Association of sense of coherence and periodontal disease severity, in two cross-sectional studies.

OBJECTIVES: To investigate the association between the individuals' level of sense of coherence (SOC) and periodontal disease severity. METHODS: The study populations originated from two stratified cross-sectional random samples of residents in a medium-sized Swedish city in 2003 and 2013, respectively. The final samples constituted 491 individuals in 2003 and 538 individuals in 2013. The samples were classified into three groups according to the severity of periodontitis (no/minor, moderate and severe). The 13-item Swedish version of Antonovsky's "Orientation to life" questionnaire, measuring the individual's SOC, was filled out. Descriptive statistics were performed as well as multinomial logistic regression analysis. Dependent variable was the severity of periodontal disease and independent variables, age in years, presently smoking and education at university level. RESULTS: In the multinomial regression analysis, smoking, age, and total SOC score were significantly associated with severe periodontitis at both examinations. The strongest predictor of severe periodontal disease was smoking. The total SOC score did not differ between the examinations, but there was a statistically significant difference in two of the SOC dimensions, manageability (lower), and comprehensibility (higher), over time. CONCLUSIONS: Individuals with severe periodontitis had significantly lower SOC compared to subjects periodontally having no/minor periodontal disease. Smoking was the strongest overall predictor of having severe periodontitis.

Is there association between stress and periodontitis?

OBJECTIVE: This study estimated the association between stress and periodontitis. MATERIALS AND METHODS: A cross-sectional study was conducted with a sample of 621 individuals. Information about individuals was obtained through a questionnaire. Stress was evaluated using the Perceived Stress Scale. The diagnosis of periodontitis was based on a complete periodontal examination including clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios (PR), crude and adjusted, and their respective 95% confidence intervals (95%CI) were estimated by Poisson regression analysis. RESULTS: In the final sample, 48.47% (301) of the individuals were classified as having stress, of which, 23.92% (72) had the diagnosis of periodontitis. Association measurements between stress and probing depth ≥ 4 mm (PRadjusted = 1.28, 95%CI [1.04 to 1.58]), stress and clinical attachment level ≥ 5 mm (PRadjusted = 1.15, 95%CI [1.01 to 1.31]), and stress and periodontitis (PRadjusted = 1.36, 95%CI [1.01 to 1.83]) showed that the frequency of these outcomes among those exposed to stress was 15-36% higher than those without the condition of stress, after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease, and body mass index. CONCLUSIONS: The findings showed positive association between exposure to stress and the presence of periodontitis, reaffirming the need to prevent and control stress. CLINICAL RELEVANCE: Although there are limitations in this study, the results showed that an association exists between stress and periodontitis, signaling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

Abstract Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ±1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.

C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour.

INTRODUCTION: Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour. METHODS: Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program. RESULTS: Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (P=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (P=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (P=0.344) or periodontitis (P=0.541). CONCLUSIONS: We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.

Symptoms of depression and their relation to myocardial infarction and periodontitis.

BACKGROUND: Psychosocial stress and depression are established risk factors for cardiovascular disease and a relationship to periodontitis has been suggested. We studied symptoms of depression and their relation to myocardial infarction and periodontitis. METHODS: In a Swedish case-control study, 805 patients, <75 years with a first myocardial infarction and 805 controls without myocardial infarction were matched for age, gender and geographic area. Mean age was 62±8 years and 81% were male. Standardised physical examination and dental panoramic X-ray for grading of periodontal status was performed. Medical history including risk factors related to cardiovascular disease and periodontitis was collected as was detailed information on perceived stress at home and work, and symptoms of depression (Montgomery Åsberg Depression Scale). A Montgomery Åsberg Depression Scale score ⩾13 was considered clinically relevant. RESULTS: A family history of cardiovascular disease, smoking and divorce was more frequent among patients than controls. Patients had more symptoms of depression than controls (14 vs 7%; p<0.001) but received less anti-depressive treatment (16 vs 42%; p<0.001). Symptoms of depression doubled the risk for myocardial infarction (Montgomery Åsberg Depression Scale: odds ratio 2.17 (95% confidence interval 1.41-3.34)). There was no difference in symptoms of depression between study participants with and without periodontitis. CONCLUSION: Patients with a first myocardial infarction were more frequently depressed than matched controls without myocardial infarction, but received less anti-depressive treatment. A relationship between depression and periodontitis could not be confirmed.

