em relação a SS, os valores variaram de 7,40 (fumo) a 88,89 (uso de fio dental), para ES, os valores variaram de 13,89 (uso de fio dental) a 97,22 (mobilidade dental). No modelo logístico final, as variáveis significativas foram migração dental, perda óssea e saúde bucal (SS=85,19; SP=66,67; AROC=79,78). As medidas de auto-relato foram divididas em 3 domínios: histórico de periodontite, auto-cuidado, sinais e sintomas de periodontite e fatores de risco para periodontite; e criado um escore para quantificar a doença. A percepção de saúde bucal esteve associada ao SOC (p=0,010), renda familiar (p=0,010), fumo (p=0,004) e uso de fio dental (p=0,017), assim como percepção de doença gengival (p=0,001) e a percepção de doença periodontal (p=0,015), também associadas ao SOC. As medidas de auto-relato apresentam valores de SS e ES úteis, sendo possível criar uma nova variável latente que represente uma série de variáveis que se correlacionam e sumarizar o questionário

Progression of periodontitis and tooth loss associated with glycemic control in individuals undergoing periodontal maintenance therapy: a 5-year follow-up study.

BACKGROUND: Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. METHODS: A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full-mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5-year interval. RESULTS: Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). CONCLUSIONS: PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.

Condição peri-implantar dos indivíduos reabilitados no curso de especialização de implantodontia do CEO-IPSEMG / Peri-implantar condition of individuals rehabilitated in the ceo-ipsemg implant post graduation course

Objetivos: Avaliar a condição peri-implantar de indivíduos submetidos à reabilitação com implantes em um curso de especialização em implantodontia. Materiais e Métodos: de um total de 350 indivíduos, 110 com prontuários odontológicos completos foram considerados elegíveis. A amostra final incluiu 30 indivíduos de ambos os sexos, 18-75 anos, baixo nível socioeconômico, grupo racial heterogêneo, com implantes dentários submetidos à carga protética por no mínimo 12 meses. Dados de interesse foram coletados dos prontuários odontológicos. Mucosite foi definida como presença de um ou mais sítios com sangramento a sondagem peri-implantar (SSi), e a peri-implantite como presença de profundidade de sondagem (PS) ≥ 5mm em um ou mais sítios com perda óssea radiográfica, associadas ou não ao SSi e/ou supuração periimplantar. Resultados: A prevalência de mucosite foi de 50% (n=15) e periimplantite 3,3% (n=1). Indivíduos com mucosite apresentaram maior média de PS em dentes (p=0,042), maior índice de placa (IP) em dentes (p=0,016), maior IP em implantes (p=0,048), maior tempo pós-cirurgia (p=0,037), e maior tempo de função dos implantes (p=0,047) quando comparados com indivíduos com saúde periimplantar. Em relação ao caso de periimplantite, o indivíduo era do sexo feminino, 54 anos, fumante, apresentando 2 implantes em função há 24 meses, ambos com diagnóstico de periimplantite. Ao exame clínico, foi observado pequena faixa de gengiva ceratinizada ao redor dos implantes e alguns dentes e sítios com PS alterada. Conclusões: A mucosite foi associada a PS, IP, tempo pós-cirurgia e tempo de função dos implantes

Aims: Evaluate periimplantar condition of subjects who underwent oral rehabilitation with dental implants in a specialization course. Methods: From a total of 350 subjects, 110 with complete dental records were determined to be eligible. Final sample comprised 30 subjects from both gender, 18-57 years of age, low socioeconomic status, multiethinic group, with implants in function for at least 12 months. Variables of interest were collected from dental records. Mucositis were defined as the presence of one or more sites with periimplantar bleeding on probing (BOPi), and periimplantitis as the presence of probing depth (PD) ≥ 5mm in one or more sites with radiographic bone loss, associated or not with BOPi and/or periimplantar suppuration. Results: Prevalence of mucositis was 50.0% (n=15) and periimplantitis was 3.3% (n=1). Subjects with mucositis presented higher mean PD in tooth (p=0.042), higher plaque index (PI) in tooth (p=0.016), higher PI in implants (p=0.048), higher time since surgery (p=0.037), and higher function time (p=0.047) when compared to subjects with periimplantar health. Regarding the periimplantitis case, the subject was female, 54 years-old, smoker, with 2 dental implants in function for 24 months, both implants diagnosed with periimplantitis. Clinical examination showed narrow width of keratinized gingiva and some teeth and sites with altered PD. Conclusions: Mucositis was associated with PD, PI, time since surgery and function time.

