Exploration of the motivations in the adherence of patients to periodontal maintenance therapy / Exploración de las motivaciones en la adherencia de los pacientes en la mantención periodontal

Introduction: Although it has been shown that the supportive periodontal therapy (SPT) is essential to maintain the results obtained by periodontal therapy, patient adherence to SPT is not usually satisfactory (4). The objective of this research is to explore the motivations in the adherence to periodontal maintenance of patients treated at Universidad Viña del Mar (UVM) during the year 2020. Material and Methods: A study based on the qualitative paradigm was carried out using a design based on discourse analysis through semi-structured interviews. A sample size of 10 participants was consolidated, by obtaining with them the saturation of data collected and of 4 main dimensions. Each interview was transcribed ad verbatim and later analyzed through the Atlas.ti 9 Software. Results: Four main categories or dimensions were created: Motivations of the patients to produce a change in their oral health; Information that the patients have regarding their oral health; Oral hygiene habits acquired after periodontal treatment; Situations that prevent adherence to periodontal treatment. Conclusion: The main motivations of patients to adhere to supportive periodontal therapy are related to the education and information they acquire in the first phase of periodontal treatment. Observing the changes during treatment, improving oral health, improving aesthetics and functionality, are other important motivations, as well as the patients' fear of losing their teeth and the desire to educate their family.

Introducción: Aunque se ha demostrado que la fase de mantención periodontal (TPS) es esencial para mantener los resultados obtenidos por la terapia periodontal, la adherencia del paciente a la TPS no es, en su mayoría, satisfactoria (4). El objetivo de esta investigación es explorar las motivaciones de los pacientes en la adherencia a la mantención periodontal, atendidos en la Universidad Viña del Mar (UVM), durante el año 2020. Material y Métodos: Se realizó una investigación basada en el paradigma cualitativo por medio de un diseño en base al análisis de discursos a través de entrevistas semiestructuradas. Se consolidó un tamaño muestral de 10 participantes, al obtener con ellos la saturación de datos recolectados y de 4 dimensiones principales, cada entrevista fue transcrita ad verbatim y posteriormente analizadas a través del Software Atlas.ti 9. Resultados: Se generaron cuatro categorías o dimensiones principales: Motivaciones del paciente para generar un cambio en su salud oral, Información que posee el paciente respecto a su salud oral, Hábitos de higiene oral adquiridos posterior al tratamiento periodontal y Situaciones que impiden la adherencia al tratamiento periodontal. Conclusión: Las motivaciones principales que presentan los pacientes para adherirse a la fase de mantención periodontal, están relacionadas con la educación e información que adquieren en la primera fase del tratamiento periodontal. Observar los cambios durante el tratamiento, adquirir salud oral, mejorar la estética y funcionalidad, son otras motivaciones de importancia, así como el miedo que presenta el paciente de perder sus dientes y las ganas de querer educar a su familia.

Nivel de conocimiento, actitudes y prácticas sobre enfermedad periodontal en pacientes diabéticos / Level of knowledge, attitudes and practices on periodontal disease in diabetic patients

RESUMEN Fundamento: La diabetes mellitus y la enfermedad periodontal tienen una relación bidireccional, siendo la prevención la herramienta indispensable para lograr el mejoramiento del nivel de salud bucal. Objetivo: Identificar el nivel de conocimientos, actitudes y prácticas de la enfermedad periodontal en pacientes diabéticos. Metodología: Se realizó un estudio observacional descriptivo de corte transversal de septiembre de 2019 a abril de 2020 en la población diabética de 19 a 40 años del Consultorio Médico de Familia n.o 11 del área de salud de Zaza del Medio perteneciente al municipio Taguasco, provincia Sancti Spíritus. Se estudiaron las variables edad, sexo, nivel de conocimiento, actitudes y prácticas sobre salud bucal. Resultados: En el 67.9 % de los pacientes se observó bajo nivel de conocimientos sobre la enfermedad periodontal, actitud desfavorable el 78.6 % y prácticas deficientes el 57.1 %. Conclusiones: La mayoría de los pacientes diabéticos presentó bajo nivel de conocimientos, actitud desfavorable y prácticas deficientes para lograr la salud periodontal.

ABSTRACT Background: Diabetes mellitus and periodontal disease have a bidirectional relationship, being prevention the essential tool to achieve an improvement in the level of oral health. Objective: To identify the level of knowledge, attitudes and practices of periodontal disease in diabetic patients. Methodology: A cross-sectional descriptive observational study was conducted from September 2019 to April 2020 in the diabetic population aged 19 to 40 years at the doctor´s office 11 in Zaza del Medio health area of Taguasco municipality in Sancti Spíritus province. The variables age, sex, level of knowledge, attitudes and practices on oral health were studied. Results: 67.9 % of the patients had a low level of knowledge about periodontal disease, 78.6 % had an unfavorable attitude and 57.1 % had deficient practices. Conclusions: The majority of diabetic patients presented low level of knowledge, non-favorable attitude and poor practices to accomplish periodontal health.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.

