O uso de probióticos como adjunto no tratamento da periodontite: revisão literatura / The use of probiotics as adjunct in the treatment of periodontitis: revisão literatura

A periodontite é definida como uma doença inflamatória crônica de natureza multifatorial associada com biofilme disbiótico. O tratamento padrão para periodontite é a Raspagem e Alisamento Radicular (RAR), no entanto quando há a presença de bolsas profundas, áreas com dificuldades de inacessibilidade como lesão de furca ou perfil microbiológico especifico, pode ser necessário a prescrição de métodos auxiliares como a antibioticoterapia. No entanto o uso de antibióticos pode causar efeitos indesejáveis. Diante disso, ao longo dos últimos anos vem crescendo o interesse de estudos sobre o uso de probióticos no tratamento da periodontite, uma vez que estes são microrganismos vivos, ou seja, que quando ingeridas corretamente são benéficas à saúde. Diante disso o presente trabalho teve como objetivo realizar uma revisão de literatura quanto ao uso de probióticos como adjuvante no tratamento da periodontite, onde foram avaliados diversos artigos científicos. Foi observado que o uso de probióticos como adjuvantes no tratamento periodontal é benéfico, no entanto, há a necessidade de realização de mais estudos para averiguação da eficiência do mesmo, assim como a necessidade deste uso ser mais conhecido pelos Cirurgiões dentistas(AU)

Periodontitis can be defined as a chronic inflammatory disease of a multifactorial nature associated with a dysbiotic biofilm. The standard treatment for periodontitis is Scaling and Root Planing (RAR, in Portuguese), however when there is the presence of deep pockets, areas with inaccessibility difficulties such as furcation lesion or specific microbiological profile, it can be necessary to prescribe auxiliary methods such as antibiotic therapy. However, the use of antibiotics can cause undesirable effects. In view of this, over the last few years, interest in studies on the use of probiotics in the treatment of periodontitis has been growing, since these are live microorganisms, that is, when ingested correctly they are beneficial to health. Therefore, the present article aimed to carry out a literature review regarding the use of probiotics as an adjuvant in the treatment of periodontitis, where several scientific articles were analyzed. It was observed that the use of probiotics as adjuvants in periodontal treatment is beneficial, however, there is a need to carry out more studies to investigate if it's really efficient, as well the dentists needs to be known about the right use(AU)

Periodontitis en niños sanos de 3 años: dos casos con seguimiento a 5 años / Periodontitis in healthy 3-year-old children: two cases with 5-year follow-up

Objetivo: La periodontitis en dentición primaria es ex- cepcional en niños sin enfermedades sistémicas. El objetivo de este informe es describir las características clínicas y ra- diográficas de dos casos de niños de 3 años sistémicamente sanos con periodontitis, y su tratamiento con seguimiento a 5 años. Casos clínicos: En ambos casos, a los 3 años de edad los niños fueron derivados al especialista en periodoncia por su odontopediatra debido a la pérdida muy temprana de inci- sivos inferiores. El examen clínico y radiográfico mostró pér- dida de inserción clínica, pérdida ósea y movilidad dental en otros incisivos superiores e inferiores. Se realizó la intercon- sulta médica y se descartó que los niños padecieran enferme- dades relacionadas con el diagnóstico de periodontitis como manifestación de una enfermedad sistémica. El tratamiento consistió en la instrucción de medidas de higiene bucal que debían ser ejecutadas por los padres, ins- trumentación subgingival, antisépticos locales, medicación antibiótica sistémica y mantenimiento periodontal. No se rea- lizaron extracciones como parte del tratamiento. En ambos casos uno de los incisivos presentes al momento de la con- sulta se perdió prematuramente, antes de los 4 años. El resto de los incisivos primarios cumplieron su ciclo normal. Luego de 5 años de seguimiento, a la edad de 8 años, ambos niños presentaban los incisivos y los primeros molares permanentes periodontalmente sanos y el resto de los dientes primarios sin signos de periodontitis (AU)