Análise da caracterização do tabagismo em individuos participantes de estudos em periodontia - uma revisão crítica da literatura / Analysis of the characterization of smoking in individuals participating in studies of Periodontology -a critical review of the literature

O objetivo do presente estudo foi por meio de uma revisão bibliográfica avaliar a caracterização do tabagismo nos estudos em Periodontia. A busca pelos estudos foi feita na base de dados Pubmed via Medline. Foram utilizados como palavras-chaves: smoking and periodontal disease, com os seguintes limites de busca: estudos publicados nos últimos 5 anos, em humanos, envolvendo adultos (19 anos ou mais), publicados em inglês ou português. Dos 657 artigos disponíveis, 244 foram utilizados nesta revisão. Apenas um artigo, publicado em 2000, foi incluído devido ao grande número de citações deste em outros estudos. Concluiu-se que – (1) os critérios utilizados para categorizar um indivíduo como fumante são bastante variados tanto em relação à quantidade fumada quanto em relação ao tempo como fumante; (2) há uma tendência em se classificar como não fumante aqueles indivíduos que nunca fumaram; (3) Questões como “quanto tempo desde o abandono do hábito de fumar não é necessário para que um indivíduo possa ser considerado ex-fumante ou não fumante ainda permanecem conflitantes; (4) Estudos longitudinais, principalmente sobre dose exposição e influência do tempo de cessação do tabagismo na condição periodontal são ainda necessários.

The principle aim of this study was with a bibliographie review to evaluate the characterization of smoking in the studies in periodontology. The search for studies was carried out in Pubmed data base via Medline. The keywords were: smoking and periodontal disease, with de following limits to search: studies published in the last five years, in humans, envolving adults (19 years or older), published in English or Portuguese. From the 657 studies available, 244 were used in this review. Only 2 studies published in 2000 and 2005 were included do to the large number of citations in other studies. We concluded that: (1) the criteria used to categorize an individiual as smoker are very a lot in so much as the amount smoke as in relation to the time as a smoker. (2) there is a tendency to classify as non smoker the individuals who have never smoked; (3) questions like how long after quiting smoking can an individual be considered na ex smoker or non smoker still remain confliting; (4) longitudinal studies, specially on the amount of exposure and the influence of time since the individual has stopped smoking on periodontal condition are still necessary.

Validação diagnóstica de questionário para pesquisa epidemiológica da doença periodontal

As medidas de auto-relato têm sido utilizadas para avaliação epidemiológica de doenças crônicas em grandes populações, oferecendo vantagens de custo e logística. Alguns quiestionários têm sido testados em diferentes populações para a avaliação de doença periodontal, com resultados ainda escassos. O foco deste estudo foi analisar o desempenho de um conjunto de medidas de auto-relato sobre doença periodontal na estimativa da prevalência da periodontite numa amostra de indivíduos brasileiros...

Revisão comparativa de terapias com enxertos autógenos e alógenos com osso fresco congelado / Comporative analysis of therapies with autogenous grafts and allogenous grafts with frozen fresh human bone

Na Odontologia, os enxertos autógenos envolvem técnicas cirúrgicas que podem apresentar grande previsibilidade. Já consagrados pela literatura, são considerados o padrão ouro. Têm o objetivo de reparar a anatomia local, possibilitando a reabilitação bucal com implantes e, assim, reconstituir a estética e a função. Porém, a necessidade de uma área doadora os torna mais complexos e com maior risco de morbidade. Para os enxertos alógenos (homoenxertos ou enxertos com osso fresco congelado), o tecido doado advém de um banco de ossos que é responsável pela captação, processamento, análise, conservação e distribuição dos tecidos. Os bancos de tecidos são regulamentados pelo Ministério da Saúde e seguem orientações da American Association Tissue Bank (AATB). A normalização dos bancos de ossos é fundamental, pois toda a fase de processamento, desde a captação até a distribuição, determina sua segurança para uso: o congelamento reduz o potencial antigênico; a seleção do material, testes sorológicos e análise do doador determinam um tecido saudável livre de microorganismos. Assim, os homoenxertos, por apresentarem uma menor complexidade cirúrgica, menor risco de morbidade e por estarem apresentando resultados promissores para cirurgias pré-implantológicas, merecem mais pesquisas para que sua previsibilidade e segurança sejam também consagradas.