Caracterización del tipo de sensibilidad dental de pacientes con periodontitis y su respuesta a los dentífricos / Characterization of the type of dental sensitivity of patients with periodontitis and their response to dentifrices

La hipersensibilidad de la dentina surge ante la exposición de esta y en respuesta a estímulos de diverso tipo, fundamentalmente de origen térmico, evaporativo, táctil, osmótico o químico. Se realizó una investigación abocada a caracterizar la hipersensibilidad dental de pacientes atendidos en consulta de odontología y la respuesta a determinado dentífrico utilizado. En el análisis de estimulación dental se tomaron 308 mediciones de la sensibilidad dental para todos los participantes (n=22), con 7 factores de tiempo (T0 antes del uso del producto, T3 días, T5 días, T8 días, T22 días y T29 días después del uso del dentífrico). Se realizó la prueba paramétrica regresión lineal simple para identificar la tendencia y el ajuste de los datos, al considerar dichas variables como una serie temporal. Se utilizaron 22 tratamientos. Casi el 91,0% expreso que el dentífrico había cumplido sus expectativas, fundamentalmente por la reducción de la hipersensibilidad a corto plazo, mientras que aproximadamente 91,0% de los casos afirmó que compraría el dentífrico (20 casos, IC 95%: 72,2% y 97,5%), respectivamente(AU)

Dentin hypersensitivity arises when exposed to it and in response to various types of stimuli, mainly of thermal, tactile evaporative, osmotic or chemical origin. An investigation was carried out aimed at characterizing the dental hypersensitivity of patients seen in the dental office and the response to a certain toothpaste used. In the dental stimulation analysis, 308 measurements of tooth sensitivity were taken for all participants (n = 22), with 7 time factors (T0 before use of the product, T3 days, T5 days, T8 days, T22 days and T29 days after using the toothpaste). The simple linear regression parametric test was performed to identify the trend and the fit of the data, considering these variables as a time series. 22 treatments were used. Almost 91.0% believed that the toothpaste had met their expectations, mainly due to the reduction in hypersensitivity in the short term, while approximately 91.0% of the cases stated that they would buy the toothpaste (20 cases, 95% CI: 72 , 2% and 97.5%), respectively(AU)

¿Es la proteína C reactiva un indicador de riesgo periodontal? / Is C Reactive Protein a Risk Indicator for Periodontal Disease?

RESUMEN: La periodontitis es una enfermedad inflamatoria crónica, multifactorial, causada por microorganismos y caracterizada por la destrucción progresiva del tejido de soporte dental. En los últimos años se han realizado estudios que señalan cierta similitud y asociación entre la periodontitis y la enfermedad cardiovascular aterosclerótica. Esta relación se ha establecido por tener ciertos factores de riesgo en común y por producir incremento plasmático de la proteína C reactiva (P-CR). A esta proteína se le atribuyen características favorables como marcador inflamatorio. Este estudio busca establecer si existe algún tipo de relación, entre la periodontitis y los valores de la P-CR antes de iniciar el tratamiento periodontal, en un grupo de pacientes de la Facultad de Odontología de la Universidad de Costa Rica. Se hicieron exámenes periodontales a 30 pacientes y se obtuvo una muestra de sangre de cada uno para determinar la concentración de P-CR. Con respecto al valor de la P-CR, se encontró que el promedio fue de 3.72mg/L (IC95%: 2.06-5.38), lo que constituye un marcador de riesgo de moderado a severo. El 54% de los pacientes presentó enfermedad periodontal crónica generalizada, sin que se encontrara diferencia estadísticamente significativa por sexo (p=0.416), ni edad (p=0.477). El 43% de los pacientes padecía de enfermedad periodontal crónica localizada y el 3% de los pacientes presentaron gingivitis. Se observó que el género femenino mostró relativamente, un mayor riesgo cardiovascular respecto al género opuesto (p=0.640). No se encontró diferencia estadísticamente significativa en el valor de P-CR por sexo, edad o la presencia de otras enfermedades, aunque esta cifra fue mayor en los que presentaron enfermedades metabólicas (5.5mg/L) con respecto a quienes no las padecían (2.7mg/L).

ABSTRACT: Periodontitis is an inflammatory multifactorial chronic disease, caused by microorganisms that destroys periodontal tissues. In the last years, several studies have described an association between periodontitis and atherosclerotic cardiovascular disease. This relationship has been made since both diseases share the same risk factors and they both increase C reactive proteins levels. C-reactive protein (C-RP) is a well-known inflammatory marker. This study was designed to try to stablish the relationship between C-RP levels and periodontitis in a group of patients that need periodontal treatment at Odontology Faculty in Universidad de Costa Rica. Periodontal examinations were done to 30 patients and blood samples were taken. The mean value of C-RP found was 3.72mg/L (IC95%: 2.06-5.38) which represents a medium- high risk level. 54% of the patients had generalized chronic periodontitis, without statistical difference when compared gender (p=0.416) or age (p=0.477). 43% had chronic localized periodontitis and 3% gingivitis. Females showed a higher risk for cardiovascular disease (p=0.640). No statistical differences were found between C-RP values relating gender, age or other comorbilities, even though mean values were always higher in those suffering metabolic diseases (5.5mg/L) compared to those values from patients not suffering the same diseases (2.7mg/L).

Efectividad de antimicrobianos en el tratamiento del raspado y alisado radicular en el adulto mayor / Effectiveness of antimicrobials in the treatment of scaling and root planing in the elderly

RESUMEN Introducción: La terapia antimicrobiana después del raspado y alisado radicular en el anciano no ha sido evaluada en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba. Objetivo: Evaluar la efectividad de la tetraciclina y azitromicina en el tratamiento del raspado y alisado radicular en el adulto mayor. Método: Estudio cuasiexperimental de intervención terapéutica, realizado entre 2018-2019, en 30 pacientes con 60 y más años y con diagnóstico de periodontitis crónica. Se crearon tres grupos con 10 casos mediante el método aleatorio simple. El Grupo 1 tratado con la técnica convencional y los Grupos 2 y 3, después de la técnica, se aplicó una concentración subgingival de tetraciclina y azitromicina respectivamente y la colocación de cemento quirúrgico por siete días. Se emplearon variables como edad, sexo, cuadro clínico, evolución de signos y síntomas al séptimo día, 1 y 3 meses, y efectividad de curación. La validación estadística fue a través de la prueba Chi-cuadrado, con un 95 % de confiabilidad y la efectividad antimicrobiana, mediante el Análisis de Varianza ANOVA. Resultados: Predominio del grupo 65-69 años y sexo femenino, persistencia de inflamación gingival en el 30,0 % del Grupo 1 al tercer mes, disminuyó la profundidad al sondaje y hubo ganancia de inserción clínica, mejorando sus medias en el tiempo. Se logró un 100,0 % de efectividad de curación en los Grupos 2 y 3. Conclusiones: Elevada efectividad de la aplicación tópica subgingival de tetraciclina y azitromicina con cemento quirúrgico, sobre aquellos tratados con raspado y alisado radicular convencional.