Aim: Periodontitis in primary dentition is exceptional in children without systemic diseases. The objective of this article is to describe the clinical and radiographic charac- teristics of two cases of systemically healthy 3-year-old chil- dren with periodontitis, and their treatment, with a 5-year follow-up. Clinical cases: In both cases, at 3 years of age, the chil- dren were referred to a periodontic specialist by their pediat- ric dentist, due to the very early loss of lower incisors. Clin- ical and radiographic examination showed loss of clinical attachment, bone loss and dental mobility in other upper and lower incisors. A medical consultation was carried out and diseases related to the diagnosis of periodontitis as a mani- festation of a systemic disease were ruled out. The treatment consisted of instruction on oral hygiene measures that had to be carried out by the parents, subgingival instrumentation, local antiseptics, systemic antibiotic medication, and perio- dontal maintenance. No extractions were performed as part of the treatment. In both cases, one of the incisors present at the time of consultation was lost prematurely, before the age of 4 years. The rest of the primary incisors completed their normal cycle. After 5 years of follow-up, at the age of 8 years, both children showed periodontally healthy incisors and first permanent molars, and the rest of the primary teeth without signs of periodontitis (AU)

Adopción/Adaptación mediante Comentario para Argentina por intermedio de la Federación Iberopanamericana de Periodoncia (FIPP) de la Guía de Práctica Clínica (GPC) de nivel S3: Tratamiento de la periodontitis en los estadios I ­ III, de la Federación Europea de Periodoncia (EFP), traducida por la Sociedad Española de Periodoncia (SEPA) / Adoption/Adaptation by Comment, for Argentina through the Iberopanamerican Federation of Periodontology (FIPP) of the S3 Level Clinical Practice Guideline (CPG): Treatment of periodontitis in stages I ­ III, of the European Federation of Periodontology (EFP), translated by the Spanish Society of Periodontics (SEPA)

La Sociedad Argentina de Periodoncia ha formulado un Comentario, analizando los condicionantes del contexto na- cional, para determinar si las recomendaciones generadas en la Guía de Práctica Clínica de nivel S3 de la Federación Eu- ropea de Periodoncia para el tratamiento de la periodontitis en estadios I-III, podrían ser aplicadas para dar respuesta a la demanda de la población, en lo referido a la salud periodontal (AU)

The Argentine Society of Periodontics has formulated a Commentary, analyzing the determining factors of the nation- al context, to determine if the recommendations generated in the Level S3 Clinical Practice Guideline of the European Fed- eration of Periodontics for the treatment of periodontitis in stages I-III could be applied to respond to the demand of the population, regarding periodontal health (AU)

Tratamento de periodontite estágio III localizado grau C em um indivíduo fumante: um relato de caso / Treatment of periodontitis stage III localized grade C in smoker individual: a case report

Objetivo: A periodontite é uma doença infecto-inflamatória que acomete os tecidos de inserção periodontal, e ser fumante representa um risco modificável significativo para todos os graus da doença. Ainda, indivíduos fumantes apresentam uma resposta inflamatória alterada quando comparados a não fumantes. Nesse contexto, o objetivo deste estudo foi reportar um relato de caso de tratamento periodontal de paciente fumante pesado. Relato de caso: O paciente DRS, sexo masculino, 22 anos, foi encaminhado à Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel) com a queixa principal de necessidade de "realização de uma limpeza dentária". Na anamnese, relatou fumar 20 cigarros ao dia, há 7 anos (7 maços-ano). Na consulta inicial, foi encontrado índice de placa visível (IPV) de 100% e índice de sangramento gengival (ISG) de 66,67%. Foi encontrado cálculo supragengival como fator retentivo de placa (FRP) em 46,30% dos sítios. Estabeleceu-se o diagnóstico de periodontite estágio III localizado grau C. Os exames periodontais foram realizados por um único pesquisador calibrado e optou-se pelo tratamento periodontal não cirúrgico. Ao exame de 12 meses, o paciente apresentou IPV de 23,45% e ISG de 22,83%. Houve ausência de FRP. De uma forma geral, foi possível constatar a diminuição significativa das bolsas periodontais, bem como o ganho significativo de inserção clínica periodontal. Considerações finais: Dessa forma, é possível concluir a efetividade da terapia periodontal não cirúrgica, aliada à manutenção periodontal e instruções de higiene para o tratamento de periodontite estágio III, grau C, em paciente fumante.(AU)