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.

Dental patients' perceptions and motivation in smoking cessation activities.

OBJECTIVE: The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry. MATERIALS AND METHODS PATIENTS: who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists. RESULTS: The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55). CONCLUSIONS: This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Evaluation of periodontitis in hospital outpatients with major depressive disorder. A focus on gingival and circulating cytokines.

An imbalance in stimulated cytokine production is associated with the etiopathogenesis of numerous diseases such as major depressive disorder (MDD) and periodontal disease. Increased cytokine levels have been reported in the gingival crevicular fluid (GCF) of patients with MDD. Thirty-six outpatients with MDD participated in this study. Each outpatient was age-matched (± 3 years) with a healthy control (n=36). The patients were controlled for race and smoking habits. Unstimulated and stimulated interleukin 6 (IL-6), interleukin 1ß (IL-1ß), and interferon-γ (INF-γ) production in whole blood culture (WBC) and IL-6 and IL-1ß levels in the GCF were evaluated. Circulating levels of IL-6 and IL-1ß (unstimulated) as well as GCF IL-1ß were modestly lower in MDD patients, compared to the levels in age-matched controls (Mann-Whitney, p=0.002, 0.0075, ANCOVA, p=0.025, respectively). In the unstimulated group, there was no correlation between the levels of circulating IL-6 and GCF IL-6 (r=0.07, p=0.67), and between the levels of circulating IL-1ß and the IL-1ß level in the CGF (r=-0.08, p=0.63). In the LPS stimulation group, there was no correlation between the levels of circulating levels of IL-6 and GCF IL-6 (r=0. 02, p=0.91) or between the circulating IL-1ß and GCF IL-1ß (r=0.13, p=0.42). We observed modest immunosuppression in MDD patients (evaluated by no stimulation whole blood culture [WBC]), especially in patients with melancholic depression, chronic depression, and severe depression.

Impact of periodontal disease and periodontal therapy on oral health-related quality of life.

OBJECTIVE: To determine the impact of periodontal disease and periodontal therapy on oral health-related quality of life using the German version of the Oral Health Impact Profile, taking into account the possible effects of age, gender and socioeconomic factors. METHODS: This is a study of 93 patients of both sexes aged 27-74 years. The sample included 82 patients with a diagnosis of periodontal diseases, 11 patients without periodontitis (control group). All patients used the German 14-item version of the Oral Health Impact Profile, as well as a socioeconomic and demographic questionnaire. This was used to assess oral health-related quality of life issues. The questionnaire and clinical inspection were done before and 6-8 weeks after the periodontal treatment. RESULTS: Periodontal diseases have an effect on oral health-related quality of life issues. Scores for the German 14-item version of the Oral Health Impact Profile were associated with severity of periodontal diseases, sex, age, oral hygiene and smoking habits. The highest scores included those patients with a probing pocket depth of > 7 mm. The median score of these patients was reduced from 14.4 at baseline to 5.5 after treatment (P = 0.007). These patients perceived physical, social and psychological changes in oral health-related quality of life after periodontal therapy. Median OHIP-G-14 scores were reduced from 6.3 at baseline to 4.8 6-8 weeks after treatment (P < 0.001). The number of teeth with a probing pocket depth > 3 mm could be reduced from 76.0% at baseline to 27.6% after treatment. CONCLUSION: The association between periodontal diseases and the oral health-related quality of life was determined. The positive effect of the periodontal treatment on the oral health related quality of life was also shown and was most pronounced for patients with a probing pocket depth of > 7 mm.