Self-Reported Periodontal Disease and its Association with Dental Anxiety in Lagos, Nigeria

ABSTRACT Objective To determine the relationship between dental anxiety and self-reported periodontal status. Material and Methods The study was conducted among 263 patients at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Self-assessed gingival and periodontal disease was measured using the validated periodontal disease self-report surveillance questionnaire. The Modified Dental Anxiety Scale (MDAS) was used for evaluating dental anxiety. Student's t-test was used to test for association between categorical variables. P-value < 0.05 was considered to be statistically significant. Results Seventy-seven (29.3%) participants had high dental anxiety, while 49 (18.6%) had very high dental anxiety. The prevalence of periodontal disease was higher among those with very high dental anxiety (77.6%), while female respondents had a significantly higher proportion of self-reported periodontitis (34.1%). There was a significantly higher prevalence of very high dental anxiety among respondents who had never visited the dentist (23.2%). Similarly, females (19.4%), middle-class respondents (30.8%), and those with a primary level of school education (23.5%) had a higher prevalence of high dental anxiety, even though the association was not significant. Conclusion The prevalence of self-reported periodontal disease among the respondents with very high dental anxiety was higher than in those with high dental anxiety and those without dental anxiety, but the difference was not significant.

Cepillos interdentales, de la teoría a la práctica. Revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, con papilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica, prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have, multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixed prosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Consensus of Chinese stomatological multidisciplinary experts on maintaining periodontal health (First edition) / 中华口腔医学杂志

Periodontal disease is the main cause of tooth loss in adults, and it is also one of the major factors affecting oral and general health. In the process of diagnosing and treating the oral diseases, many subspecialties of stomatology will involve in the maintenance of periodontal tissue health. The Chinese Stomatological Association organized a number of experts in related disciplines to thrash out the present expert consensus in order to enhance the awareness of dental clinicians to maintain the health of periodontal tissues and to standardize the procedures of diagnosis and treatment. The clinicians' abilities in prevention and treatment of oral diseases will be hopefully elevated if the clinicians, especially in such disciplines as prosthodontics, orthodontics, oral implantology, operative dentistry and endodontics, can early recognize and identify the periodontal disease and the damage degree of periodontal tissues, adopt the appropriate intervention measures and predict the prognosis scientifically.

Percepción de pacientes respecto a la enfermedad periodontal en la Clínica Estomatológica Docente Julio Antonio Mella, Guantánamo / Perception of patients about periodontal disease at the Julio Antonio Mella Teaching Stomatological Clinic, Guantanamo

RESUMEN Introducción: Las enfermedades periodontales son un problema de salud bucal, y para prevenirlas es esencial el cuidado de las encías. Objetivo: Precisar la percepción de pacientes afectados sobre esta enfermedad para sustentar la sistematización de las bases teóricas dirigidas a la preparación de estudiantes de Estomatología y estomatólogos generales integrales en formación respecto al tema. Método: Se realizó un estudio descriptivo, prospectivo y transversal en la Clínica Estomatológica Docente "Julio Antonio Mella" adscrita la Universidad de Ciencias Médicas Guantánamo. Se encuestaron 25 pacientes con diagnóstico de enfermedad periodontal para indagar su percepción sobre la enfermedad. Los resultados se resumieron mediante frecuencias absolutas y se expresaron mediante tablas. Resultados: Lo más común es que los pacientes revelaran una opinión desfavorable en relación con los temas: expresión de una empobrecida educación sobre esta enfermedad (n=22), actitud insuficiente para el autocuidado de las encías (n=22) e Insatisfacciones con las acciones educativas en función de su prevención (n=14). Conclusiones: Los pacientes revelan una inadecuada percepción de la enfermedad periodontal lo que sustenta la sistematización de las bases teóricas para la comprensión de la necesidad de desarrollar en ellos una cultura del cuidado de las encías por una salud periodontal. Además, se reitera el valor del estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsable de la educación de la población en función de la prevención de las enfermedades periodontales.

ABSTRACT Introduction: Periodontal diseases are caused by an inadequate oral health, and to prevent them, gum care is essential. Objective: To specify the perception of affected patients about this disease in order to support the systematization of the theoretical bases directed to the preparation in the subject of students of stomatology and comprehensive general stomatologists in training. Method: A descriptive, prospective and cross-sectional study was carried out in the Stomatological Teaching Clinic "Julio A. Mella", a branch of the University of Medical Sciences of Guantanamo. Twenty-five patients with diagnosis of periodontal disease were surveyed to as cert a in their perception of the disease. The results were summarized by means of absolute frequencies and expressed in tables. Results: it was common that patients revealed an un favor able opinion regarding the following topics: absolute lack of knowledge about this disease (n=22), insufficient posture of the patients about gum self-care (n=22) and dissatisfaction with educational actions in terms of prevention (n=14). Conclusions: Patients reveal an inadequate perception of periodontal disease which supports the systematization of the theoretical bases for the understanding of the need to develop in them a culture of gum care for a good periodontal health. Furthermore, the value of the stomatologist, the family, the school, the media and the community as social agents responsible for the education of the population in terms of the prevention of periodontal diseases is reiterated.

