Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.

AIM: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features. MATERIALS AND METHODS: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire. RESULTS: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p < .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events. CONCLUSIONS: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial.

PURPOSE: Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents. METHODS: A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests. RESULTS: In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007). CONCLUSION: This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

Periodontal clinical status, microbial profile, and expression of interleukin-1ß in men under androgenic anabolic steroids abuse.

OBJECTIVES: Androgenic anabolic steroids (AAS) abuse is a serious health problem associated to several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1ß in men using AAS. MATERIALS AND METHODS: Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1ß, and proportions of 40 bacterial species. RESULTS: Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1ß expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1ß expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1ß or total protein concentrations. CONCLUSIONS: AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites. CLINICAL RELEVANCE: Dental care professionals should perform full mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.

Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: A cohort study.

AIM: To evaluate if non-diabetic subjects with periodontitis respond better than subjects with type 2 diabetes to the treatment protocol of scaling and root planing (SRP), metronidazole (MTZ) and amoxicillin (AMX). MATERIAL AND METHODS: Diabetic and nondiabetic subjects with severe periodontitis received SRP + MTZ (400 mg/thrice a day [TID]) + AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Subjects were monitored at baseline, 3, 6 and 12 months post-therapy. RESULTS: Twenty-nine type 2 diabetics and 29 non-diabetic subjects participated of this study. Of the non-diabetics and diabetics, 68.9% and 75.9%, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth [PD] ≥5 mm) at 1 year post-therapy (p > 0.05). The diabetic group presented lower mean clinical attachment gain from baseline to 1 year post-therapy and higher mean proportions of the red and orange complexes than the non-diabetic group (p < 0.05). CONCLUSIONS: Non-diabetic subjects with severe periodontitis did not respond better than type 2 diabetic subjects to the treatment protocol of SRP + MTZ + AMX, both in terms of achieving the clinical endpoint for treatment and of PD improvement. Diabetic subjects exhibited a slightly worse microbiological response and showed a healing process more associated with gingival recession than the non-diabetics.

Improving adolescents' periodontal health: evaluation of a mobile oral health App associated with conventional educational methods: a cluster randomized trial.

BACKGROUND: Adolescence is a decisive period in the construction of new conduits. OBJECTIVE: The influence of an App associated with conventional educational methods in adolescents' oral health. STUDY DESIGN: Randomized controlled trial including 291 participants (mean age = 16.1 years) in baseline. The study consisted of four phases. Interventions were evaluated through the knowledge score (KS) and oral indexes (OHI-S/GBI). KS was obtained through five affirmations about periodontal diseases applied in different moments (pre-test, post-test, and follow-up test). Phase I included pre-test and oral clinical examination. Sample was randomly divided into two groups: oral (OG) and video orientation (VG) and post-test (phase II). Phase III characterized the formation of groups: OG + App/OG without App/VG + App/VG without App. App consisted of reinforcement messages which was sent during 30 days. Phase IV comprised follow-up test and clinical evaluation. RESULTS: There was no significant difference in KS between OG/VG. Overall, App improved KS (P < 0.001). VG + App showed a significant increase in KS in the follow-up test compared to the post-test (P = 0.046). There was a significant reduction in oral indexes for all methods. CONCLUSION: App was effective in increasing knowledge, especially associated with video. The different methods were equally effective for a better standard in oral hygiene.

Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial.

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ + amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). A secondary aim was to examine a possible added effect of chlorhexidine to these therapies. METHODS: One hundred and eighteen subjects received scaling and root planing (SRP) only or with MTZ [400 mg/thrice a day (TID)] or MTZ+AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% chlorhexidine twice a day (BID) for 2 months. Subjects were clinically monitored at baseline, 3, 6 and 12-months post-therapy. RESULTS: The two antibiotic groups showed lower mean number of sites with probing depth (PD) ≥5 mm and fewer subjects exhibiting ≥9 of these sites at 1-year post-treatment. Logistic regression analysis showed that antibiotics were the only significant predictors of subjects presenting ≤4 sites with PD ≥5 mm at 1 year (MTZ+AMX: OR, 13.33; 95%CI, 3.75-47.39/p = 0.0000; MTZ: OR, 7.26; 95%CI, 2.26-23.30/p = 0.0004). The frequency of adverse events did not differ between the two antibiotic treatments (p > 0.05). The chlorhexidine subgroups showed a trend (p > 0.05) to present fewer residual sites ≥5 mm compared with the placebo subgroups at 1 year. CONCLUSION: Treatment of generalized ChP is significantly improved by the adjunctive use of MTZ+AMX and MTZ.

Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: a randomized placebo-controlled clinical trial.

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ+amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). MATERIALS AND METHODS: Fifty-one subjects (n=17/group) were randomly assigned to receive scaling and root planing (SRP) only or combined with MTZ (400 mg t.i.d.) or MTZ+AMX (500 mg t.i.d.) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-SRP. Nine plaque samples/subject were analysed by checkerboard DNA-DNA hybridization for 40 bacterial species. RESULTS: Subjects receiving MTZ+AMX exhibited a greater mean gain of clinical attachment, reduction in probing depth (PD) in intermediate and deep sites and a lower percentage of sites with PD5 mm at 3 months, in comparison with those treated with SRP only (p<0.05). The major benefit from the adjunctive use of MTZ was a greater reduction in PD in deep sites. SRP+MTZ+AMX was the only treatment that significantly reduced the levels and proportions of all red complex pathogens and elicited a significantly greater beneficial change in the microbial profile in comparison with SRP only. CONCLUSION: The adjunctive use of MTZ+AMX offers short-term clinical and microbiological benefits, over SRP alone, in the treatment of non-smokers subjects with generalized ChP. The added benefits of MTZ were less evident.

Self-perception of periodontal health status among individuals with Fanconi anemia.

INTRODUCTION: Fanconi anemia (FA) is a rare genetic disease characterized by congenital malformations and bone marrow failure. One of the most common oral diseases in individuals with FA is periodontitis and adequate self-perception of periodontal status could contribute to its prevention and early detection. AIM: To compare oral health self-perception, measured by a questionnaire, with the clinical oral condition of patients with FA. METHODS AND RESULTS: Fifty-six patients with FA, over 11 years of age, answered a questionnaire about dental history and self-reported oral health. Decayed, missing, and filled teeth (DMFT), Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI) were measured. The median age of participants was 21 years (min 11, max 44), 31 (55%) were females and 25 (45%) males. Thirty-five (62.5%) participants rated their oral condition as satisfactory and 7 (12.5%) participants reported tooth mobility, 10 (17.9%) exposed roots and 21 (37.5%) gingival bleeding. Clinical examination detected average DMFT = 5.23, VPI = 31.36% and GBI = 33.77%. The gingival bleeding report was more frequent among individuals with higher GBI (p =  0.014). The DMFT was higher in those who had already undergone dental treatments (p =  0.031). There was an association between participants who presented dental caries and who rated their oral health as poor (p =  0.03). The question "Do your gums bleed easily?" had good accuracy in the evaluation of periodontal disease (p =  0.68). CONCLUSION: Oral health self-perception of individuals with FA about gingival inflammation was associated with their gingival bleeding index.

Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial.

BACKGROUND: The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis. METHODS: Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines. STATISTICAL ANALYSES: The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%. TRIAL REGISTRATION: ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.

Are Information Technologies Capable of Stimulating the Use of Dental Floss by Adolescents? A Cluster Randomised Clinical Trial.

PURPOSE: To analyse the effect of information technologies on improving the frequency of the use of dental floss among adolescents. MATERIALS AND METHODS: A randomised, controlled clinical trial was conducted with 291 adolescents (mean age: 16.1 years) in three phases. Phase I involved the application of a questionnaire and clinical examinations using the simplified Oral Hygiene Index and gingival bleeding index. In phase II, the adolescents were randomly allocated to four groups: oral counseling (OR) and the use of an application (App) for smartphones; OR without the app; video (VD) and app; and VD without app. Messages were set through the app for 30 days. Phase III involved the second administration of the questionnaire and clinical examination. The frequency of dental floss use was evaluated in phases I and III. The groups were categorised into the use of technology (VD and/or App) and non-use of technology (OR alone). RESULTS: Statistically significant reductions in the clinical indices were found with all educational methods (p < 0.005) and improvements were found in the use of dental floss (p < 0.001). Moreover, information technologies were associated with an improvement in the frequency of dental floss use (p < 0.033). CONCLUSION: All methods were effective at improving clinical indicators. The use of information technologies can be considered an effective tool for improving dental floss use among adolescents.