Diazepam reverses the alveolar bone loss and hippocampal interleukin-1beta and interleukin-6 enhanced by conditioned fear stress in ligature-induced periodontal disease in rats.

BACKGROUND AND OBJECTIVE: Stress and anxiety have been associated with chronic periodontitis, but few studies examining the effects of psychotropic drugs on periodontal health have been performed. Therefore, we aimed to investigate the effects of diazepam on the progression of periodontitis in chronically stressed rats. MATERIAL AND METHODS: Fourteen Wistar rats were submitted to ligature-induced periodontal disease and were divided into four groups . Two groups were not stressed, whereas two groups were submitted to a conditioned fear stress paradigm for 38 d. Daily diazepam treatment (2 mg/kg, orally) was administered to one unstressed group and to one group submitted to a conditioned fear stress paradigm from day 2 to the day 39, at which point the rats were submitted to an open field test and were killed on day 40. Brains and mandibles were removed for histological and immunohistochemical analyses. RESULTS: Animals exposed to conditioned fear stress presented an increase in freezing behavior, a decrease in locomotor activity, enhanced alveolar bone loss and higher levels of hippocampal interleukin-1beta (IL-1ß) and interleukin-6 (IL-6), compared with the control group. Diazepam, at the dose used in the current study, had no effect on freezing behavior but reversed the decrease in locomotor activity provoked by stress. Additionally, the treatment reduced the levels of hippocampal IL-1ß and IL-6 and alveolar bone loss in Wistar rats. Neither conditioned fear stress nor diazepam treatment had an effect on periodontal IL-1ß or IL-6 levels in animals. CONCLUSION: Our results suggest that diazepam treatment reduces bone loss in rats submitted to conditioned fear stress. In addition, diazepam treatment led to decreased IL-1ß and IL-6 levels in the hippocampus.

Psychosocial distress and periodontitis in adolescents.

PURPOSE: To assess whether adolescents with periodontitis presented with higher scores for non-psychotic psychosocial disorders than control subjects without periodontitis. MATERIALS AND METHODS: A case control study (n = 160) nested in a well-defined adolescent population (n = 9,163) was performed using the 28-item Spanish version of the General Health Questionnaire. The inclusion criterion for being a case was a clinical attachment level of >= 3 mm in at least two teeth. Multiple logistic regression analyses were used to assess the association between periodontitis and psychosocial distress. RESULTS: The response rate was high and 94% of the participants answered all the items of the questionnaire. Similarly, the internal consistency of the instrument was high (Cronbach's = 0.91). The results of multiple logistic regression analyses, adjusted for age and gender, suggested an association between case status and higher total scoring for psychosocial distress (OR = 1.69). Among the four subdomains of the General Health Questionnaire, the dimensions 'somatic symptoms' and 'severe depression' appeared positively associated with periodontal case status, albeit not significantly. CONCLUSION: The findings of this study suggest that the association between periodontitis and dimensions of psychosocial distress can be documented early in life. This calls for awareness on the part of healthcare providers attending adolescents.

Potential impact of surgical periodontal therapy on oral health-related quality of life in patients with periodontitis: a pilot study.

AIM: To gain insight into the impact of periodontal surgery on oral health-related quality of life (QoL) of patients with periodontitis. MATERIAL AND METHODS: Study participants were recruited from moderate to severe periodontitis patients. After initial periodontal therapy, participants received periodontal surgery. Oral Health-related Quality of Life Model for Dental Hygiene (OHRQL) was used to assess participant's QoL at each time point of periodontal evaluation (baseline, at least 3 weeks after initial therapy and 3-4 months after surgery). RESULTS: A total of 21 patients completed OHRQL assessment after surgery. Compared with baseline, a progressive improvement in periodontal parameters was observed during the periodontal therapy. The total mean OHRQL score at baseline (25.5 ± 11.4) was significantly reduced (improved) after initial therapy and after surgery (16.7 ± 9.5 and 15.0 ± 9.7, respectively; p < 0.01). However, no significant difference was found between the OHRQL score after initial therapy and that after surgery. CONCLUSIONS: No significant differences in patients' oral health-related QoL were observed between post-initial therapy and post-surgery intervals, although a tendency of surgery to determine an improvement in QoL was observed when compared with post-initial treatment.