Objective: Periodontitis is an infect-inflammatory diseases that affects the periodontal attachment tissues, and being smoker represents a significant modifiable risk for all degrees of the disease. Moreover, smokers have an altered inflammatory response when compared to non-smokers. Therefore, the aim of this study was to report a case report of periodontal treatment of a heavy smoker. Case report: A patient DRS, male, 22 years old, was referred to the School of Dentistry of the Federal University of Pelotas (UFPel) with the main complaint of the need to "perform a dental cleaning". During the anamnesis, he reported smoking 20 cigarettes a day for 7 years (7 pack-years). In the initial appointment, a visible plaque index (VPI) of 100% and a gingival bleeding index (GBI) of 66.67% were found. Supragingival calculus was found as a plaque retentive factor (PRF) in 46.30% of the sites. The diagnosis of periodontitis stage III localized grade C was established. Periodontal examinations were performed by a single calibrated researcher and non-surgical periodontal treatment was chosen. At the 12-month appointment, the patient had an VPI of 23.45% and an GBI of 22.83%. There was absence of PRF. In general, it was possible to observe a significant decrease in periodontal pockets, as well as a significant gain in periodontal clinical attachment. Final considerations: Thus, it is possible to conclude the effectiveness of non-surgical periodontal therapy, combined with periodontal maintenance and hygiene instructions for the treatment of periodontitis stage III localized grade C in a smoker.(AU)

Effect of probiotic therapy on periodontal tissues and intestinal mucosa of rats with ligature-induced periodontitis / Efeito da terapia probiótica nos tecidos periodontais e mucosa intestinal de ratos com periodontite induzida por ligadura

INTRODUCTION: As periodontitis is caused by dysbiotic biofilm, it is believed that therapy with probiotics can act to control the mechanisms of adhesion and colonization, competing with invading microorganisms. OBJECTIVE: Evaluate probiotic therapy effect on periodontal tissues and intestinal mucosa of rats with ligature-induced periodontitis. METHODS: 32 Wistar rats were divided into four groups (n=8): Control Group (CG); Periodontal disease (PD); Probiotic (PROB); PD + probiotic (PDPRO). PD and PDPRO received a ligature over the first lower molars and PROB and PDPRO the probiotic Lactobacillus acidophilus based were given orally for 44 days. The animals were euthanized and the blood was collected for evaluation of triglyceride and cholesterol concentrations. The hemimandibles were collected for histomorphometric and radiographic analysis. The duodenum was removed for morphological evaluation and gingival tissue around the molars was collected for analysis of IL-17. RESULTS: The ANOVA one-way test was used followed by Tukey Test. PDPRO had a significantly lower bone loss than the PD (p<0.05) and a smaller number of osteoclasts on PDPRO when compared to the PD. As for IL-17, there was a decrease in the PDPRO when compared to the PD. The histomorphometry of the duodenum showed that there was a significant increase in the width of the villi in PROB only. CONCLUSION: The therapy with probiotics was effective to avoid the development of periodontitis by reducing alveolar bone loss and inflammation modulation and increasing the width of the duodenum villi, which may help to restabilize the balance of the gastrointestinal tract.

INTRODUÇÃO: Como a periodontite é causada por biofilme disbiótico, acredita-se que a terapia com probióticos possa atuar no controle dos mecanismos de adesão e colonização, competindo com microrganismos invasores. OBJETIVO: Avaliar o efeito da terapia probiótica nos tecidos periodontais e mucosa intestinal de ratos com periodontite induzida por ligadura. MÉTODOS: 32 ratos Wistar foram divididos em quatro grupos (n=8): Grupo Controle (GC); Doença periodontal (PD); Probiótico (PROB); PD + probiótico (PDPRO). PD e PDPRO receberam ligadura sobre os primeiros molares inferiores e PROB e PDPRO, o probiótico à base de Lactobacillus acidophilus dado via oral por 44 dias. Os animais foram sacrificados e o sangue coletado para avaliação das concentrações de triglicerídeos e colesterol total. As hemimandíbulas foram coletadas para análise histomorfométrica e radiográfica. O duodeno foi removido para avaliação morfológica e o tecido gengival ao redor dos molares foi coletado para análise de IL-17. RESULTADOS: Foi usado Teste ANOVA seguido pelo Teste de Tukey. PDPRO teve uma perda óssea significativamente menor do que o PD (p<0.05) e um menor número de osteoclastos no PDPRO quando comparado ao PD. Já para IL-17, houve diminuição do PDPRO em relação ao PD. A histomorfometria do duodeno mostrou que houve aumento significativo da largura das vilosidades no PROB somente. CONCLUSÃO: A terapia com probiótico foi eficaz para evitar o desenvolvimento de periodontite por reduzir a perda óssea alveolar e a modulação da inflamação e aumentar a largura das vilosidades duodenais, o que pode ajudar a estabilizar o equilíbrio do trato gastrointestinal.