Periodontal Attachment Loss in Children with Amegakaryocytic Purpura: Case Reports of Two Male Siblings.

AIMS: To report the periodontal condition of two siblings (ages 2 and 4) diagnosed with congenital Amegakaryocytic Purpura (AP), who underwent allogeneic hematopoietic stem cell transplant (HSCT) and developed graft-versus-host disease (GVHD) with oral manifestations. METHODS: Clinical history was obtained through physical examination and medical records. Patients received clinical and microbiological assessment at 2 months post-HSCT, when they started to show signs and symptoms of GVHD and were monitored at 8/15-months post-transplant. They were treated by means of prophylaxis and oral hygiene instruction. Two supragingival biofilm samples were collected from each patient and analyzed by Checkerboard DNA-DNA hybridization. RESULTS: Patients developed severe periodontal clinical attachment loss (CAL) in deciduous dentition associated with recession of the periodontal tissues. They also presented GVHD lesions in the oral mucosa, lips and tongue. Caries lesions, gingivitis, and heavy biofilm deposits were identified. The microbiological profile of biofilm samples presented high levels and proportions of periodontal pathogens, such as Aggregatibacter actinomycetemcomitans. CONCLUSION: The cases presented suggested that severe periodontal CAL in children with AP may be an atypical manifestation associated with AP and/or GVHD, which may be aggravated by the presence of a dysbiotic biofilm containing periodontal pathogens, especially A. actinomycetemcomitans.

In Vitro Antimicrobial Effect of Cetylpyridinium Chloride on Complex Multispecies Subgingival Biofilm.

Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.

Proposal of a Clinical Endpoint for Periodontal Trials: The Treat-to-Target Approach.

OBJECTIVE: The selection of proper outcome measures is a critical step in clinical research. Most randomized clinical trials (RCTs) assessing the effects of initial anti-infective periodontal therapies use surrogate outcomes as primary outcome variables, such as mean changes in probing depth (PD) or in clinical attachment. However, these parameters do not reflect disease remission/control at patient level, which has led to subjective interpretations of the data from RCTs and Systematic Reviews. Based on a comprehensive analysis of 724 patients from USA, Germany and Brazil treated for periodontitis, this paper suggests that the clinical endpoint of "≤4 sites with PD≥5mm" is effective in determining disease remission/control after active periodontal treatment and therefore, may represent a pertinent endpoint for applying the treat-to-target concept in RCTs. Furthermore, regression models showed that the presence of >10% and >20% sites with bleeding on probing in the mouth post-treatment increases the risk of a patient leaving the endpoint from 1-2 years (OR=3.5 and 8.7, respectively). Researchers are encouraged to present results on this outcome when reporting their trials, as this will allow for an objective comparison across studies and facilitate systematic reviews, and consequently, the extrapolation of data from research to clinical practice.

Self-perception of periodontal health status among individuals with Fanconi anemia

ABSTRACT Introduction: Fanconi anemia (FA) is a rare genetic disease characterized by congenital malformations and bone marrow failure. One of the most common oral diseases in individuals with FA is periodontitis and adequate self-perception of periodontal status could contribute to its prevention and early detection. Aim: To compare oral health self-perception, measured by a questionnaire, with the clinical oral condition of patients with FA. Methods and Results: Fifty-six patients with FA, over 11 years of age, answered a questionnaire about dental history and self-reported oral health. Decayed, missing, and filled teeth (DMFT), Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI) were measured. The median age of participants was 21 years (min 11, max 44), 31 (55%) were females and 25 (45%) males. Thirty-five (62.5%) participants rated their oral condition as satisfactory and 7 (12.5%) participants reported tooth mobility, 10 (17.9%) exposed roots and 21 (37.5%) gingival bleeding. Clinical examination detected average DMFT = 5.23, VPI = 31.36% and GBI = 33.77%. The gingival bleeding report was more frequent among individuals with higher GBI (p = 0.014). The DMFT was higher in those who had already undergone dental treatments (p = 0.031). There was an association between participants who presented dental caries and who rated their oral health as poor (p = 0.03). The question "Do your gums bleed easily?" had good accuracy in the evaluation of periodontal disease (p = 0.68). Conclusion: Oral health self-perception of individuals with FA about gingival inflammation was associated with their gingival bleeding index.