Strategies for the prevention of periodontal disease and its impact on general health in Latin America. Section III: Prevention

Abstract: Dental plaque removal and the understanding of risk factors, risk indicators and social determinants are important components in the prevention of periodontal disease. Periodontal diseases and dental caries are largely preventable conditions, but require a "common risk factor approach" with non-communicable diseases with the purpose of improving their prevention and control, and positive impact on health. The aim of this consensus was to identify the evidence and gaps in periodontal prevention in Latin American, and to propose individual and collective recommendations for the population, health professionals, dental practice and government. The prevention of periodontal diseases in Latin America has mainly been focused on oral hygiene instruction, use of toothbrushes and interproximal devices, but in some patients, it is necessary to use adjuncts to these measures, such as antimicrobial and/or probiotic products that are backed by broad scientific evidence. Some evidence has shown that there are inadequate knowledge, attitudes and practices among patients, dentist and other health professionals. The prevention of periodontal diseases and caries should be adopted as a healthy lifestyle routine, because of their local and systemic effects. Recently, new empowerment strategies have been proposed in order to generate behavioral changes. Periodontal diseases can often be prevented, or controlled by joined efforts between government health systems, scientific associations, universities, health professionals, private companies and communities. In conclusion, the relations between periodontal diseases, caries, healthy lifestyles and NCD's offer an ideal opportunity to change Latin American prevention strategies at both the individual level and population levels.

Association Between Periodontal Health Knowledge and Oral Hygiene in Brazilian Adolescents

Abstract Objective: To evaluate the influence of oral health knowledge in adolescents' oral hygiene pattern. Material and Methods: Cross-sectional study involving 291 participants aged between 14 and 19 years old enrolled in a public school in Curitiba, Brazil. A self-administered questionnaire containing five affirmations about periodontal diseases and their forms of prevention was arranged on a three-point Likert scale. Correct answers were given a weight=1 and incorrect ones, weight=0. The knowledge score (KS) was determined by the sum. Socioeconomic and demographic data were obtained by a questionnaire sent to those responsible. The oral hygiene pattern was evaluated through the simplified oral hygiene index (OHI-S) by a calibrated researcher (K=0.89). Mann-Whitney U test and univariate and multivariate Poisson regression with robust variance were used for data analysis (α=0.05). Results: There was an inversely proportional association between KS and OHI-S (p=0.018). The multiple model showed that adolescents with a lower KS (PR = 0.93, CI95%: 0.88-0.99), male gender (PR = 1.17, CI95%: 1.01-1.37) and whose caregivers presented a lower level of education (PR=1.30, CI95%: 1.03-1.64) showed a higher index of dental plaque. Conclusion: The level of oral health knowledge, the gender and the caregivers' level of education influences the adolescents' oral hygiene pattern.

Odontología y nutrigenómica / Dentistry and nutrigenomics

La salud bucal está relacionada con varios factores que son considerados dañinos o protectores para poder estar en un equilibrio de la salud, desde el punto de vista preventivo debemos de enfocarnos cada vez más a aquellos factores protectores, como lo es la nutrición, ya que el alimentarnos adecuadamente nos ayuda a estar sanos, no solamente de la cavidad bucal sino de todo nuestro cuerpo. Una de las ciencias que ha tenido un creciente avance para el entendimiento de este fenómeno es la nutrigenómica, ya que nos ayuda a entender como los alimentos y sus contenidos desde el punto de vista genético colaboran a tener una mejor salud (AU)

Oral health is related to several factors that are considered harmful or protective to be in a balance of health, from the preventive point of view we must focus increasingly on those protective factors, such as nutrition, since to feed ourselves properly helps us to be healthy, not only of the oral cavity but of our whole body. One of the sciences that has had a growing advance for the understanding of this phenomenon is the nutriogenomic, since it helps us to understand how foods and their contents from the genetic point of view collaborate to have a better health (AU)

Cepillos interdentales, de la teoría a la práctica: revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, conpapilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica,prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixedprosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Effect of bovine milk fermented with Lactobacillus rhamnosus L8020 on periodontal disease in individuals with intellectual disability: a randomized clinical trial