ABSTRACT Introduction: Antimicrobial therapy after scaling and root planing treatment in the elderly has not been evaluated at the "Mártires del Moncada" Provincial Teaching Stomatology Clinic in Santiago de Cuba. Objective: To evaluate the effectiveness of tetracycline and azithromycin in the treatment of scaling and root planing in the elderly. Method: Quasi-experimental study of therapeutic intervention, carried out between 2018 and 2019, on 30 patients with the age of 60 and over and diagnosed with chronic periodontitis. Three groups with 10 cases were created using the simple randomized method. Group 1 treated with the conventional technique and groups 2 and 3, after using the same technique, a subgingival concentration of tetracycline and azithromycin was applied respectively and surgical cement placement for 7 days. Variables such as age, sex, clinical picture, evolution of signs and symptoms at the seventh day, 1 and 3 months, and healing effectiveness were used. The statistical validation was through the Chi-square test, with a 95% reliability and the antimicrobial effectiveness, through the Analysis of Variance ANOVA. Results: Predominance of the group age between 65 and 69 years and female sex, persistent gingival inflammation in 30,0 % of group 1 at the third month, decreased the depth of the catheterization and there was a clinical insertion gain, improving their averages in time. A 100.0% healing effectiveness was achieved in groups 2 and 3. Conclusions: High effectiveness of subgingival topical application of tetracycline and azithromycin with surgical cement, over patients treated with conventional scaling and root planing.

Comparing the Levels of Gingival Crevicular Fluid Prostaglandin E2 in Generalized Chronic Periodontitis Between Healthy and Type 2 Diabetes Patients: A Case-Control Study

Objective: To compare the prostaglandin E2 (PGE2) levels of gingival crevicular fluid in generalized chronic periodontitis between healthy and type 2 diabetic patients. Material and Methods: 56 diabetic and non-diabetic participants with generalized chronic periodontitis were selected randomly. They were divided into two groups (G1: generalized chronic periodontitis patients with normal blood sugar; and G2: generalized chronic periodontitis patients with diabetes). Gingival crevicular fluid samples were obtained from both groups. The average of 2 samples per day were centrifuged in a laboratory at 2500 rpm and temperature of 4°C for 5 minutes and placed in a refrigerator at -20°C. The level of PGE2 was measured using ELISA and Abcam kit. Data were analyzed by Kolmogorov-Smirnov, Mann-Whitney U Test, Pearson and independent T tests. The significant amount was considered 0.05 in this test (α<0.05). Results: The mean level of PGE2 was significantly different in the two groups and the mean level of PGE2 in the control group was lower than the case group. There was no statistically significant relationship between PGE2 with pocket depth, fasting blood sugar (FBS) and HBA1C (p>0.05). Conclusion: PGE2 level of diabetic patient group with chronic generalized periodontitis was significantly more than non-diabetic group with generalized chronic periodontitis.

Efect of Anaheal (Bromelain) Drug on the Periodontal Clinical Indices in Nonsurgical Periodontal Treatment of Patients with Chronic Periodontitis

Objective: To evaluate the effect of Anaheal (Bromelain) drug on the periodontal clinical indices in nonsurgical periodontal treatment of patients with chronic periodontitis. Material and Methods: In this double blind clinical trial, 80 patients with chronic moderate periodontitis and a healthy systemic status were chosen, and divided into two 40-subject groups. Thereafter, the standard treatment of periodontitis including scaling and root planning in one session by the unit operator was performed for all patients. Eventually, one group of the patients was administered Bromelain medication (500-mg capsule twice a day) one hour before food, while the other group was given placebo. Four and eight weeks after the treatment, the clinical periodontal indicators were measured and recorded in both groups. The data were assessed using descriptive statistics and analytical test methods (Mann-U-Whitney and Chi-square). P value less than 0.05 was considered statistically significant. Results: Gingival index, probing depth and plaque index before the treatment were similar in both groups (Anaheal and placebo). However, four and eight weeks after the treatment, the three studied indices were significantly lower in the Anaheal group as compared to the placebo (p<0.05). The index of bleeding on probing was also similar before the treatment and four weeks after the treatment in both groups. However, eight weeks after the treatment, this index was significantly lower in the Anaheal group as compared to the placebo group (p<0.05). Conclusion: Administration of oral Anaheal medication after nonsurgical periodontal treatments reduced all the clinical periodontal indices among patients with chronic periodontitis as compared to the control group. Therefore, it can be a suitable substitute for the common oral industrial antibiotics.

Evaluation of Salivary Levels of Plasminogen Activator Inhibitor-2 in Patients with Moderate Generalized Chronic Periodontitis: A Case- Control Study

Objective: To compare salivary levels of PAI-2 in patients with moderate generalized chronic periodontitis before and after treatment and healthy subjects. Material and Methods: The present case-control study evaluated patients with generalized moderate chronic periodontitis (the case group) and subjects with healthy gingiva (the control group). The healthy subjects were evaluated once and the cases were evaluated twice (before and after treatment) by collecting their salivary samples. ELISA technique was used to determine PAI-2 salivary levels. Data were analyzed with the use of SPSS 17. The level of significance was set at 5%. Results: The mean salivary levels of PAI-2 in the case and control groups were 45.63 ± 8.63 and 22.01 ± 9.77 ng, respectively (p<0.0001). In addition, PAI-2 salivary levels in the case group subjects after treatment was 27.43 ± 5.79 ng, which was lower than that before treatment (45.63 ± 8.63 ng) (p<0.0001). The mean salivary level of PAI-2 in subjects with periodontitis after treatment (27.43 ± 5.79) was not significantly different from that in healthy subjects (22.01 ± 9.77) (p>0.05). Conclusion: The salivary levels of PAI-2 in patient with moderate generalized chronic periodontitis were higher than these in healthy subjects. However, the salivary levels of PAI-2 decreased in the case group subjects after treatment, with no significant difference from the healthy subjects.

Factores de riesgo modificables e inmodificables de la periodontitis: revisión narrativa / Modifiable and Non-Modifiable Risk Factors of Chronic Periodontitis: A Narrative Review

Antecedentes: La periodontitis crónica asociada a la placa bacteriana tiene factores de riesgo modificables e inmodificables que deben tenerse en cuenta en su prevención y control. Objetivo: Analizar la evidencia disponible sobre los factores de riesgo modificables e inmodificables de la periodontitis crónica con el fin de escribir guías de manejo clínico. Métodos: Se realizó una búsqueda sistemática de la literatura en tres bases de datos (PubMed, LiLACS y Embase) usando la siguiente combinación de términos del Medical Subejct Headings de Medline: "risk indicator OR risk factor AND chronic periodontitis". También se buscaron artículos y literatura gris en Google Académico. Se incluyeron estudios de corte transversal, casos y controles, longitudinales, ensayos clínicos controlados y revisiones generales y sistemáticas de la literatura. Se efectuó una revisión narrativa sobre el tema con las referencias más relevantes encontradas. Resultados: Se analizaron 39 artículos que cumplieron con los criterios de la búsqueda. Entre los factores de riesgo modificables se encontraron: diabetes no controlada, obesidad, estrés, tabaquismo y placa bacteriana. Los factores de riesgo inmodificables hallados fueron: cambios hormonales, infección por VIH, neutropenia, edad, sexo, raza y genética. Los dos factores de riesgo más frecuentemente asociados, además de la placa bacteriana, fueron diabetes y tabaquismo. Conclusiones: El control de la periodontitis crónica debe basarse no solo en el control de la placa bacteriana sino también en la prevención mediante la identificación temprana y el control de factores de riesgo para evitar la aparición o el avance de esta enfermedad.