In vitro antimicrobial effect of cetylpyridinium chloride on complex multispecies subgingival biofilm

Abstract Periodontopathogenic subgingival biofilm is the main etiological agent of periodontitis. Thus, a search for antimicrobials as adjuvant for periodontal treatment in the literature is intense. Cetylpyridinium chloride (CPC) is a well-known antimicrobial agent commonly used in mouthrinses. However, CPC effects on a complex biofilm model were not found over the literature. Therefore, the aim of this manuscript is to evaluate 0.075% CPC antimicrobial properties in a multispecies subgingival biofilm model in vitro. The subgingival biofilm composed by 31 species related to periodontitis was formed for 7 days, using the calgary device. The treatments with CPC and chlorhexidine (CHX) 0.12% (as positive control) were performed 2x/day, for 1 min, from day 3 until the end of experimental period, totaling 8 treatments. After 7 days of biofilm formation, biofilm metabolic activity was evaluated by a colorimetric reaction and biofilms microbial composition by DNA-DNA hybridization. Statistical analysis was performed using ANOVA with data transformed via BOX-COX followed by Dunnett post-hoc. Both CPC and CHX reduced biofilm metabolic activity in 60% and presented antimicrobial activity against 13 different species. Specifically, only CHX reduced levels of F.n. vicentii and P. gingivalis while only CPC reduced A. odontolyticus and A. israelli. CPC was as effective as CHX as antimicrobial through in vitro complex multispecies subgingival biofilm. However, future studies using in vivo models of experimental periodontal disease should be performed to prove such effect.

Resumo O biofilme subgengival periodontopatogênico é o principal agente etiológico da periodontite. Assim, a pesquisa de antimicrobianos como adjuvantes para o tratamento periodontal na literatura é intensa. Cloreto de cetilpiridínio (CPC) é um agente antimicrobiano comumente usado em enxaguatórios bucais. No entanto não foram encontrados na literatura estudos avaliando os efeitos do CPC em um modelo complexo de biofilme. Portanto, o objetivo deste artigo é avaliar as propriedades antimicrobianas do cloreto de cetilpiridinio 0,075% em um modelo de biofilme subgengival multiespécie in vitro. O biofilme subgengival composto por 31 espécies relacionadas à periodontite foi formado por 7 dias, utilizando o dispositivo calgary. Os tratamentos com CPC e clorexidina (CHX) 0,12% (controle positivo) foram realizados 2x/dia, por 1 min, do dia 3 até o final do período experimental, totalizando 8 tratamentos. Após 7 dias de formação do biofilme, a atividade metabólica do biofilme foi avaliada por reação colorimétrica e a composição microbiana dos biofilmes por hibridização DNA-DNA. A análise estatística foi realizada usando ANOVA com dados transformados via BOX-COX seguido do teste de Dunnett. Tanto o CPC como a CHX reduziram a atividade metabólica do biofilme em aproximadamente 60% e apresentaram atividade antimicrobiana contra 13 espécies diferentes. Especificamente, apenas os níveis de F.n. Vicentii e P. gingivalis foram reduzidos somente pelo tratamento com a CHX enquanto apenas o CPC reduziu A. odontolyticus e A. israelli. O CPC foi tão eficaz quanto o CHX como antimicrobiano através de biofilme subgengival complexo multiespecífico in vitro. No entanto, futuros estudos usando modelos in vivo de doença periodontal experimental devem ser realizados para comprovar tal efeito.

Análise físico-química da superfície de titânio após tratamento químico de descontaminação com clorexidina: estudo in vitro / Physical and chemical analysis of the titanium surface after chemical treatment of decontamination with chlorexidine: in vitro study