Abstract Studies on the oral health of individuals with intellectual disability (ID) have identified problems that include a high prevalence of periodontal disease. The use of probiotics to treat periodontal disease has been the focus of considerable research, and bovine milk fermented with Lactobacillus rhamnosus L8020 (L8020 yogurt) has been shown to reduce the oral prevalence of four periodontal pathogens. Objective The aim of this randomized, double-blind, placebo-controlled trial was to compare the effects of L8020 yogurt (test group) with those of placebo yogurt (placebo group) on the papillary-marginal-attached (PMA) index, gingival index (GI), and probing depth (PD) in 23 individuals with ID. Methodology All patients were required to consume the allocated yogurt after breakfast for 90 days. PMA index and GI scores as well as PDs were assessed before the start of yogurt consumption (baseline), after 45 and 90 days of consumption, and 30 days after the cessation of consumption. Student's t-test, Mann-Whitney U test or Fisher's exact test was used for inter-group comparisons, and the mixed effect model of repeated measurements was used for data analysis. Results The decrease in PMA index score was significantly greater in the test group than in the placebo group (p<0.001). The GI score also decreased during the study, with a tendency for greater decrease in the test group. Furthermore, decreases in PD between baseline, 45 and 90 days tended to be greater in the test group than in the placebo group. Conclusion These results suggest that regular consumption of bovine milk fermented with L. rhamnosus L8020 can lower the risk of periodontal disease in individuals with ID.

Programa educativo dirigido a la prevención de la enfermedad periodontal en adolescentes / Educative program for preventing periodontal disease in teenagers

RESUMEN Introducción: constituye un reto modificar hábitos y conductas perjudiciales para la salud bucal de los adolescentes, a través de programas educativos. Objetivo: elaborar un programa educativo para la prevención de la enfermedad periodontal en adolescentes. Materiales y métodos: se realizó un estudio descriptivo transversal, en el período comprendido de noviembre del 2016 a abril del 2017, en los adolescentes de séptimo grado de la Escuela Secundaria Básica Urbana "13 de Marzo", de Placetas. Enfermedad periodontal, sexo, nivel de información sobre la enfermedad periodontal constituyeron las variables del estudio. A partir de la información obtenida se diseñó el programa educativo. La investigación se efectuó teniendo presente las normas éticas internacionales para la investigación biomédica. Se utilizaron frecuencias absolutas y porcentajes. Resultados: el 69,2 % de los adolescentes estaban enfermos, el 64 % de las féminas y el 50 % de los varones presentaron gingivitis leve. Solamente el 10,3 % padecían gingivitis moderada. El 65,8 % de los adolescentes tenían un nivel de información insuficiente. El programa abordó temas como: prevención de la enfermedad periodontal, realización del cepillado dental, efecto del tabaco en el periodonto y la importancia de una dieta balanceada. Se tuvo en cuenta el nivel y la edad de los alumnos a quienes estuvo dirigido el programa. Se realizaron múltiples técnicas participativas para motivar a los estudiantes sobre el tema. Conclusiones: el programa educativo fue valorado por criterios de especialistas como positivo por el nivel de pertinencia para resolver las carencias detectadas (AU).

ABSTRACT Introduction: it is a challenge to modify harmful habits and behaviours for the oral health of teenagers through educative programs. Objective: to prepare an educative program for preventing periodontal disease in teenagers. Materials and methods: a cross-sectional, descriptive study was carried out in the period from November 2016 to April 2017 in 7th grade teenagers from the Urban Junior High School "13 de Marzo", of Placetas. The variables of the study were periodontal disease, sex, and information level on periodontal disease. The educative program was prepared on the basis of the gathered information. The research was carried out taking into account the international ethic norms for the biomedical research. Absolute frequencies and percentages were used for the analysis of the results. Results: 69,2 % of the patients suffered the disease; 64 % of the female students and 50 % of the male ones had mild gingivitis. Only 10,3 % suffered moderated gingivitis. 65,8 % of the patients had an inadequate information level. The program dealt with themes like periodontal disease prevention; teeth brushing; effects of smoking in the periodontium and importance of a balanced diet. The educational level and age of the students to which the program was directed at were taken into account. Many participative techniques were applied to motivate the students on the theme. Conclusions: the educative program was valued as positive according to the criteria of specialists due to the level of relevance to solve the deficiencies that were found (AU).

Periodontal health knowledge and awareness among subjects with fixed orthodontic appliance

Abstract Objective: To report on periodontal health knowledge and awareness among orthodontic patients and to investigate the effect of age, attitude and duration of orthodontic treatment on periodontal health awareness among orthodontic patients. Methods: A total of 297 orthodontics patient (90 males, 207 females) with mean age of 17.7 ± 5.0 years (older then 18 years = 119, 18 years or younger = 178) were included in this study. Subjects were currently wearing upper and lower fixed orthodontic appliances for an mean period of 12.55 ± 10.86 months (less than or equal to 18 months = 231, more than 18 months = 66). Data was collected through a self-administered questionnaire (demographic characteristics, subjects' awareness toward their periodontal health, periodontal knowledge among orthodontic patient and patients' attitude toward orthodontic treatment regarding periodontal health) and clinical periodontal examination. Results: Periodontal knowledge was poor among orthodontic patients in relation to dental plaque. Only 24 subjects (8%) correctly answered knowledge-related questions. Adult orthodontic patients reported negative attitude toward fixed orthodontic treatment in respect to periodontal health (p<0.001). Duration of orthodontic treatment negatively affected subjects' attitude toward fixed orthodontic treatment (p<0.01). The majority of subjects were in the high level of awareness group (64%). Orthodontic patients' awareness toward their periodontal health during fixed orthodontic treatment was affected by attitude scores (p=0.005), number of teeth with gingival recession (p=0.041), Gingival Index (p=0.000), duration of treatment (p=0.047) and age (p=0.008). Conclusions: Periodontal health knowledge among orthodontic patients was poor. Orthodontic patients' awareness of their periodontal health was moderate and was affected by age, attitude and duration of orthodontic treatment.