Background: Dental-plaque associated chronic periodontitis is influenced by modifiable and non-modifiable risk factors that must be addressed through preventive and corrective treatment. Purpose: To analyze available evidence on modifiable and non-modifiable risk factors of chronic periodontitis in order to write clinical management guidelines. Methods: A systematic search of literature was conducted in three databases (PubMed, LiLACS, and Embase) using the following combination of terms from the Medical Subject Headings: "risk indicator OR risk factor AND chronic periodontitis." Other articles and gray literature were search in Google Scholar. The search included cross-sectional, cohort, and case control studies, controlled clinical trials, and general and systematic literature reviews. A narrative review was conducted with the most relevant articles found. Results: 39 articles met the search criteria. Modifiable risk factors found were: non-controlled diabetes, obesity, stress, smoking, and dental plaque. Non-modifiable factors were: hormonal changes, HIV infection, neutropenia, age, sex, race, and genetics. Besides dental plaque, the two most frequently associated factors were diabetes and smoking. Conclusion: The treatment of chronic periodontitis must focus, in addition to controlling dental plaque, on early detection prevention and risk-factor control to avoid the occurrence and advance of this type of disease.

Estimation and Comparison of Erythrocyte and Hemoglobin Levels in Subjects with Healthy Periodontium and Chronic Periodontitis

Objective: To compare and evaluate the relationship between anemia and periodontitis by estimation of peripheral blood between healthy patients and chronic periodontitis patients. Material and Methods: Of the total of 230 outpatients approached to participate in the study, 100 eligible patients were selected as per the selection criteria. After written consent, these patients were divided into two groups according to the clinical parameters as healthy and disease (chronic periodontitis) groups. Under aseptic conditions, venous blood samples were obtained by vein-puncture in the ante-cubital fossa without excessive venous stasis and the mean value of erythrocytes (EC), hemoglobin concentration (HGB), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were measured. Paired t-test was employed to find the significance of study parameters on continuous scale within the group analysis and unpaired t-test (two tailed, dependent) was used to find the significance of study parameters on continuous scale in the inter group analysis. Results: Generally, the healthy group reported higher levels of EC, HGB, MCV and MCH than the periodontitis group. The mean hemoglobin level was significantly higher (p-value<0.05) in healthy patients (12.66 ±1.41 gm/dl) whereas a slightly lower level of 11.32±1.85 gm/dl was observed in patients with chronic periodontitis. Similarly, the range of erythrocyte count of healthy patients was significantly higher (3.69-5.29 million/µl) than chronic periodontitis patients (3.33-5.97 million/µl). Whilst MCV was higher in healthy patients but non-significant, higher mean MCH of 27.75 ± 3.25 pg/cell was reported in healthy patients compared to mean of 25.73 ± 3.22 pg/cell in patients with chronic periodontitis. Conclusion: Significant hematological differences in EC, HGB, MCV and MCH between healthy periodontium and chronic periodontitis subjects were seen indicating mild anemia.

Microorganismos en lengua y saliva de pacientes edéntulos y con periodontitis crónica y su posible conexión con la Proteína C reactiva / Microorganisms in the Tongue and Saliva of Edentulous and Chronic Periodontal Disease Patients and the Possible Relation to the C-Reactive Protein

Antecedentes: Existe evidencia clínica y experimental que la proteína C reactiva (PCR) es un marcador de inflamación sistêmica asociado a periodontitis crónica. Esta enfermedad es la principal causa de cdcntulismo y ambas condiciones presentan, en algunos casos, los mismos microorganismos. Objetivo : Identificar microorganismos periodontopatógenos presentes en pacientes cdéntulos y en pacientes con periodontitis moderada/avanzada y establecer su relación con la PCR ultrasensible (PCR-us). Métodos: Se realizó un estudio de corte transversal en 61 pacientes mayores de 30 años de edad, divididos en dos grupos: con periodontitis crónica y cdcntulos. A cada paciente se le tomó una muestra de saliva y del dorso de la lengua, para identificación microbiológica de microorganismos, y muestra sérica, para evaluación de PCR-us. Se analizó la asociación entre microorganismos, PCR-us y por grupo de pacientes. Resultados: La PCR-us mostró un valor máximo de 1,12 mg/1 en el grupo de cdéntulos sin mostrar diferencia estadísticamente significativa con el grupo de periodontitis crónica (p = 0,29). Sin embargo, valores mayores de PCR-us se observaron en pacientes con microorganismos como Candida albicans, Porphiromona gingival is, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) y Bactcroidcs thctaiotaomicron. Conclusión: De acuerdo con los resultados de este estudio, no hay diferencia en PCR-us entre pacientes cdéntulos y aquellos con enfermedad periodontal. Se encontraron periodontopatógenos en cdéntulos principalmente Capnocytophaga sp., A. nacslundii y S. intermedius, tanto en lengua como en saliva.

Background: Ihcrc is clinical and experimental evidence that C-Rcactivc Protein (CRP) is a systemic inflammation marker associated to the chronic periodontal disease. This disease is the main cause of cdcntulousncss and, in some eases, both conditions involve the same microorganisms. Objective: To identify the pcriodontopathic microorganisms appearing in both edentulous patients and patients with moderate/advanced periodontal disease and to determine how they relate to the ultrasensible CRP (US-CRP). Methods: A cross-sectional study was carried out in 61 patients with ages above 30 years divided into two groups: patients with chronic periodontal disease and edentulous patients. Each patient was taken a saliva sample from the tongue dorsum for microbiologic identification of microorganisms, and scrum samples for US-CRP evaluation. The relation between microorganisms and US-CRP was analyzed and described per group. Results: Ihc US-CRP showed a maximum value of 112 mg/L in the edentulous group without any statistically significant difference as compared to the periodontal chronic disease group (p = 029). However, higher values of US-CRP were observed in patients with microorganisms such as Candida albicans, Porphiromona gingivalis, Actinomyces nacslundii (A. nacslundii), Capnocytophaga sp., Streptococcus intermedius (S. intermedius) and Bactcroidcs thctaiotaomicron. Conclusion: Based on the results herein, no difference is observed for che US-CRP between edentulous patients and chronic periodontal disease patients. 'Ihc main periodontal pathogens found in the edentulous subjects include Capnocytophaga sp., A. nacslundii and S. intermedius, both in the tongue and the saliva.