Introdução: Tratamentos têm sido propostos para a peri-implantite com o objetivo de descontaminar a superfície dos implantes, removendo microrganismos que podem estar associados à doença. Objetivo: O objetivo deste estudo foi avaliar a ação in vitro de diferentes métodos de aplicação de digluconato de clorexidina (CLX) na descontaminação de discos de titânio (Ti) com microtopografia e seu efeito físico-químico sobre a superfície. Material e método: Vinte discos de Ti foram expostos a inóculo de Escherichia coli por 24 horas. Foram distribuídos em quatro grupos de descontaminação (n=5): 1 - um minuto de exposição à solução de CLX 0,12%; 2 - dois minutos de exposição à solução de CLX 0,12%; 3 - esfregaço durante um minuto com gel de CLX 1%; 4 - esfregaço durante um minuto com gel de CLX 2%. O produto de cada disco foi diluído e plaqueado individualmente. Após 24 horas, realizou-se contagem das unidades de colônias formadas (UFC). Resultado: O grupo com o menor número de crescimento de UFC foi o grupo 4 (0,20±0,37), com apenas UFC em uma das amostras. Seguido do grupo 2 (0,40±0,73), grupo 1 (18,60±33,96). O grupo 3 apresentou as maiores quantidades de UFC (36,07±41,39). Em todas as amostras, foi possível observar uma diminuição estatisticamente significante da concentração superficial de Ti, assim como um aumento de oxigênio. Conclusão: Pode-se concluir que o uso de CLX gel a 2% em superfícies de Ti com microtopografia contaminadas com E. coli propicia a eliminação das UFC e que sua aplicação resulta em diminuição do percentual de Ti e aumento do teor de O.

Introduction: Treatments have been proposed for peri-implantitis aiming to decontaminate the implants` surface removing microorganisms associated with the disease. Objective: The objective of this study was to evaluate the in vitro action of application of chlorhexidine digluconate (CLX) in the decontamination of titanium (Ti) discs with microtopography and its chemical-physical effect on the surface. Material and method: Twenty Ti discs were exposed to the Escherichia coli inoculum for 24 hours. Distributed equally in 4 decontamination groups (n = 5): 1- one minute of exposure to the 0.12% CLX solution; 2- two minutes of exposure to the 0.12% CLX solution; 3- smear for 1 minute with 1% CLX gel; and 4- smearing for 1 minute with 2% CLX gel. The product was diluted and plated individually. After 24 hours, colony units formed (CFU) were counted. Result: The group with the lowest number of CFU growth was group 4 (0.20 ± 0.37) with only one CFU in one of the samples. Followed by group 2 (0.40 ± 0.73), group 1 (18.60 ± 33.96), and group 3, which presented the highest amounts of CFU (36.07 ± 41.39). In all samples it was possible to observe a statistically significant decrease in the surface concentration of Ti, as well as an increase in oxygen. Conclusion: It can be concluded that the use of 2% CLX gel on Ti surfaces with microtopography contaminated with E.coli allows the elimination of CFU, and that its application results in a decrease in the percentage of Ti and an increase in the content of O.

Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas: un estudio piloto / Longitudinal evaluation of oral mucositis in hematopoietic stem cell transplantation: a pilot study

Resumen Objetivo: Describir la incidencia y el puntaje de la mucositis oral (MO) y las morbilidades relacionadas en individuos sometidos a trasplante de células madre hematopoyéticas (TCMH) a lo largo del período de inmunosupresión. Métodos: Los sujetos con enfermedades onco / hematológicas, mayores de 14 años, sometidos a TCMH alogénico fueron evaluados diariamente por la presencia y clasificación de OM, nivel de dolor, disfagia, disgeusia y xerostomía. El examen comenzó dos días antes de la infusión de células madre hematopoyéticas y finalizó veinte días después. La OM se clasificó de acuerdo con la escala de la OMS y se utilizó la escala analógica visual (EVA) para medir el nivel de dolor. Resultados: Se reclutaron 23 individuos, el 83% con enfermedades malignas y el 91% con OM. La mediana del grado máximo de OM fue 3 y el nivel máximo de dolor fue 9. Hubo una mediana de 11 días de uso de medicación opioide. Los sujetos que tuvieron el mayor número de días con dolor en la boca alcanzaron el grado máximo de OM y el mayor número de días y el uso de opioides. Conclusión: Hubo una alta incidencia y puntuaciones más altas de OM, pérdida de masa corporal y dolor en esta muestra.