Resumo Objetivo: relatar sobre o conhecimento e a conscientização quanto à saúde periodontal dos pacientes ortodônticos e investigar os efeitos da idade, atitude e duração do tratamento sobre a conscientização da saúde periodontal entre esses pacientes. Métodos: um total de 297 pacientes foi incluído nesse estudo (90 homens e 207 mulheres), com idade média de 17,7±5,0 anos (maiores de 18 anos = 119, iguais ou menores de 18 anos = 178). Os indivíduos estavam usando aparelhos ortodônticos fixos nas arcadas superior e inferior por um período médio de 12,55±10,86 meses (18 meses ou menos = 231, mais de 18 meses = 66). Os dados foram coletados por meio de um questionário autoaplicável (características demográficas, conscientização com relação à saúde periodontal, conhecimento periodontal entre os pacientes ortodônticos e a atitude dos pacientes com relação ao tratamento ortodôntico com relação à saúde periodontal) e exame clínico periodontal. Resultados: o conhecimento periodontal entre os pacientes ortodônticos foi pequeno com relação à placa bacteriana. Somente 24 indivíduos (8%) responderam corretamente às questões relacionadas ao conhecimento. Os pacientes ortodônticos adultos relataram uma atitude negativa quanto ao tratamento com aparelhos fixos, com relação à saúde periodontal (p<0,001). A duração do tratamento afetou negativamente a atitude dos indivíduos com relação ao tratamento com aparelhos fixos (p<0,01). A maioria dos indivíduos estava no nível mais alto do grupo conscientização (64%). A conscientização dos pacientes ortodônticos com relação à sua saúde periodontal durante o tratamento ortodôntico com aparelhos fixos foi afetada pelos escores da atitude (p=0,005), pelo número de dentes com retração gengival (p=0.041), Índice Gengival (p=0,000), duração do tratamento (p=0,047) e idade (p=0,008). Conclusões: o conhecimento sobre a saúde periodontal entre os pacientes foi pequeno. A conscientização dos pacientes quanto à sua saúde periodontal foi moderada e foi afetada pela idade, atitude e duração do tratamento ortodôntico.

The effects of different restorative materials on periodontopathogens in combined restorative-periodontal treatment

Abstract Objective The aim of the study was to evaluate the association between subgingival restorations and the target periodontopathogenic bacteria (Pg, Td and Pi) in subgingival biofilm during one year after combined restorative-periodontal treatment. Material and Methods Seventeen systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were included in the study. A total of 51 combined defects were treated with connective tissue graft plus a nanofilled composite resin (NCR+CTG), a resin-modified glass ionemer cement (RMGI+CTG) and a fluoride-releasing resin material with pre-reacted glass (PRG), called giomer (Giomer+CTG). Periodontal clinical measurements and subgingival plaque samples were obtained from all combined defects at baseline and at 6 and 12 months after the surgery. The number of bacteria were evaluated by the real-time polymerase chain reaction (qPCR) method. Results No statistically significant difference in the amount of DNA copies of Pg, Td and Pi was observed in any of the groups at any time points (p>0.05). In addition, there was no statistically significant difference in the amount of DNA copies of the bacteria at baseline and at 6 and 12 months postoperatively, regardless of treatment group (p>0.05). Conclusion This study suggests that subgingivally placed NCR, RMGI and giomer restorations can show similar effects on periodontopathogenic bacteria in the treatment of gingival recessions that are associated with noncarious cervical lesions (NCCLs).

Educational interventions in health services and oral health: systematic review / Intervenções educativas em serviços de saúde e saúde bucal: revisão sistemática

ABSTRACT OBJECTIVE To analyze the effectiveness of educational interventions performed in health services in the improvement of clinical behaviors and outcomes in oral health. METHODS We have carried out a systematic review of the literature searching the PubMed, Lilacs, and SciELO databases. We have included studies that have investigated interventions performed by health professionals working in health services and who have used educational actions as main approach to improve behavioral and clinical outcomes in oral health. RESULTS The search amounted to 832 articles and 14 of them met all the inclusion criteria. Five studies have only exclusively evaluated the effectiveness of interventions on caries reduction, three have exceptionally evaluated oral health behaviors, and the other articles have evaluated the effectiveness of interventions for both clinical outcomes (dental caries and periodontal conditions) and behaviors in oral health. Most of the studies (n = 9) were based on randomized controlled trials; the other ones have evaluated before and after the intervention. Five studies have reported a significant reduction of dental caries, and five of the six studies evaluating behavioral outcomes have found some positive change. CONCLUSIONS Most studies evaluating behavioral and periodontal outcomes have shown significant improvements in favor of interventions. All studies evaluating caries have shown a reduction in new lesions or cases of the disease in the groups receiving the interventions, although only five of the eleven articles have found a statistically significant difference. Educational interventions carried out by health professionals in the context of their practice have the potential to promote oral health in the population.