Mesenchymal stem cell-derived apoptotic bodies alleviate alveolar bone destruction by regulating osteoclast differentiation and function / 国际口腔科学杂志·英文版

Periodontitis is caused by overactive osteoclast activity that results in the loss of periodontal supporting tissue and mesenchymal stem cells (MSCs) are essential for periodontal regeneration. However, the hypoxic periodontal microenvironment during periodontitis induces the apoptosis of MSCs. Apoptotic bodies (ABs) are the major product of apoptotic cells and have been attracting increased attention as potential mediators for periodontitis treatment, thus we investigated the effects of ABs derived from MSCs on periodontitis. MSCs were derived from bone marrows of mice and were cultured under hypoxic conditions for 72 h, after which ABs were isolated from the culture supernatant using a multi-filtration system. The results demonstrate that ABs derived from MSCs inhibited osteoclast differentiation and alveolar bone resorption. miRNA array analysis showed that miR-223-3p is highly enriched in those ABs and is critical for their therapeutic effects. Targetscan and luciferase activity results confirmed that Itgb1 is targeted by miR-223-3p, which interferes with the function of osteoclasts. Additionally, DC-STAMP is a key regulator that mediates membrane infusion. ABs and pre-osteoclasts expressed high levels of DC-STAMP on their membranes, which mediates the engulfment of ABs by pre-osteoclasts. ABs with knock-down of DC-STAMP failed to be engulfed by pre-osteoclasts. Collectively, MSC-derived ABs are targeted to be engulfed by pre-osteoclasts via DC-STAMP, which rescued alveolar bone loss by transferring miR-223-3p to osteoclasts, which in turn led to the attenuation of their differentiation and bone resorption. These results suggest that MSC-derived ABs are promising therapeutic agents for the treatment of periodontitis.

Treatment strategies for periodontitis patients with systemic disease / 华西口腔医学杂志

Periodontitis is a chronic inflammatory disease that destroys the integrity of tooth-supporting tissue. Periodontitis is listed as a major oral disease by the World Health Organization and is a public-health problem affecting global oral and systemic health. The fourth national oral health epidemiological survey has revealed that periodontitis is one of the most common oral problems in China. With the development of science and medicine, increased attention is being paid to the importance of oral health and its influence on general health. Accordingly, stomatologists are required to master more relevant information on clinical diagnosis and treatment, as well as to pay more attention to the diagnosis and treatment methods of patients with different systemic diseases. This article expounds the diagnosis and treatment strategy of patients with systemic disease periodontitis. We aimed to help stomatologists make more reasonable diagnosis and treatment decisions.

Diagnosis and treatment strategy of periodontitis with diabetes / 中华口腔医学杂志

The number of diabetic patients visiting stomatology for periodontal disease is increasing, and the symptoms are relatively severe, and often complications increase the complexity of periodontal treatment. This article briefly describes the research progress and clinical manifestations of the epidemiology and related pathological mechanisms of periodontitis with diabetes, focusing on the treatment and providing reference for stomatologists in the clinical diagnosis and treatment of patients with diabetic periodontitis.

Effect of periodontal debridement plus systemic azithromycin in subjects with stage III periodontitis: a randomized controlled clinical trial / Efecto del desbridamiento periodontal más azitromicina sistémica en sujetos con periodontitis estadio III: un ensayo clínico controlado aleatorio

Aim: To evaluate the effect of the systemic administration of azi-thromycin (AZM) as an adjunct to non-surgical periodontal therapy (NSPT) on the clinical and microbiological variables of patients with periodontitis. Material and Methods: Eighteen volunteers received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), O'Leary index (OI), bleeding on probing (BoP) at baseline and during the first, third and sixth month and microbiologically, at baseline and at 3 and 6 months after therapy, by conventional polymerase chain reaction tests. Results: Fourteen patients completed the study (n=7/group). Differences statistically significant were observed among both groups. The experimental group presented: A PPD mean (p=0.04) significantly lower and PPD reduction (p=0.02), at 6-months post NSPT. Regarding changes (∆), at the third month post NSPT, there was a significant increase in the number of shallow sites (p<0.001) and a decrease in the intermediate sites (p<0.001). In addition, a significant decrease in the mean number of deep sites (p=0.04) was detected at 6 months post treatment. There was also a significant decrease in periodontal index BoP at 1 (p=0.01), 3 (p<0.001) and 6 (p=0.01) months and OI at 3- and 6-months (p<0.001), post treatment. Regarding the presence of periodontal pathogens, no significant differences were observed, intra and inter groups. Conclusion: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone.