Marcadores salivares para a periodontite crônica no diabético tipo 2 / Salivar markers for chronic periodontitis in diabetic type 2

Introdução: a periodontite crônica é a sexta doença infecciosa mais prevalente no mundo, seus fatores de risco são o aumento da idade, tabaco, fatores genéticos, obesidade e distúrbios sistêmicos como o diabetes. O diabetes é uma pandemia tanto em países desenvolvidos como em desenvolvimento, é uma doença complexa com graus variados de complicações sistêmicas e orais. Assim, é urgente a necessidade de um método fácil para detectá-la permitindo a intervenção antes da progressão da doença periodontal. Á análise de metabólitos da saliva tem sido proposta como uma ferramenta efetiva para o diagnóstico e tratamento periodontal. Objetivo: discorrer sobre alternativas de diagnóstico de periodontite crônica em pacientes diabéticos tipo 2 utilizando marcadores salivares. Metodologia: Foi realizada uma busca eletrônica no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), para a realização do referido levantamento, utilizou-se os descritores "Type 2 diabetes mellitus, chronic periodontitis, Biomarkers, Saliva". Resultados: a detecção precoce da periodontite crônica não é apenas vital para reduzir a sua gravidade e prevenir complicações, mas também crítico para aumentar a taxa de sucesso da terapia. Conclusão: a utilização de biomarcadores na medicina é uma realidade difundida e tem relação direta com a modernização dos meios de saúde, na odontologia vem se pleiteando seu uso, mas ainda necessita de maiores estudos e aperfeiçoamentos das técnicas já empregadas com o intuito de diminuir seus custos, aumentar especificidade e acesso dos profissionais de saúde.(AU)

Introduction: Chronic periodontitis is the sixth most prevalent infectious disease in the world. Its risk factors are increased age, tobacco, genetic factors, obesity, and systemic disorders such as diabetes. Diabetes is a pandemic in both developed and developing countries, it is a complex disease with varying degrees of systemic and oral complications. Thus, there is an urgent need for an easy method to detect it allowing intervention before the progression of periodontal disease. The analysis of saliva metabolites has been proposed as an effective tool for periodontal diagnosis and treatment. Objective: To discuss alternatives for diagnosis of chronic periodontitis in type 2 diabetic patients using salivary markers. Methodology: An electronic search was performed in the Portal of Periodicals of the Coordination of Improvement of Higher Level Personnel (CAPES). The descriptors "Type 2 diabetes mellitus, chronic periodontitis, Biomarkers, Saliva" were used to perform this survey. Results: early detection of chronic periodontitis is not only vital to reduce its severity and prevent complications, but also critical to increase the success rate of therapy. Conclusion: the use of biomarkers in medicine is a widespread reality and has a direct relationship with the modernization of health facilities. In dentistry, its use has been sought, but it still needs further studies and improvements of techniques already employed with the intention of reducing its Increase the specificity and access of health professionals.(AU)

Eficacia de terapia fotodinámica como complemento de terapia convencional periodontal versus terapia convencional en el tratamiento de pacientes adultos con periodontitis crónica: una revisión sistemática con metaanálisis / Effectiveness photodynamic therapy complementing conventional periodontal therapy versus conventional therapy in the treatment of adult patients with chronic periodontitis: a systematic review with meta-analyses

Se evaluó la eficacia de la terapia fotodinámica como complemento de terapia periodontal convencional comparándola con la terapia convencional en el tratamiento de sacos periodontales en pacientes adultos con periodontitis crónica basándose en ensayos clínicos comprendidos entre los años 2010 y 2015, para determinar si su uso otorga mejores resultados para el tratamiento de esta enfermedad. Se seleccionaron ensayos clínicos aleatorios prospectivos, aleatorizados o no aleatorizados, controlados y no controlados que permitieron la comparación entre el tratamiento convencional y la terapia fotodinámica, con un grupo en el cual se utilizó sólo la terapia convencional. Los datos de los ensayos clínicos fueron ingresados al software Review Manager®. Se realizaron tres metaanálisis para las variables: Nivel de inserción clínica (NIC) y profundidad de sondaje (PS), el test de I2 fue utilizado para medir la heterogeneidad del estudio y posteriormente un análisis de sensibilidad para determinar los estudios heterogéneos. Se pudieron analizar 7 estudios, con un total de 186 pacientes, quienes fueron controlados 3 meses post tratamiento. Se utilizó la diferencia de medias, un intervalo de confianza de 95 % para medir el NIC y PS. A los 3 meses, no se encontró diferencias significativas en NIC (p= 0,93) y PS (p= 0,71). Conclusión: La terapia fotodinámica en complementación a la terapia convencional no otorga mejor resultado clínico ni estadístico comparado con la terapia convencional al evaluar el nivel de inserción clínica. Al evaluar la profundidad de sondaje es recomendable la utilización de terapia convencional sola.

The efficacy of photodynamic therapy as an adjunct to conventional periodontal therapy evaluated by comparing with conventional therapy alone in the treatment of periodontal pockets in adult patients with chronic periodontitis based on clinical trials between 2010 and 2015, to determine if its use can provide better results for treating this disease. Prospective randomized clinical trials and randomized clinical trials or non-randomized, controlled and uncontrolled that allowed comparison between a group which was applied to conventional therapy and photodynamic therapy, a similar group was selected to which you He applied only conventional therapy. Data from clinical trials entered into Review Manager®. Three meta-analyzes for the variables analyzed were performed: Level clinical attachment (NIC) and probing depth (PS), the test of I2 was used to measure the heterogeneity of the study and then a sensitivity analysis to determine which studies awardedheterogeneity. As results, seven studies analyzed in 186 patients who underwent treatment at least controlled within 3 months post treatment. The mean difference was used, a confidence interval of 95 % to measure the NIC and PS. At 3 months, no significant differences in NIC (p= 0.93) and PS (p= 0.71). In conclusion, the photodynamic therapy complementary to conventional therapy does not provide better clinical or statistical results compared with conventional therapy to evaluate the clinical attachment level. In assessing probing depth, is advisable to use conventional therapy alone.

Comportamento dos sistemas peroxidase e antioxidante, e produtos de peroxidação lipídica na saliva total de pacientes com diabetes mellitus 2 antes e após tratamento periodontal não cirúrgico / Peroxidase and antioxidant systems and lipid peroxidation products behavior in type 2 diabetes mellitus patients whole saliva before and after periodontal treatment