RESUMO OBJETIVO Analisar a efetividade de intervenções educativas realizadas em serviços de saúde na melhoria de comportamentos e desfechos clínicos em saúde bucal. MÉTODOS Foi realizada uma revisão sistemática da literatura com busca nas bases de dados PubMed, Lilacs e SciELO. Foram incluídos estudos que investigaram intervenções realizadas por profissionais de saúde atuantes em serviços de saúde e que utilizaram como principal abordagem ações de educação com a finalidade de melhorar desfechos comportamentais e clínicos em saúde bucal. RESULTADOS A busca totalizou 832 artigos e 14 preencheram todos os critérios de inclusão. Cinco estudos verificaram exclusivamente a efetividade das intervenções na redução de cárie, três avaliaram excepcionalmente comportamentos em saúde bucal, os demais artigos julgaram a efetividade das intervenções tanto para desfechos clínicos (cárie dentária e condições periodontais) quanto para comportamentos em saúde bucal. A maioria dos estudos (n = 9) foi baseada em ensaios randomizados e controlados, os demais avaliaram o antes e depois da intervenção. Cinco estudos reportaram redução significativa de cárie dentária, e cinco dos seis estudos que avaliaram desfechos comportamentais encontraram alguma mudança positiva. CONCLUSÕES A maioria dos estudos que avaliaram desfechos comportamentais e periodontais mostrou melhorias significativas a favor das intervenções. Todos os estudos que avaliaram cárie mostraram a diminuição de novas lesões ou casos da doença nos grupos que receberam as intervenções, embora apenas cinco dos 11 artigos tenham encontrado uma diferença estatisticamente significativa. As intervenções educativas realizadas por profissionais de saúde no contexto de sua prática apresentam potencial em promover a saúde bucal da população.

Efeito da administração local ou sistêmica do Lactobacillus reuteri, no tratamento da doença periodontal experimentalmente induzida em ratos, submetidos à quimioterapia com 5-fluorouracil: estudo histopatológico, histométrico e imunoistoquímico / Effect of local or systemic administration of Lactobacillus reuteri in the treatment of experimentally induced periodontal disease in rats submitted to 5-fluorouracil chemotherapy: histopathological, histometric and immunohistochemical study

Introdução e objetivo: Os probióticos (PROs) estão sendo intensamente avaliados na prevenção ou tratamento de doenças da cavidade oral, que estão associadas a uma mudança na composição e atividade microbiana do biofilme e resposta do hospedeiro. O objetivo desse estudo foi avaliar o efeito do Lactobacillus reuteri aplicado localmente ou sistemicamente como coadjuvante ao tratamento periodontal não cirúrgico de raspagem e alisamento radicular (RAR), na periodontite experimentalmente induzida em animais submetidos ao tratamento com 5-fluorouracil (5-FU). Material e Métodos: A indução da periodontite experimental (PE) foi realizada com a colocação de um fio de algodão ao redor dos primeiros molares inferiores esquerdos de 108 ratos, que permaneceu por 7 dias. Todos os animais receberam o quimioterápico no momento da indução da PE (60mg/kg) e 48 horas após (40mg/kg) e foram separados aleatoriamente em 6 grupos com 18 animais cada um, com os seguintes tratamentos: 5FU: sem tratamento local ou sistêmico; 5FU/RAR: receberam tratamento com RAR seguido de 1 aplicação local de solução fisiológica salina (SS; 0,16mL); Grupo 5FU/SSL: RAR e 4 aplicações locais de SS (0,16mL); 5FU/SSS: RAR e 4 gavagens com SS (0,16mL); 5FU/PL: RAR e 4 aplicações locais de PRO (0,16 mL); 5FU/PS: RAR e 4 gavagens com PRO (0,16mL). 6 animais de cada grupo foram submetidos à eutanásia aos 7, 15 e 30 dias pós-tratamentos. A área da furca dos molares foi submetida às análises histopatológica, histométrica e dos padrões de imunomarcação para TRAP, PCNA, RANKL, OPG, OCN e TGF-ß1. Os dados obtidos foram submetidos à análise estatística (α=5%). Resultados: O grupo 5FU/PS apresentou melhora no processo inflamatório em todos os períodos. Houve maior perda óssea alveolar (PO) nos espécimes do grupo 5FU/SSS comparado ao 5FU/SSL (p˂0,01) no período de 7 dias de avaliação. No período de 15 dias os espécimes dos grupos 5FU/SSL e 5FU/SSS demonstraram maior PO comparado aos grupos 5FU (p˂0,05) e 5FU/PS (p˂0,05). Aos 30 dias a PO mostrou-se maior nos espécimes do grupo 5FU/PL comparado aos grupos 5FU/RAR (p˂0,05), 5FU/SSS (p˂0,05) e 5FU/PS (p˂0,05). Na análise intragrupo houve menor PO no grupo 5FU/RAR e 5FU/PS aos 30 dias em relação aos 7 dias (p˂0,05). Na imunomarcação de células TRAP-positivas não foi evidenciada diferença significante entre os grupos e períodos; houve maior imunomarcação de células PCNA-positivas aos 7 dias no grupo 5FU/RAR comparado ao 5FU/SSS. Prevaleceu baixo padrão de imunomarcação de TGF-ß1 e OCN nos grupos 5FU, 5FU/RAR, 5FU/SSL e 5FU/SSS e o grupo 5FU/PS apresentou aos 7 dias um moderado padrão de imunomarcação e aos 15 e 30 dias um alto padrão de imunomarcação. Na análise de RANKL prevaleceu um alto padrão de imunomarcação nos grupos 5FU, 5FU/RAR, 5FU/SSL, 5FU/SSS em todos os períodos e o grupo 5FU/PS apresentou aos 7 e 15 dias um moderado padrão de imunomarcação e aos 30 dias predominou um padrão de imunomarcação que variou do moderado ao baixo. Prevaleceu um padrão baixo de imunomarcação em todos os grupos experimentais e períodos, com exceção dos grupos 5FU/PL e 5FU/PS aos 30 dias (moderado padrão de imunomarcação) na análise de OPG. Conclusão: Diante dos resultados obtidos e com a metodologia empregada pode ser concluído que o uso sistêmico do Lactobacillus reuteri promoveu redução da inflamação e beneficiou o processo de reparação dos tecidos periodontais, porém não foi capaz de reduzir a PO na região de furca, demonstrando ser uma terapia periodontal coadjuvante promissora em animais submetidos à quimioterapia com 5-FU(AU)