Objetivo: Evaluar el efecto de la administración sistémica de azitromicina (AZM) como coadyuvante de la terapia periodontal no quirúrgica (TPNQ) en las variables clínicas y microbiológicas de pacientes con periodontitis. Material y Métodos: Dieciocho voluntarios recibieron TPNQ combinado con placebo o AZM (500 mg/día) durante 3 días (n=9/grupo). Fueron monitoreados clínicamente para determinar Profundidad de Sondaje del Saco (PSS), Nivel de Inserción Clínica (NIC), Índice de O'Leary (IO), Sangrado al sondaje (SS) al inicio y durante el primer, tercer y sexto mes y microbiológicamente, al inicio y a los 3 y 6 meses después de la terapia, mediante la reacción en cadena de la polimerasa convencional. Resultados: Catorce pacientes completaron el estudio (n=7/grupo). Se observaron diferencias estadísticamente significativas entre ambos grupos. El grupo experimental presentó una media de PSS significativamente menor (p=0,04) y una reducción de PSS (p=0,02), a los 6 meses post TPNQ. En cuanto al delta (∆) pre y post tratamiento, al tercer mes post TPNQ, hubo un aumento significativo en el número de sitios poco profundos (p<0.001) y una disminución en los sitios intermedios (p<0.001). Además, se detectó una disminución significativa en la media de los sitios profundos (p=0.04) a los 6 meses post tratamiento. También hubo una disminución significativa en el índice SS al primer (p=0.01), tercer (p<0. 0 01) y sexto mes (p=0.01) post TPNQ y del IO al tercer y sexto mes (p<0.001), post tratamiento. En cuanto a la presencia de patógenos periodontales, no se observaron diferencias significativas tanto intra como ínter grupos. Conclusión: AZM como adyuvante a TPNQ proporciona efectos benéficos adicionales en la PSS y SS en comparación a TPNQ solo.

Efeito do probiótico lactobacilus casei adjunto a terapia periodontal em modelo experimental de periodontite: uma relação entre periodonto e intestino / Effect of the probiotic lactobacilus casei as an adjunct to periodontal therapy in an experimental model of periodontitis: a relationship between periodontium and intestine

A periodontite é uma condição crônica inflamatória que pode influenciar a microbiota intestinal. O tratamento padrão ouro para a periodontite inclui a raspagem e o alisamento corono-radicular (RACR), porém em casos complexos pode-se utilizar terapias adjuvantes, como os probióticos. A utilização deste tratamento adjuvante poderá contribuir para a melhoria da condição periodontal e a simbiose intestinal. O objetivo deste estudo foi avaliar o efeito na inflamação periodontal e intestinal da utilização do Lactobacillus casei (LC) adjunto a RACR em camundongos Balb/c com periodontite, induzida por ligadura. Este estudo é um ensaio pré-clínico, in vivo, randomizado, cego e controlado por placebo, constituído por 36 camundongos Balb/c machos. Os animais foram submetidos a indução da periodontite por colocação de ligadura com fio de seda 4.0 ao redor do segundo molar superior direito, sendo divididos em 4 grupos,o grupo controle: Sem Periodontite e sem RACR (n=8); Grupo Ligadura: Com Periodondite e sem RACR (n=10); Grupo raspagem: Com Periodontite e com RACR (n=10) ; Grupo raspagem + L.casei (n=8): Com Periodontite e com RACR + administração de LC, por gavagem, durante 30 dias. Foram realizadas análises de citocinas pelo método ELISA no tecido gengival (IL-6), intestinal (IL-1ß, IL-6 e IL-10) e sanguíneo (IL-1ß e IL-6), além de análises bioquímicas (TGO, TGP, ureia e creatinina) e contagem diferencial de leucócitos do sangue. Foram coletados fragmentos do intestino grosso desses animais e analisados quanto a biomarcadores do estresse oxidativo (SOD, GSH e MDA), atividade da acetilcolinesterase (AChE) e foi realizada contagem da população de Bactérias Produtoras de Ácido Láctico das fezes dos animais. A utilização do LC adjunto a RACR resultou em uma redução na expressão da IL-6 no tecido gengival de camundogos com Periodontite (p < 0,05). Para as inteleucinas séricas (IL-1ß e IL-6), não houve diferenças entre os grupos (p > 0,05). Já para as citocinas intestinais houve uma redução na expressão de IL-10 (p < 0,05), para os grupos em que foi induzida a Periodontite. Com relação ao estresse oxidativo intestinal os animais do Grupo raspagem e raspagem + LC tiveram uma redução dos níveis de MDA (p < 0,05), para a SOD e o GSH, não houve diferenças significativas entre os 4 grupos pesquisados (p < 0,05). Conclui-se que o uso de LC adjunto a RACR em camungongos com periodontite induzida por ligadura pode reduzir a liberação de IL-6 no tecido gengival. Com relação aos efeitos intestinais foi observada a modulação da resposta inflamatória, com a redução de MDA, nos animais que receberam o tratamento periodontal. E a redução da expressão da IL-10, nos animais com Periodontite (AU).