The relationship between social network, social support and periodontal disease among older Americans.

AIM: The objectives of this study were to examine the relationship between social network, social support and periodontal disease among older American adults and to test whether social network and support mediates socioeconomic inequality in periodontal disease. MATERIALS AND METHODS: Data pertaining to participants aged 60 years and over from the National Health and Nutrition Examination Survey 2001-2004 were used. Periodontal disease variables were extent loss of periodontal attachment ≥3 mm and moderate periodontitis. Social support and networks were indicated by the need for emotional support, number of close friends and marital status. RESULTS: Widowed and those with lowest number of friends had higher rates of the extent of loss of periodontal attachment (1.27, 95% CI: 1.03, 1.58) and (1.22, 95% CI: 1.03, 1.45), respectively. Marital status and number of friends were not significantly associated with moderate periodontitis after adjusting for behavioural factors. The need for more emotional support was not related to periodontal disease in this analysis. Social networks and support had no impact on socioeconomic inequality in periodontal disease. CONCLUSION: Certain aspects of social network, namely being widowed and having fewer friends, were linked to the extent of loss of periodontal attachment but not to the definition of moderate periodontitis, in older adults.

Oral impact on daily performance, personality traits, and compliance in periodontal maintenance therapy.

BACKGROUND: To our knowledge, the association between personality traits and oral health impacts on daily activities among patients under periodontal maintenance was not previously evaluated. The present study aims to determine the oral health impacts among regular- and erratic-complier patients and their correlations with personality traits by means of the oral impacts on daily performance (OIDP) and the neuroticism extraversion openness five-factor inventory (NEO FFI-R) instruments. METHODS: A total of 58 regular and 58 erratic compliers matched by sex, diabetes, and smoking were recruited from a cohort of 238 participants under periodontal maintenance. Periodontal examinations and questionnaire applications were performed in recalls during a 3-year interval. The influence of variables of interest on the OIDP was evaluated through univariate and multivariate linear regression analyses. RESULTS: The periodontal status of regular compliers was significantly better than that of erratic compliers. Erratic compliers presented higher OIDP scores (36.34 ± 6.64) compared to regular compliers (30.45 ± 7.72). Higher scores of neuroticism and conscientiousness (R(2) = 68%; P <0.001) were associated with higher OIDP scores among regular compliers, whereas among erratic compliers, lower scores of neuroticism, higher openness, and extraversion (R(2) = 77%; P = 0.001) were associated with higher OIDP scores. CONCLUSION: Personality traits, mainly neuroticism, showed significant influences on OIDP among patients under periodontal maintenance.

Traditional and emerging oral health practices in parts of Nigeria.

OBJECTIVE: The purpose of this study was to document the beliefs and perceptions and emerging oral health care practices in parts of Nigeria. METHODS: A descriptive study, based in four different locations that were selected to reflect urban-rural and geographical spread, was conducted. Focus group discussions and in-depth interviews were conducted among representative groups and significant gatekeepers in the study areas. The discussions focused on oral health problems frequently encountered in the communities, their dietary and snacking habits as well as the dental remedies commonly employed by the people for prophylactic and therapeutic purposes. RESULTS: It was revealed that in both rural and urban low- to- middle socio-economic classes, periodontitis was the commonest dental problem in adults, while dental caries in children appeared to be also a cause for concern especially in northern Nigeria and the urban south. Most adults ate the local staple carbohydrate diets, however large quantities of cariogenic snacks were reported to be consumed. Chewing sticks and locally prepared toothpastes ranked prominent among the tooth cleaning implements, but many in the cities used toothbrushes. Various dental care remedies were employed ranging from warm saline wash to herbal preparations, antibiotics and battery water. In communities studied, the belief in ill defined "worms" as causative agents of all oral health problems was very firm. Consultation with traditional oral healthcare practitioners was a practice commonly observed in all study sites. CONCLUSION: This study has highlighted specific areas for intervention in disease prevention and oral health promotion in Nigeria.