Probiotics (PROs) have been intensively evaluated to prevent or treat oral cavity diseases, associated with a change in the composition and microbial activity of the biofilm and response of the host. The aim of this study was to evaluate the effect of Lactobacillus reuteri applied locally or systemically as a coadjuvant to the non-surgical periodontal treatment of scaling and root planing (SRP) in experimentally induced periodontitis in animals treated with 5-fluorouracil (5-FU). Induction of experimental periodontitis (EP) was performed by placing a cotton thread around the left lower molars of 108 rats, which were kept there for 7 days. All animals underwent chemotherapy twice. They were 60mg/kg at the time they were subjected to ligature induction and again another 40 mg/kg, 48 hours later. They were randomly divided into 6 groups with 18 animals each and they received the following treatments: 5FU: treated animals with 5-FU; 5FU/SRP: 5-FU treated animals receiving SRP treatment followed by physiological saline (SS) solution; 5FU/SSL group: animals treated with 5-FU, who received SRP treatment and local SS applications; 5FU/SSS: animals treated with 5-FU, who received SRP treatment and systemic treatment with SS; 5FU/PL: animals treated with 5-FU, who received SRP treatment and local applications of PRO; 5FU/PS: animals treated with 5-FU, who received SRP treatment and systemic treatment with PRO (0.16ml x 4 days). Six animals from each group were submitted to euthanasia at 7, 15 and 30 days after treatments. The area of the molar furcation was submitted to histopathological, histometric and immunolabeling analysis for TRAP, PCNA, RANKL, OPG, OCN and TGF-ß1. The data were submitted to statistical analysis (α = 5%). There was greater bone loss (BL) in the 5FU/SSS group compared to the 5FU/SSL group (p˂0.01) in the 7-day evaluation period. In the 15-day period, specimens from the 5FU/SSL and 5FU/SSS groups showed a higher BL compared to the 5FU (p˂0.05) and 5FU/PS (p˂0.05) groups. At 30 days the BL was higher in the 5FU/PL group compared to the 5FU/SRP (p˂0.05), 5FU/SSS (p˂0.05) and 5FU/PS groups (p˂0.05). In the intragroup analysis there was a lower BL in the 5FU/SRP group and 5FU/PS at 30 days compared to 7 days (p˂0.05).In the immunostaining of TRAP-positive cells no significant difference between groups and periods was evidenced; there was greater immunolabeling of PCNA-positive cells at 7 days in the 5FU/SRP group compared to 5FU/SSS. Low prevalence of TGF-ß1 and OCN immunostaining in the 5FU, 5FU/RAR, 5FU/SSL and 5FU/SSS groups prevailed at all periods. The 5FU/PS group presented at 7 days a moderate pattern of immunostaining and at 15 and 30 days a high standard of immunoblotting of TGF-ß1 and OCN; the 5FU/PL group presented a moderate pattern of TGF-ß1 and OCN immunoregulation at 7, 15 and 30 days; for RANKL a high standard of immunostaining in the 5FU, 5FU/SRP, 5FU/SSL, 5FU/SSS groups prevailed at all periods, 5FU/PL prevailed at 7 days a high standard of immunostaining and a moderate immunostaining pattern at 15 and 30 days and 5FU/PS showed a moderate immunostaining pattern at 7 and 15 days, and at 30 days a predominance of the immunoblot pattern varied from moderate to low; for OPG a low pattern of immunoblotting prevailed in all experimental groups and periods, except for 5FU/PL and 5FU/PS at 30 days that presented a moderate pattern of immunostaining. Based on the results obtained in this study and the methodology used to work on it, it was concluded that the use of Lactobacillus reuteri promoted reduction of inflamation and benefited the process of repairing periodontal tissues, but it was not able to reduce the BL in the furca region, proving to be a therapy promising adjuvant periodontal in animals submitted to 5-FU chemotherapy(AU)