Periodontitis is a chronic inflammatory condition that can influence the gut microbiota. The gold standard treatment for periodontitis includes scaling and crown-root planing, but in complex cases adjuvant therapies such as probiotics can be used. The use of this adjuvant treatment may contribute to the improvement of periodontal condition and intestinal symbiosis. The aim of this study was to evaluate the effect on periodontal and intestinal inflammation of the use of Lactobacillus casei (LC) adjunct to scaling and root planing (RACR) in Balb/c mice with ligature-induced periodontitis. This study is a preclinical, in vivo, randomized, blinded, placebo-controlled trial consisting of 40 male Balb/c mice. The animals were submitted to periodontitis induction by placing a 4.0 silk suture ligature around the upper right second molar. The sample was divided into 4 groups, each with 10 animals: Group I: Without Periodontitis and without RACR; Group II: With Periodontitis and without RACR; Group III: With Periodontitis and with RACR; Group IV: With Periodontitis and with RACR + gavage of LC, for 30 days. Cytokine analyzes were performed by the ELISA method in gingival tissue (IL-6), intestinal tissue (IL-1ß, IL-6 and IL-10) and blood (IL-1ß and IL-6), the blood was also subjected to analysis biochemical (TGO, TGP, urea and creatinine) and differential leukocyte count. Fragments of the large intestine of these animals were collected and analyzed for biomarkers of oxidative stress (SOD, GSH and MDA), acetylcholinesterase (AChE) activity, and the population of Lactic Acid-Producing Bacteria in the animals' feces was counted. The use of LC adjunct to RACR resulted in a reduction in the expression of IL-6 in the gingival tissue of mice with Periodontitis (p < 0.05), for the blood inteleukins (IL-1ß and IL-6), there were no differences between the groups (p > 0.05). As for intestinal cytokines, there was a reduction in the expression of IL-10 (p < 0.05), for the groups that presented Periodontitis. Regarding intestinal oxidative stress, the animals in Groups III and IV had a reduction in MDA levels (p < 0.05), for SOD and GSH, there were no significant differences between the 4 groups studied (p < 0.05 ). It is concluded that the use of LC adjunct to RACR in mice with ligation-induced periodontitis can reduce the release of IL-6 in the gingival tissue. Regarding the intestinal effects, two effects were found: The first related to the modulation of the inflammatory response, with the reduction of MDA, in the animals that received periodontal treatment. And the second related to a pro-inflammatory effect, with the reduction of IL-10 expression (AU).

Evaluation of pain perception on periodontal probing in patients with dental plaque induced gingivitis and chronic periodontitis - a cross sectional study, part I / Evaluación de la percepción del dolor al sondaje periodontal en pacientes con gingivitis inducida por placa dental y periodontitis crónica: un estudio transversal, parte I

Background: Probing of periodontal pockets is an essential part in the diagnosis of periodontal disease. Fifteen to seventy seven percent of untreated periodontal patients experience pain during probing. Hence the aim of this study is to evaluate the pain perceived by patients with gingivitis and periodontitis during periodontal probing. The goals of this study were to compare the patients' pain perception when using a conventional UNC15 probe and a manual pressure sensitive periodontal probe, and to relate the clinical features of gingivitis and periodontitis to the discomfort associated with periodontal probing. Material and Methods: A total of 475 subjects were recruited into the study. The subjects were initially divided into two groups ­ Group ­ A (Gingivitis group - 275 patients) and Group ­ B (Chronic Periodontitis group -200 patients) according to the AAP 1999 Classification. These two groups were further subdivided into two groups each (Gingivitis ­ Conventional Probe ­ GCP, Gingivitis ­ Manual Pressure Sensitive Probe ­ GMPS, Periodontitis - Conventional Probe ­ PCP, Periodontitis ­ Manual Pressure Sensitive Probe ­ PMPS) using a computer generated program of random numbers. Results: A significant difference was noted in pain perception when pressure sensitive probe was used compared to conventional UNC-15 probe. Reduced Bleeding on Probing and Pain scores were noted in Chronic periodontitis subjects with use of pressure sensitive probe, which was statistically significant (p<0.001). Conclusion: Dentistry has changed its focus towards painless dentistry. In this context, the present study presents data towards use of manual pressure sensitive probes, which offers an advantage of low cost when compared to more advanced computerized systems with reduced pain during periodontal examination. It could result in a positive attitude of the patients towards continuous supportive periodontal therapy thereby monitoring periodontal health.