Avaliação quantitativa das citocinas IL-4, IL-6, IL-8, IL-10 e do TGF-β, presentes na saliva de pacientes com periodontite, antes e após a submissão à psicoterapia: análise comparativa com pacientes controles / Quantitative evaluation of the cytokines IL-4, IL-6, IL-8, IL-10 and TGF-β presents in the saliva of patients with periodontitis, before and after submission to psychotherapy: comparative analisys with control patients

Considerando a condição multi-fatorial da etiologia da doença periodontal, em particular a influência do estresse, evidente na literatura, esta pesquisa teve como propósito avaliar 2 grupos de indivíduos com doença periodontal, sendo que um grupo foi submetido à psicoterapia (grupo experimental - N=13) por 3 meses, enquanto o outro grupo serviu como controle(N=13); em ambos os grupos nenhuma intervenção periodontal foi realizada nesse período, seja curativa ou preventiva. Os dados obtidos dos indivíduos de ambos os grupos, no "baseline" e no final do experimento (após 3 meses) incluíram: níveis das citocinas IL-4, IL-6, IL-8, IL-10 e TGF- β (salivares), parâmetros periodontais (profundidade de sondagem-PS, nível de inserção- NI, recessão gengival, índice de placa-IP, índice gengival-IG) e o número de dentes perdidos (NDP). Também o nível de cortisol (NC) e análise psicológica do grau de estresse dos indivíduos que compuseram a amostra, foram importados de GREGHI-2009, para análise conjunta com os demais parâmetros. Os pacientes foram triados seguindo vários critérios de exclusão e inclusão. Na análise dos parâmetros periodontais verificou-se que no grupo experimental houve uma melhora significante do IP e do IG, e no grupo controle ocorreu uma piora significante do IP. A análise laboratorial mostrou que o NC diminuiu de forma significativa no grupo experimental e no grupo controle houve um aumento significativo do nível de IL-6. Cabe destacar que, embora as diferenças entre os níveis iniciais e finais das citocinas analisadas, não tenham sido estatisticamente significantes, no grupo experimental houve uma tendência do aumento das citocinas anti-inflamatórias e diminuição das citocinas pró-inflamatórias. Como conclusão final admitiu-se que o estresse pode repercutir negativamente no controle de placa, que o NC elevado pode aumentar os riscos de comprometimento periodontal, que a psicoterapia pode interferir de forma positiva em alguns parâmetros clínicos...

Considering the multi-factorial etiology of periodontal disease, particularly the evidence based influence of stress, this research aimed at evaluating two groups of individuals with periodontal disease. One of them was subjected to psychotherapy (experimental group N=13) during 3 months while the other served as control group (N=13); none f the groups received any curative or preventive periodontal intervention in the period. The achieved data from both groups of individuals at baseline and at the end of the experiment (3 months) included: cytokines levels IL-4, IL-6, IL-8, IL-10 and TGF- β (salivary), periodontal parameters (probing depth - PS, attachment level - NI, gingival recession, plaque index - IP, gingival index -IG) and number of lost teeth (NDP). The cortisol level (NC) and the psychological analysis of the stress level in the individuals who constituted the sample were imported from GREGHI-2009 for concurrent analysis with the other parameters. The patients were selected by respecting several inclusion and exclusion criteria. The periodontal parameters analysis showed that there was a significant improvement of IP and IG in the experimental group and there was a significant worsening of IP in the control group. The laboratorial analysis showed that the NC diminished significantly in the experimental group and there was a significant magnification in the level of IL-6 in the control group. It is worthwhile to emphasize that even though the differences between the initial and final levels of the analyzed cytokines were not statistically significant, there was a tendency of augmentation in the anti-inflammatory cytokines levels and decrease in the pro-inflammatory cytokines levels in the experimental group. As a final conclusion, it was accepted that the stress can negatively influence the plaque control, the elevated NC can increase the risk for periodontal breakdown, the psychotherapy can positively interfere in some clinical and laboratorial...