O estresse oxidativo (EO), fenômeno decorrente do desequilíbrio entre a geração de espécies reativas de oxigênio (ERO) e/ou depleção antioxidante (AO), está envolvido na patogênese de diversas doenças e desordens, incluindo o diabetes mellitus tipo 2 (DM2) e a doença periodontal. Uma das conseqüências da geração excessiva das ERO é a destruição tecidual promovida pela peroxidação lipídica, e para combater estes efeitos deletérios, o organismo desenvolveu mecanismos de defesa, como os AO e peroxidases. Objetivos: Avaliar o comportamento dos marcadores de EO na saliva total (SALT) de pacientes com ou sem DM2, portadores ou não de periodontite crônica generalizada (PCG); e verificar e comparar o efeito do tratamento periodontal não-cirúrgico (TPNC) sobre esses marcadores entre os pacientes. Materiais e Métodos: 121 pacientes participaram deste estudo e foram alocados em 4 grupos: diabéticos com PCG (DMPC), diabéticos sem PCG (DM), pacientes sistemicamente saudáveis com PCG (PC) e pacientes sistemicamente saudáveis e sem periodontite (C). Os índices de Placa (IP), nível clínico de inserção (NCI), profundidade clínica de sondagem (PCS) e sangramento à sondagem (SS) foram coletados para a avaliação dos parâmetros clínicos periodontais. Foram também coletadas amostras de sangue periférico e SALT para analisar respectivamente a hemoglobina glicada (HbA1c) e os marcadores de EO, superóxido dismutase (SOD), estado total de antioxidante (TAS) e substâncias reativas do ácido tiobarbitúrico (TBARS) e peroxidase salivar (SPO). As coletas foram realizadas no baseline e após 30 dias do tratamento, previamente à avaliação e reavaliação clínica. Os pacientes DMCP e PC passaram por TPNC, e os DM e C, receberam apenas orientação de higiene oral e profilaxia. Resultados: No baseline, os grupos DMPC e PC apresentaram

valores significativamente maiores dos parâmetros clínicos PCS, SS, IP e NCI quando comparados aos grupos DM e C (p<0.05). Após o TPNC, todos esses parâmetros mostraram melhoras significativas (p<0,05). A HbA1c foi significativamente maior no grupo DMPC quando comparado com DM no baseline (p<0,05), no entanto, o TPNC não promoveu melhora significativa após 1 e 3 meses de acompanhamento glicêmico, ainda que, a redução percentual (0,4%) observada possa ser considerada importante. Quanto aos marcadores, no grupo DMPC os valores de TBARS foram significativamente menores comparados aos grupos DM, PC e C (p<0.05), e os de SPO foi significativamente maior em relação aos grupos PC e C (p<0.05), com correlação negativa entre TBARS e SPO (r=-0.35; p=0.002), enquanto que os valores de TAS e SOD não mostraram diferenças significativas entre os grupos estudados (p>0.05). Após o TPNC, os níveis de TBARS aumentaram significativamente, e os de SPO diminuíram significativamente apenas no grupo DMPC (p<0.05 e p<0.05), ao passo que os valores de SOD e TAS permaneceram inalterados nos dois grupos. Conclusão: No baseline, os valores de TBARS e de SPO estiveram alterados nos pacientes DMPC com resultados que mostram correlação inversa entre TBARS/SPO, e após o TPNC houve nova alteração. O comportamento dos marcadores de EO na saliva mostrou a busca pelo ponto de equilíbrio por diversas vias e que este pode ser alterado pelo uso de medicamentos, como a metformina.

Oxidative stress (OS), resulting phenomenon from reactive oxidative species (ROS) and/or antioxidant (AO) depletion imbalance, is involved in many diseases and disorders pathogenesis, including type 2 diabetes mellitus (T2DM) and periodontal disease. One of the ROS excessive generation consequences is the tissue destruction promoted by lipid peroxidation. To strike ROS deleterious effects, the organism developed several defense mechanisms, such as AO and peroxidase systems. Objectives: To evaluate the OS markers behavior in whole saliva (WS) of patients who has or not T2DM, with or without generalized chronic periodontitis (GCP); and to verify and to compare non-surgical periodontal treatment (NSPT) effect on these markers. Material and Methods: 121 patients participated of this study and were allocated in 4 groups: diabetics with chronic periodontitis (DMPC), diabetics periodontally heathy (DM), sistemically healthy with chronic periodontitis (PC) and sistemically and periodontally healthy patients (C). Plaque index (PI), clinical attachment level (CAL), probing depth (PD) and bleeding on probing (BOP) were collected for periodontal clinical paramethers. Peripheral blood and WS samples were collected respectively for glycated hemoglobin (HbA1c) and OS markers, such as superoxide dismutase (SOD), total antioxidant status (TAS), thiobarbituric acid reacting substances (TBARS) and salivary peroxidase (SPO), assessment. Collections were performed at baseline and 30 days after treatment, previously to clinical evaluation and reevaluation. GCP patients (DMPC and PC)

were submitted to NSPT, and those with periodontal health (DM and C) received oral hygiene instructions and prophilaxys only. Results: At baseline, DMPC and PC patients showed PD, BOP, PI and CAL higher levels when compared to DM and C groups (p<0.05). After NSPT, all these clinical parameters had significant improvement (p<0.05) in both groups. HbA1c medians were significantly higher in DMPC when compared to DM, at baseline, however, the NSPT did not improved after 1 and 3 months of glicemic control, though percentual reduction (0.4%) observed at clinical point of view might be considered important. As to laboratorial analysis, in DMPC group, TBARS levels were significantly decreased compared to DM, PC and C (p<0.05), and SPO activity were significantly higher than PC and C (p<0.05), with negative correlation between TBARS and SPO (r=-0.35; p=0.002), while TAS levels and SOD activity did not show any significant differences...

Estimation of salivary neopterin in chronic periodontitis.

Background: Periodontal diseases are the most common bacterial infection predominantly associated with Gram‑negative microorganisms that exist in the subgingival biofilm. Analysis of saliva provides a noninvasive means of evaluating the role of the host response in periodontal disease. Though salivary enzymes can be used as the biomarkers, neopterin has been recently used as one of the important diagnostic tools in the field of periodontics. Hence, we aimed to identify the neopterin levels in unsimulated saliva from the chronic periodontitis patients and compare them with the periodontally healthy subjects. Materials and Methods: Twenty subjects participated in the study and were categorized as the experimental group (chronic periodontitis patients) and control groups (healthy subjects). Unstimulated saliva samples were collected from both the groups for neopterin estimation. Neopterin in saliva was estimated using Shimadzu High Performance Liquid Chromatography with LC‑20AD pump system, equipped with RF‑10 AXL fluorescence detector. Statistical Analysis Used: Data were expressed as mean ± SD and analyzed using GraphPad Prism version 6.0 (California, USA). Statistical analysis was done by Student’s t‑test Results: The neopterin level in unstimulated saliva was found to be higher in the experimental group than the control group with P ≤ 0.05. Conclusions: The chronic periodontitis patients showed higher neopterin level in unstimulated saliva as compared to control. Hence, neopterin can be used as a potential biomarker for identification of the periodontal disease in its initial stage can help in preventing the disease progression.

Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction / Relação entre a proteína C ultrarreativa, diabetes e doença periodontal em pacientes com ou sem infarto do miocárdio

Objective: The purpose of this study was to evaluate the impact of diabetes and periodontal disease in us-CRP, an inflammatory marker in patients with and without acute myocardial infarction (AMI). Subjects and methods: A case-control study was conducted in 401 subjects aged between 30 and 75 years, living in Bogotá D.C. (Colombia). Patients arriving at the emergency room of the San Ignacio University Hospital with AMI were included into the case group. The control group was defined as those subjects without AMI. The following blood tests were performed: complete blood count (CBC), glycemia, total cholesterol, triglycerides, cHDL, cLDL, and us-CRP. Patients with infections or antibiotic treatment within the last three months, who had received periodontal treatment within the six months prior to the study entry, had oral ulcerations, or less than seven teeth were excluded from the study. Periodontal disease was diagnosed based on the 1999 Armitage’s classification. Results: The mean us-CRP value found in diabetic patients with severe chronic periodontitis was 5.31 mg/L (SD 6.82), and 2.38 mg/L (SD 4.42) in non-diabetic patients, being statistically significant (p = 0.000). Conclusion: Diabetes had an impact in periodontal disease and us-CRP. In patients with AMI, DM and PD considerably increased the us-CRP. .

Objetivo: O objetivo deste estudo foi avaliar o impacto do diabetes e da doença periodontal na us-CRP, um marcador inflamatório em pacientes com ou sem infarto agudo do miocárdio (IAM). Sujeitos e métodos: Um estudo caso-controle foi conduzido em 401 sujeitos com idades entre 30 e 75 anos que moravam em Bogotá D.C. (Colômbia). Os pacientes que chegavam ao pronto-socorro do hospital universitário de San Ignacio com IAM foram incluídos no grupo caso. O grupo controle foi definido por sujeitos sem IAM. Foram feitos os seguintes exames de sangue: contagem total de eritrócitos (CTE), glicemia, colesterol total, triglicérides, cHDL, cLDL e us-CRP. Os pacientes com infecções ou em tratamento com antibióticos nos últimos três meses, que receberam tratamentos periodontal nos seis meses anteriores ao estudo, tinham úlceras orais ou menos de sete dentes foram excluídos do estudo. A classificação de Armitage de 1999 foi usada para definir a doença periodontal. Resultados: O valor médio de us-CRP observados em pacientes diabéticos com periodontite crônica grave foi 5,31 mg/L (SD 6,82) e 2,38 mg/L (SD 4,42) em pacientes não diabéticos, um valor estatisticamente significativo (p = 0,000). Conclusão: O diabetes tem um impacto na doença periodontal e na us-CRP. Em pacientes com IAM, DM e DP, a us-CRP foi consideravelmente mais alta. .

Avaliação de marcadores inflamatórios séricos em indivíduos com diabetes mellitus tipo 2 após tratamento periodontal intensivo não-cirúrgico: estudo clínico randomizado / Evaluation of serum inflammatory markers in individuals with type 2 diabetes mellitus after intensive non-surgical periodontal therapy: a randomized clinical trial effects

O objetivo deste trabalho foi comparar os efeitos sorológicos e clínicos de dois protocolos de terapias periodontais em indivíduos com diabetes tipo 2 (DMT2) e periodontite crônica. Foram analisados 36 pacientes, randomizados em dois grupos: um grupo recebeu terapia intensiva de raspagem e alisamento radicular (INT; n=18) e outro recebeu apenas raspagem supragengival (SUP; n=18). Os grupos foram avaliados quanto aos parâmetros clínicos periodontais e marcadores inflamatórios séricos, antes e após 6 meses do tratamento periodontal. O exame clínico periodontal avaliou: placa visível (IP), índice gengival (IG), supuração (SUPUR), profundidade clínica de sondagem (PCS) e nível clínico de inserção (NCI). Amostras sanguíneas foram obtidas para análise de marcadores inflamatórios e hemoglobina glicada (HbA1c). Os marcadores de inflamação avaliados foram: interleucina (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, fator estimulador de colônias granulocitárias (G-CSF), fator estimulador de colônias de granulócitos-macrófagos (GM-CSF), interferon- (IFN-), proteína quimiotática de monócito-1 (MCP-1), proteína inflamatória de macrófago-1 (MIP-1) e fator de necrose tumoral (TNF-), através do imunoensaio multiplex (Bioplex). Ambas as terapias resultaram na melhora de quase todos os parâmetros clínicos periodontais (p<0,05), com exceção do NCI (p=0,09) no grupo SUP. Não houve diferença significativa para os níveis de IL-1, IL-4, IL-5, IL-10, IL-13, MIP-1 e TNF- (p>0,05), após tratamento, em ambas as terapias. Houve redução significativa de IL-6 (p=0,01), IL-12 (p=0,04) e MCP-1 (p=0,02) no grupo INT e de GCS-F nos grupos SUP (p=0,04) e INT (p=0,01). Os níveis de IL-2, IL-7, IL-8, IL-17, GM-CSF e IFN- não foram detectados. A terapia INT tem um efeito benéfico na redução dos níveis séricos de IL-6, IL-12 e MCP-1, na redução de PCS em sítios profundos e no ganho de inserção quando comparado à terapia supragengival em um período de 6 meses...

The objective of this study was to compare the serological and clinical effects of two periodontal therapies in individuals with type 2 diabetes (T2DM) and chronic periodontitis. 36 patients were analyzed, randomized into two groups: one group received intensive t of scaling and root planing (INT, n=18) and another received only supragingival scaling (SUP, n=18). The groups were evaluated for periodontal parameters and serum inflammatory markers before and after 6 months of periodontal treatment. The periodontal parameters assessed were: visible plaque (PI), gingival index (GI), suppuration (SUP), probing pocket depth (PPD) and clinical attachment level (CAL). Blood samples were obtained for analysis of inflammatory markers and glycated hemoglobin (HbA1c). The inflammatory markers evaluated were: interleukin (IL)- 1 , IL- 2, IL -4, IL -5, IL -6, IL -7 , IL-8 , IL-10 , IL-12 , IL-13 , IL -17, granulocyte colony-stimulated factor (G -CSF), colony stimulating factor granulocyte-macrophage (GM -CSF), interferon - (IFN - ), monocyte chemotactic protein-1 (MCP-1) , macrophage inflammatory protein-1 (MIP-1 ) and tumor necrosis factor (TNF- ) through a multiplex immunoassay (Bioplex). Both therapies resulted in improvement of almost all periodontal clinical parameters (p<0.05), with the exception of the NCI in SUP group. There was no significant difference for (IL )- 1 , IL- 4, IL -5, IL-10 , IL-13 , MIP- 1 and TNF- after treatment for both therapies (p>0.05). A significant reduction was observed in IL-6 (p=0.01), IL-12 (p=0.04) and MCP-1 (p=0.02) levels for INT group and in GCS- F levels for SUP (p=0.04) and INT (p=0.01) groups. The levels of IL-2, IL -7, IL-8 , IL-17, GM- CSF and IFN- were not detectable. The INT therapy has a beneficial effect in reducing serum levels of IL-6, IL-12 and MCP-1, in reducing PPD of deep sites and in attachment gain when compared to SUP therapy considering a period of 6 months...