Antecedentes: El sondaje de los sacos periodontales es una parte esencial en el diagnóstico de la enfermedad periodontal. Del quince al setenta y siete por ciento de los pacientes periodontales no tratados experimentan dolor durante el sondaje. De ahí que el objetivo de este estudio fué evaluar el dolor percibido por pacientes con gingivitis y periodontitis durante el sondaje periodontal. Los objetivos de este estudio fueron comparar la percepción del dolor de los pacientes al usar una sonda UNC15 convencional y una sonda periodontal sensible a la presión manual, y relacionar las características clínicas de la gingivitis y la periodontitis con la incomodidad asociada con el sondaje periodontal. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron inicialmente en dos grupos - Grupo - A (grupo de Gingivitis - 275 pacientes) y Grupo - B (grupo de Periodontitis Crónica - 200 pacientes) de acuerdo con la Clasificación AAP 1999. Estos dos grupos se subdividieron en dos grupos cada uno (Gingivitis - Sonda convencional - GCP, Gingivitis - Sonda manual sensible a la presión - GMPS, Periodontitis - Sonda convencional - PCP, Periodontitis - Sonda manual sensible a la presión - PMPS) usando un programa generado por computadora de datos aleatorios. números. Resultados: Se notó una diferencia significativa en la percepción del dolor cuando se usó una sonda sensible a la presión en comparación con la sonda UNC-15 convencional (p<0,001). Conclusion: La odontología ha cambiado su enfoque hacia una odontología sin dolor. En este contexto, el presente estudio presenta datos hacia el uso de sondas manuales sensibles a la presión, que ofrece una ventaja de bajo costo en comparación con sistemas computarizados más avanzados con reducción del dolor durante el examen periodontal. Podría resultar en una actitud positiva de los pacientes hacia la terapia periodontal de apoyo continuo, monitoreando así la salud periodontal.

Evaluation of homeopathy effects associated with conventional periodontal therapy in randomized treatment of diabetic and non-diabetic patients with periodontitis

Periodontitis and Diabetes Mellitus type 2 (DMII) are chronic diseases treated by conventional practices and traditional medicine. In many cases, when conventional medicine cannot offer a satisfactory treatment, increases the demand for alternative therapies in chronic conditions. The aim of this study randomized was to compare and evaluate for one year clinical and serologic parameters the effects of homeopathy as an adjunct of conventional periodontal therapy in individual with periodontitis and DMII. Materials and Methods:85 individuals, of both genders, between 35 and 70 years old, participated in this randomized study, which 70 were eligible in Institute of Endocrinology and Diabetes of Rio de Janeiro-Brazil. They were divided into two groups G-1: individuals with periodontitis without systemic conditions and G-2: individuals with periodontitis and DMII. Both groups received homeopathic treatment and were evaluated in clinical and laboratorial examinations. The medication used was chosen based on the similarity principle, following the Berberis 6CH protocol (2 tablets, 2 times a day for 45 days), Mercurius Solubilis / Belladona / Hepar Sulfur-6CH (2 tablets, 3 times a day for 15 days) and a Pyrogenium 200CH biotherapeutic (single weekly dose, 2 weeks). Medications are prescribed in diluted low concentration doses for all signs and symptoms, while biotherapy is used for chronic stimulation Results:Both groups showed significant improvements throughout the study,clinical and laboratorial, at 1 year baseline: reductions in total cholesterol, triglycerides, glucose, glycated hemoglobin, uric acid and CPR. Statistical and descriptive analyzes were performed. The data obtained after laboratory analysis were tabulated and then submitted to the SPSS 17.0 software for Windows (SPSS Inc., Chicago, IL) and significance level with p <0.05. For most of parameters, G-1 performed better than G-2 (p<0.05).Conclusion:After 1 year follow-up this clinical trial suggest that homeopathy therapy, as an adjunct of periondontal treatment, improves local and systemic parameters and can provide better health condition.