Avaliação quantitativa das citocinas IL-4, IL-6, IL-8, IL-10 e do TGF-β, presentes na saliva de pacientes com periodontite, antes e após a submissão à psicoterapia: análise comparativa com pacientes controles / Quantitative evaluation of the cytokines IL-4, IL-6, IL-8, IL-10 and TGF-β presents in the saliva of patients with periodontitis, before and after submission to psychotherapy: comparative analisys with control patients

Considerando a condição multi-fatorial da etiologia da doença periodontal, em particular a influência do estresse, evidente na literatura, esta pesquisa teve como propósito avaliar 2 grupos de indivíduos com doença periodontal, sendo que um grupo foi submetido à psicoterapia (grupo experimental - N=13) por 3 meses, enquanto o outro grupo serviu como controle(N=13); em ambos os grupos nenhuma intervenção periodontal foi realizada nesse período, seja curativa ou preventiva. Os dados obtidos dos indivíduos de ambos os grupos, no "baseline" e no final do experimento (após 3 meses) incluíram: níveis das citocinas IL-4, IL-6, IL-8, IL-10 e TGF- β (salivares), parâmetros periodontais (profundidade de sondagem-PS, nível de inserção- NI, recessão gengival, índice de placa-IP, índice gengival-IG) e o número de dentes perdidos (NDP). Também o nível de cortisol (NC) e análise psicológica do grau de estresse dos indivíduos que compuseram a amostra, foram importados de GREGHI-2009, para análise conjunta com os demais parâmetros. Os pacientes foram triados seguindo vários critérios de exclusão e inclusão. Na análise dos parâmetros periodontais verificou-se que no grupo experimental houve uma melhora significante do IP e do IG, e no grupo controle ocorreu uma piora significante do IP. A análise laboratorial mostrou que o NC diminuiu de forma significativa no grupo experimental e no grupo controle houve um aumento significativo do nível de IL-6. Cabe destacar que, embora as diferenças entre os níveis iniciais e finais das citocinas analisadas, não tenham sido estatisticamente significantes, no grupo experimental houve uma tendência do aumento das citocinas anti-inflamatórias e diminuição das citocinas pró-inflamatórias. Como conclusão final admitiu-se que o estresse pode repercutir negativamente no controle de placa, que o NC elevado pode aumentar os riscos de comprometimento periodontal, que a psicoterapia pode interferir de forma positiva em alguns parâmetros clínicos...

Considering the multi-factorial etiology of periodontal disease, particularly the evidence based influence of stress, this research aimed at evaluating two groups of individuals with periodontal disease. One of them was subjected to psychotherapy (experimental group N=13) during 3 months while the other served as control group (N=13); none f the groups received any curative or preventive periodontal intervention in the period. The achieved data from both groups of individuals at baseline and at the end of the experiment (3 months) included: cytokines levels IL-4, IL-6, IL-8, IL-10 and TGF- β (salivary), periodontal parameters (probing depth - PS, attachment level - NI, gingival recession, plaque index - IP, gingival index -IG) and number of lost teeth (NDP). The cortisol level (NC) and the psychological analysis of the stress level in the individuals who constituted the sample were imported from GREGHI-2009 for concurrent analysis with the other parameters. The patients were selected by respecting several inclusion and exclusion criteria. The periodontal parameters analysis showed that there was a significant improvement of IP and IG in the experimental group and there was a significant worsening of IP in the control group. The laboratorial analysis showed that the NC diminished significantly in the experimental group and there was a significant magnification in the level of IL-6 in the control group. It is worthwhile to emphasize that even though the differences between the initial and final levels of the analyzed cytokines were not statistically significant, there was a tendency of augmentation in the anti-inflammatory cytokines levels and decrease in the pro-inflammatory cytokines levels in the experimental group. As a final conclusion, it was accepted that the stress can negatively influence the plaque control, the elevated NC can increase the risk for periodontal breakdown, the psychotherapy can positively interfere in some clinical and laboratorial...