Abstract Aim: To describe the oral mucositis (OM)` incidence and score, and related morbidities in individuals submitted to Hematopoietic Stem Cell Transplantation (HSCT) throughout the immunosuppression period of time. Methods: Subjects with onco / hematological diseases, older than 14 years, submitted to allogeneic HSCT were daily evaluated by the presence and classification of OM, pain level, dysphagia, dysgeusia and xerostomia. The examination started two days before the infusion of hematopoietic stem cells and ended twenty days later. The OM was classified according to the WHO scale and visual analog scale (VAS) was used to measure pain level. Results: Twenty-three individuals were recruted, 83% with malignant diseases and 91% had OM. The median of maximum OM degree was 3 and the maximum pain level was 9. There was a median of 11 days of opioid medication use. The subjects who had the highest mean number of days with mouth pain reached the maximum degree of OM and higher number of days and opiod use. Conclusion: There was a high incidence and high scores of OM, loss of body mass and pain in this sample.

Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs.

Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of ß-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.

Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs

Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.

Doença periodontal e sua influência no controle metabólico do diabete / Periodontal disease and its influence on the metabolic control of diabetes

INTRODUÇÃO: Atualmente se aceita que a doença periodontal (DP) é mais prevalente e mais severa em pessoas portadoras de diabete melito (DM) do que nas não diabéticas. Por outro lado, indivíduos com periodontite severa podem apresentar dificuldade em realizar o controle glicêmico. OBJETIVO: Por meio de uma revisão da literatura, determinar a influência da DP no controle metabólico dos pacientes diabéticos. REVISÃO DE LITERATURA: Mediante pesquisa na base de dados PubMed entre os meses de novembro e dezembro de 2008 foram relacionados diversos artigos da bibliografia atual e clássica, utilizando unitermos como periodontite e diabete melito. Dos 44 trabalhos encontrados, metade (n = 22) referia-se a estudos em humanos após tratamento periodontal mecânico somente ou associado a uma terapia antimicrobiana tópica ou sistêmica. Destes, dez apresentaram resultados benéficos quanto ao controle glicêmico. Três artigos (n = 3) traziam pesquisas simulando a periodontite em ratos pré-dispostos ou portadores de DM. Os resultados para as investigações epidemiológicas (n = 5), de revisão de literatura e meta-análise (n = 14) mostraram-se positivamente similares aos estudos em humanos após tratamento periodontal para quatro e 11 artigos, nessa ordem. As possíveis trajetórias patofisiológicas comuns entre DP e DM avaliadas pelos autores foram relacionadas a marcadores inflamatórios, à resposta do hospedeiro alterada e à resistência a insulina. CONCLUSÃO: A periodontite pode influenciar no controle glicêmico do diabete. No entanto a padronização das pesquisas no tocante à terapia periodontal e ao grupo testado torna-se necessária para consolidar a relação bidirecional entre DP e DM e auxiliar no tratamento multiprofissional dos pacientes acometidos por tais patologias.

INTRODUCTION: Currently, it is accepted that the periodontal disease is more prevalent and severe in people with diabetes mellitus glycemic index. compared to non-diabetic people. On the other hand, patients with severe periodontitis may present difficulty in performing glycemic control. OBJECTIVE: The objective of the present study is to determine, through a literature review, the influence of the periodontal disease on the metabolic control of diabetic patients. LITERATURE REVIEW: PubMed database was searched, from November to December of 2008, and several studies comprising the current and classic literature were listed, using the following uniterms: periodontitis and diabetes mellitus. Forty and four reports were found. Half of them (n = 22) was conducted in humans after the mechanic periodontal treatment alone or associated with a topic or systemic antimicrobial therapy. Ten of these studies presented beneficial results regarding to the glycemic control. Three studies (n = 3) were conducted in animals, simulating periodontitis in pre-diabetic or diabetic rats. The results of epidemiologic (n = 5), literature review, and meta-analysis (n = 14) studies were positively similar to the studies in humans after the periodontal treatment, in 4 and 11 articles, respectively. The most common possible patho-physiological paths between periodontal disease (DP) and diabetes mellitus (DM) evaluated by the authors were related to the inflammatory markers, the host's modified response, and the resistance to insulin. CONCLUSION: Periodontitis may influence on the glycemic control of diabetes. However, the study's standardization in relation to both the periodontal therapy and the studied groups are necessary to consolidate the bidirectional relationship between DP and DM and to help in the multidisciplinary treatment of the patients suffering of these diseases.