Autocuidado de las encías y salud periodontal / Autocuidado das gengivas e saúde periodontal / Self-care of the gingiva and periodontal health

Introducción: en Cuba se prioriza la atención a la salud bucal, la que está determinada por diferentes factores, entre los que prevalece la incidencia de la enfermedad periodontal que hoy se reconoce como problema de salud, pues daña el bienestar biopsicosocial del individuo. Objetivo: brindar a los estomatólogos las bases teóricas que le permitan enriquecer su preparación respecto al tema enfermedad periodontal y de esta manera mejorar su contribución a su prevención desde el nivel de atención primaria a la salud bucal. Método: se sistematizaron los referentes relacionados con la enfermedad periodontal en la Facultad de Ciencias Médicas de Guantánamo, en el período de enero a julio de 2017. Resultados: el primer estadío de la enfermedad periodontal se conoce como gingivitis. La enfermedad periodontal incide hasta en un 20 % de la población mundial. El cuidado de las encías para la prevención de la enfermedad periodontal requiere que el individuo se apropie de los saberes esenciales que le posibiliten esta finalidad, a fin de que sean capaces de percibir el riesgo de ella y contribuir con las acciones dirigidas a la protección o restauración de la salud periodontal. Conclusiones: se ofrecen bases teóricas para la comprensión de la necesidad de desarrollar en los pacientes una cultura del cuidado de las encías por una salud periodontal. Se reitera el valor de estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsables de la educación de la población en función de la promoción de salud periodontal y la prevención de las enfermedades periodontales(AU)

Introduction: in Cuba attention to oral health is prioritized, which is determined by various factors, including incidence of periodontal disease that now a day is recognized as a health problem, it damages the individual as well as biopsicosocial well-being. Objective: stomatologists provide the theoretical bases that allow them to enrich their preparation on the subject periodontal disease thus improve their contribution to prevent primary care level to oral health. Method: the references related to periodontal disease in the Faculty of Medical Sciences of Guantanamo are systematized, from January to July 2017. Results: first stage of periodontal disease is known as gingivitis. Periodontal disease affects 20% of the world population. The gingiva care to prevent periodontal disease requires the individual to appropriate the essential knowledges that will enable this purpose, so that they are able to perceive the risk of it and contribute to actions with the aim of protecting periodontal health. Conclusions: theoretical basis for understanding the need to develop in patients offer culture of gingival care by a periodontal health. The value of stomatology, family, school, community media and reiterated responsible for education as social agents of the population depending on periodontal health promotion and prevention of periodontal diseases(AU)

Introdução: Cuba atenção à saúde bucal é priorizada, que é determinada por vários fatores, incluindo a incidência de doença periodontal que prevalece é agora reconhecida como um problema de saúde, ele danifica o bem-estar biopsicossocial do indivíduo. Objetivo: fornecer aos estomatologistas as bases teóricas que lhes permitirão enriquecer seu preparo em relação à questão da doença periodontal e, assim, melhorar sua contribuição para sua prevenção, desde o nível de atenção primária até a saúde bucal. Método: os referentes à doença periodontal foram sistematizados na Faculdade de Ciências Médicas de Guantánamo, no período de janeiro a julho de 2017. Resultados: o primeiro estágio da doença periodontal é conhecido como gengivite. A doença periodontal afeta até 20% da população mundial. O cuidado das gengivas para a prevenção da doença periodontal exige que o indivíduo se aproprie dos conhecimentos essenciais que possibilitam esse propósito, para que eles sejam capazes de perceber o risco dele e contribuir com as ações voltadas à proteção ou Restauração da saúde periodontal. Conclusões: bases teóricas são oferecidas para a compreensão da necessidade de desenvolver em pacientes uma cultura de cuidado gengival para a saúde periodontal. O valor do estomatologista, da família, da escola, da mídia e da comunidade são reiterados como agentes sociais responsáveis pela educação da população em termos de promoção da saúde periodontal e prevenção de doenças periodontais(AU)