Involvement of psychosocial factors in the association of obesity with periodontitis.

The present case-control study of 79 subjects (19-69 yr) was designed to assess the relationship of several psychological determinants to periodontal disease and obesity. Periodontal clinical examinations were performed, and the subjects were asked to complete a set of questionnaires measuring Type A personality, anxiety, depression, dental anxiety, hopelessness, emotional intelligence, stress, self-esteem, optimism and satisfaction with life. In a bivariate analysis, overweight individuals presented higher levels of smoking exposure, anxiety and depression and lower levels of optimism and satisfaction with life. They were mainly females, with a higher number of sites and teeth with probing depth (PD) >6 mm and clinical attachment level (CAL) >5 mm. Patients with a mean PD exceeding 3 mm and a bleeding on probing index of >25% presented higher values of dental anxiety and lower levels of self-esteem. Multiple linear regression analyses revealed that dental anxiety was positively associated with the number of teeth with a PD of >6 mm and with reasons for visiting a dentist, while satisfaction with life was associated with flossing frequency. We conclude that there is an association between several psychological determinants, periodontitis, and body mass index.

Immediate post-operative effects of different periodontal treatment modalities on oral health-related quality of life: a randomized clinical trial.

AIM: Oral health-related quality of life (OHQoL) characterizes a person's perception of how oral health influences an individual's life quality. The aim of this study is to investigate how the treatment modalities may affect the immediate post-operative quality of life of patients with periodontitis. MATERIALS AND METHODS: Sixty psychologically and socio-demographically matched periodontitis patients were randomly divided into three groups [20 non-surgical (NS), 20 surgical (SG), 20 surgical plus enamel matrix protein derivative (S+EMD)]. The OHQoL was assessed with two patient-centred outcome measures [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)] in the post-operative period of 1 week. RESULTS: Whereas there were no differences of OHQoL at the baseline, the patients treated by surgery had reported that they had experienced a worse OHQoL compared with the NS and S+EMD groups both in the OHIP-14 and GOHA indexes (p=0.001). CONCLUSIONS: The results of this study clearly indicated that patient perceptions on the immediate post-operative period were significantly better in the NS and S+EMD groups when compared with the SG group. These findings need to be confirmed in further studies with larger populations.

Perception of dental fluorosis and other oral health disorders by 12-year-old Brazilian children.

AIM: The aim of this study was to verify the perception of dental fluorosis as an oral health problem by 12-year-old Brazilian children and to evaluate if they were able to detect other oral disorders. METHODOLOGY: The sample consisted of 401 schoolchildren. Firstly, clinical examinations were performed using a visual method under natural light. After that, children answered a questionnaire with the purpose of assessing the self-perception of their oral health problems. Next, the volunteers were shown a photo album containing 24 photographs, and had to match each photo with a severity scale. RESULTS: The prevalence of fluorosis was 18.2%; 81.8% of this total in fluorosis scale T-F 1. Of the 401 children, 48.9% (n = 196) answered oral health problems related to concerns, such as aesthetic appearance or pain. Among them, only two children, both with fluorosis T-F 2, correlated their problems with the presence of stained teeth. As regards the photo album analysis, the children considered photos showing fluorosis T-F 7-9 as the most severe, whereas the photo of an orally healthy patient was considered the least severe. CONCLUSION: Children did not show negative perception of dental fluorosis, except for dental fluorosis at severe levels (T-F 7-9), and were mainly able to detect aesthetic or pain-related problems.