Efeito da terapia periodontal sobre a expressão do receptor ativado por protease do tipo 2 (PAR2) em pacientes com periodontite crônica / Evaluation of the protease activated receptor 2 (PAR2) expression in chronic periodontitis patients, before and after non-surgical periodontal treatment

O receptor ativado por protease do tipo 2 (PAR2) está envolvido na patogênese de doenças inflamatórias crônicas, incluindo a periodontite. O PAR2 pode ser ativado pela gingipaína, produzida pela Porphyromonas gingivalis (P. gingivalis) e proteinase 3 (P3) do neutrófilo. A ativação do PAR2 desempenha um papel relevante nos processos inflamatórios ao induzir a liberação de importantes mediadores pró-inflamatórios associados à destruição periodontal. No presente estudo, o efeito do tratamento periodontal não-cirúrgico na expressão do PAR2 por células do fluido gengival, bem como a sua associação com os níveis de mediadores pró-inflamatórios e proteases ativadoras foram investigados em pacientes com periodontite. Além disso, avaliou-se in vitro o envolvimento da via de sinalização MAPK-p38 na ativação do PAR2 e a influência deste na produção de superóxido (O2-) e na capacidade de fagocitose em neutrófilos do sangue periférico humano infectados pela P. gingivalis. Um aumento significativo (P < 0,05) da expressão do RNAm e proteica do PAR2 por células do fluido gengival foi positivamente associado aos parâmetros clínicos inflamatórios e aos níveis de interleucina (IL)-6, IL-8, fator de necrose tumoral-, metaloproteinases da matriz (MMP)-2, MMP-8, fator de crescimento de hepatócitos e fator de crescimento endotelial vascular, avaliados por Bioplex. Níveis elevados de RNAm da gingipaína e P3, expressão reduzida do RNAm da dentilisina (P < 0,05), bem como redução significativa (P < 0,05) dos níveis de inibidores de protease secretados por leucócitos e elafina (avaliados por ELISA), também foram associados à superexpressão do PAR2. Sítios periodontalmente saudáveis de indivíduos com periodontite crônica apresentaram uma menor expressão do RNAm e proteica do PAR2 (P < 0,05). O tratamento periodontal resultou na diminuição significativa da expressão de PAR2 (P < 0,05), correlacionada com a diminuição da expressão de mediadores inflamatórios (P < 0,05), bem como com suas proteases ativadoras (P < 0,05). Além disso, o uso do antagonista do PAR2 suprimiu significativamente (P < 0,05) a produção de superóxido em neutrófilos do sangue periférico humano, denotando o papel do PAR2 nessa importante função celular. Dessa forma, concluímos que o tratamento periodontal, o qual resulta na diminuição dos níveis de proteases e mediadores pró-inflamatórios, está associado com uma diminuição da expressão do PAR2, portanto, sugerindo que a expressão de PAR2 é influenciada pela presença da infecção periodontal, e não uma característica constitutiva favorecendo a inflamação periodontal.

Protease-activated receptor-2 (PAR2) is implicated in the pathogenesis of chronic inflammatory diseases including periodontitis; it can be activated by gingipain, produced by Porphyromonas gingivalis (P. gingivalis), and by neutrophil-protease 3 (P3). PAR2 activation plays a relevant role in inflammatory processes by inducing the release of important inflammatory mediators associated with periodontal breakdown. In the present study, the effect of non-surgical periodontal treatment on PAR2 expression and its association with levels of pro-inflammatory mediators, and activating proteases were investigated in chronic periodontitis patients. Moreover it was evaluated in vitro the role of MAPK-p38 signaling pathway during PAR2 activation and its influence on superoxide production and phagocytosis capacity in peripheral human neutrophils infected with P. gingivalis. A significant mRNA and protein over-expression of PAR2 (P < 0.05) in gingival crevicular fluid cells was positively associated to inflammatory clinical parameters, and to the levels of interleukin (IL)-6, IL-8, tumor necrosis factor-alpha, matrix metalloproteases (MMP)-2, MMP-8, hepatocyte growth factor, and vascular endothelial growth factor (evaluated by Bioplex). Elevated levels of gingipain and P3 (P < 0.05), and decreased levels of dentilisin mRNA and protease inhibitors, secretory leucocyte protease inhibitor and elafina (P < 0.05) (evaluated by ELISA), were also associated to PAR2 overexpression. Periodontally healthy sites from chronic periodontitis individuals showed a diminished expression of PAR2 mRNA and PAR2 protein level (P < 0.05). Furthermore, periodontal treatment resulted in decreased PAR2 expression (P < 0.05), correlated with decreased expression of inflammatory mediators (P < 0.05) and activating proteases (P < 0.05). Moreover, PAR2 antagonist reduced significantly superoxide production in human neutrophils (P < 0.05) showing the role of PAR2 on this important cellular function. We concluded that periodontal treatment resulted on decreased levels of proteases, and pro-inflammatory mediators is associated to decreased PAR2 expression, therefore suggesting that PAR2 expression is influenced by the presence of periodontal infection, and not a constitutive characteristic favoring periodontal inflammation.

Influência do diabetes mellitus do tipo 2 na expressão dos receptores ativados por protease do tipo 1 (PAR1) e do tipo 2 (PAR2) em pacientes com periodontite crônica / Influence of diabetes mellitus type 2 in the expression of protease-activated receptor type 1 (PAR1) and type 2 (PAR2) in patients with chronic periodontitis

O receptor ativado por protease do tipo 1 (PAR1) parece estar associado ao reparo periodontal, enquanto o tipo 2 (PAR2) com a inflamação periodontal. Esses receptores podem ser ativados pelas proteases gingipaina, uma protease secretada pela Porphyromonas gingivalis, um importante periodontopatógeno, e pela proteinase-3 de neutrófilos (P3), que é liberada por neutrófilos quando expostos a um estímulo inflamatório. Uma vez que o diabetes é reconhecido como um fator de risco importante para a doença periodontal, o objetivo deste estudo foi investigar a expressão de PAR1 e de PAR2 e de seus ativadores, gingipaina e P3 no fluido gengival (FG) de pacientes diabéticos com periodontite crônica, antes e após tratamento periodontal não cirúrgico. Amostras de FG e os parâmetros clínicos, como profundidade de sondagem (PS), nível clínico de inserção (NCI), sangramento à sondagem (SS) e índice de placa (IP) foram coletados de pacientes sistemicamente saudáveis e de pacientes com diabetes mellitus do tipo 2 (DMT2) com periodontite crônica , no baseline e após o tratamento periodontal não cirúrgico. As expressões gênicas de PAR1, PAR2, gingipaina e P3 no FG foram quantificadas por qPCR. Os parâmetros clínicos melhoraram significativamente após a terapia periodontal (p <0,01). O diabetes levou ao aumento da expressão de PAR1 no fluido gengival e na presença da periodontite crônica diminuiu significativamente a expressão de PAR1, PAR2 e P3 (p<0,05). Além disso, o tratamento periodontal não cirúrgico em diabéticos resultou no aumento da expressão de PAR1 e de PAR2 (p<0,05). Dentro dos limites do presente estudo, sugerimos que os PARs podem estar associados com a inflamação periodontal em diabéticos.

Protease activated receptor type 1 (PAR1) seems to play a role in periodontal repair, while PAR2 is associated with periodontal inflammation. These receptors can be activated by gingipain, a protease released from Porphyromonas gingivalis, an important periodontal pathogen, and neutrophil proteinase-3 (P3), which is released by neutrophils when exposed to an inflammatory stimulus. Since diabetes is known risk factor to periodontal disease, the aim of this study was to investigate PAR1 and PAR2 mRNA expression at the gingival crevicular fluid (GCF) in diabetic patients with chronic periodontitis, before and after non-surgical periodontal treatment. GCF samples and clinical parameters consisting of measuring probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were collected from systemically healthy patients and patients with type 2 diabetes mellitus with chronic periodontitis, at baseline and after nonsurgical periodontal treatment. PAR1 and PAR2, as well the expression of the activators gingipain and P3 at the GCF were quantified by qPCR. The clinical parameters improved significantly after periodontal therapy (p <0.01). Diabetes led to increased expression of PAR1 in the GCF, and the presence of chronic periodontitis significantly decreased the expression of PAR1, PAR2 and P3 (p <0.05). Moreover, non-surgical periodontal treatment in diabetics resulted in increased expression of PAR1 and PAR2 (p <0.05). Within the limits of this study, we suggest that PARs may be associated with periodontal inflammation in diabetics.

Efeito da severidade da doença periodontal sobre a expressão do Receptor Ativado por Protease do Tipo 2 (PAR-2) / Effect of the severity of periodontal disease on the expression of Protease Activated Receptor Type 2 (PAR-2)

Pesquisas recentes investigando o receptor ativado por protease do tipo 2 (PAR-2) sugerem uma associação entre este receptor e a inflamação periodontal. Além disso, é sabido que a gingipaína, protease bacteriana secretada por um importante periodontopatógeno, Porphyromonas gingivalis (Pg), tem a capacidade de ativar o PAR-2. Ademais, um estudo anterior do grupo, verificou que quanto mais profunda a bolsa periodontal, maior era a expressão do receptor PAR-2. No entanto, não é sabido se a expressão de PAR-2 é proporcional a severidade de doença periodontal e a quantidade de gingipaína expressa na bolsa periodontal. Desta forma, o presente estudo, verificou no fluido gengival a correlação entre a expressão gênica de PAR-2 (Real Time-PCR) com os parâmetros clínicos periodontais, e a expressão gênica da protease gingipaína em pacientes com periodontite crônica severa e moderada, antes e após o tratamento periodontal não-cirúrgico. A expressão de PAR-2 e da protease gingipaína foi estatisticamente maior nos pacientes do grupo periodontite crônica severa (PS) em comparação com os pacientes do grupo periodontite crônica modera (PM) e controle (C). Além disso, o tratamento periodontal levou à redução significativa (p<0.05) da expressão de PAR-2 nos pacientes com periodontite crônica moderada. Em conclusão, dentro dos limites do presente estudo, nós demonstramos que a severidade da doença periodontal e a expressão de gingipaína influenciaram a expressão de PAR-2 no fluido gengival de pacientes com periodontite crônica.

Recent studies investigating the protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. In addition, it is known that gingipain, a bacterial protease secreted by an important periodontopathogen, Porphyromonas gingivalis (Pg), has the ability to activate PAR- 2. Furthermore, a previous study from our group found that the deeper the periodontal pocket, the higher the expression of the PAR-2 receptor. However, it is not known whether the expression of PAR-2 is associated to the severity of periodontal disease and the amount of gingipain expressed in the periodontal pocket. Thus, the present study verified, in the gingival fluid, the correlation between the PAR-2 gene expression (Real Time-PCR) with the clinical periodontal parameters, and the gene expression of the gingipain protease in patients with moderate and severe chronic periodontitis before and after non-surgical periodontal treatment. PAR-2 expression and gingipain protease were statistically more expressed in patients of the severe chronic periodontitis group (PS) compared with those in the moderate chronic periodontitis group (PM) and control group (C). Furthermore, periodontal treatment led to a significant reduction (p <0.05) in the expression of PAR-2 in patients with moderate chronic periodontitis. In conclusion, within the limits of the present study, we demonstrated that the severity of periodontal disease and the expression of gingipain influenced the PAR-2 expression in the gingival fluid of patients with chronic periodontitis.

Detecção e quantificação de patógenos periodontais em fumantes e não fumantes com periodontite crônica pela PCR em tempo real / Detection and quantification of periodontal pathogens in smokers and never-smokers with chronic periodontitis by Real-Time Polymerase Chain Reaction

O objetivo do presente trabalho foi comparar fumantes e não fumantes com periodontite crônica com relação a presença e quantidade de patógenos periodontais, através da reação em cadeia da polimerase em tempo real. Quarenta fumantes e quarenta não fumantes, pareados por idade, sexo e profundidade clínica de sondagem dos sítios de coleta microbiológica, foram incluídos no estudo. Foi realizado exame periodontal completo, e coletado um pool de biofilme subgengival dos sítios mais profundos de cada quadrante, em cada sujeito de pesquisa. Para confirmar os dados sobre tabagismo, os sujeitos foram submetidos à avaliação das concentrações de monóxido de carbono expirado, através de um monoxímetro. A presença e quantificação de Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia e Treponema denticola foi determinada pela reação em cadeia da polimerase em tempo real. Fumantes apresentaram maior média de profundidade clínica de sondagem (p = 0,001) e nível clinico de inserção (p = 0,006), e menos sítios com sangramento à sondagem (p = 0,001) do que os não fumantes. Foi observada associação entre fumo e presença de A. actinomycetemcomitans (p < 0,001). Contagens médias de A. actinomycetemcomitans (p < 0,001), P. gingivalis (p = 0,042) e T. forsythia (p < 0,001) foram significantemente maiores nos fumantes. Os resultados permitiram concluir que o fumo altera a composição da microbiota subgengival em indivíduos com periodontite crônica, com diferenças na presença e quantidade dos patógenos periodontais investigados

The aim of the present investigation is to compare smokers and nonsmokers with chronic periodontitis, regarding the presence and quantity of periodontal pathogens, using real-time polymerase chain reaction. Forty current smokers and forty never-smokers, matched for age, sex and sampling sites mean probing depth, were included in this investigation. A full-mouth periodontal examination was performed, and a pooled subgingival plaque sample was collected from the deepest site, in each quadrant, of each subject. To confirm smoking status, subjects had their expired air carbon monoxide concentrations measured with the help of a carbon monoxide monitor. The presence and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were determined by real-time polymerase chain reaction. Smokers presented greater overall mean probing depth (p = 0,001) and mean clinical attachment level (p = 0,006), and fewer bleeding on probing sites (p = 0,001). An association was observed between smoking status and presence of A. actinomycetemcomitans (p < 0.001). Counts of A. actinomycetemcomitans (p < 0,001), P. gingivalis (p = 0,042) and T. forsythia (p< 0,001) were significantly higher in smokers. We concluded that smoking changes the composition of the subgingival microbiota in chronic periodontitis patients, with differences in the presence and quantification of investigated periodontopathogens