Patient experience and non-surgical periodontal therapy in a postgraduate periodontal training program: A qualitative study

ABSTRACT: Objective: To explore patient experience for non-surgical periodontal therapy using phenomenography. Methods: This qualitative study was performed in a postgraduate specialist training program in periodontics. Patients reported their experiences through in-depth interviews in order to recognize the impact of non-surgical periodontal therapy on their quality of life and their satisfaction. A homogeneous sampling procedure was used, establishing redundancy after the fifteenth interview. Interviews were audio recorded, transcribed and analyzed by three researchers who codified the answers into categories to determine the emerging topics. Results: The core emerging themes were: (i) lack of information about periodontal disease; (ii) experience during treatment; (iii) treatment implications; and (iv) clinician-patient relationship. Conclusions: Patients seem to have limited knowledge about periodontal diseases. Reasons for attendance mainly include bleeding gums, tooth mobility, and aesthetic problems. Therapy can generate pain, fear, and is considered invasive, whereas dentine hypersensitivity may occur post-operatively. Despite this, patients would be willing to undergo treatment again and were generally satisfied with the level of care and treatment received.

Adopción/Adaptación para España de la Guía de Práctica Clínica de Nivel S3 de la Federación Europea de Periodoncia (EFP) - Tratamiento de la Periodontitis en Estadios I-III / Adoption/Adaptation for Spain of the Level S3 Clinical Practice Guideline of the European Federation of Periodontology (EFP) - Treatment of Periodontitis in Stages I-III

Resumen Antecedentes: La clasificación de la periodontitis recientemente introducida en el World Workshop de 2017, que incorpora estadios y grados de la enfermedad, tiene por objeto vincular la clasificación de la enfermedad con los enfoques preventivos y terapéuticos, ya que no solo describe su gravedad y el alcance, sino también el grado de complejidad y el riesgo de un individuo. Por lo tanto, es necesario contar con directrices clínicas basadas en la evidencia que ofrezcan recomendaciones para tratar la periodontitis. Objetivo: El objetivo del presente proyecto fue desarrollar una Guía de Práctica Clínica (CPG, por sus siglas en inglés, clinical practice guideline) de nivel S3 para el tratamiento de la periodontitis en los estadios I-III. Material y métodos: Estas CPG S3 se elaboraron bajo los auspicios de la Federación Europea de Periodoncia (EFP), siguiendo la orientación metodológica de la Asociación de Sociedades Médico-Científicas de Alemania y la estructura Grading of Recommendations Assessment, Development and Evaluation (GRADE). El proceso, riguroso y transparente, incluyó la síntesis de las investigaciones relevantes en 15 revisiones sistemáticas encargadas de manera específica, la evaluación de la calidad y la solidez de la evidencia, la formulación de recomendaciones específicas, así como lograr un acuerdo, sobre esas recomendaciones, por parte de expertos destacados y una amplia base de partes interesadas. Resultados: Estas CPG S3 abordan el tratamiento de la periodontitis (estadios I, II y III) utilizando un enfoque gradual preestablecido del tratamiento que, según el estadio de la enfermedad, debe ser incremental, incluyendo en cada caso diferentes intervenciones. Se llegó a un acuerdo sobre las recomendaciones relativas a las diferentes intervenciones, dirigidas a: i) cambios de comportamiento, control de biofilm supragingival, inflamación gingival y factores de riesgo; ii) instrumentación supragingival y subgingival, con y sin tratamientos coadyuvantes; iii) diferentes tipos de intervenciones quirúrgicas periodontales; y iv) el mantenimiento periodontal necesario para extender los beneficios a lo largo del tiempo. Conclusión: Esta Guía S3 informa a los clínicos, a los sistemas de salud, a los encargados de formular políticas sanitarias e, indirectamente, al público, sobre las modalidades disponibles y más eficaces para tratar la periodontitis y mantener una dentición sana durante toda la vida, de acuerdo con la evidencia disponible en el momento de su publicación.

Traducción al español de la Guía de Práctica Clínica de Nivel S3 de la Federación Europea de Periodoncia (EFP) - Tratamiento de la periodontitis en Estadios I-III / Spanish translation of the Level S3 Clinical Practice Guideline of the European Federation of Periodontology (EFP) - Treatment of periodontitis in Stages I-III

Resumen. Antecedentes: La clasificación de la periodontitis recientemente introducida en el World Workshop de 2017, que incorpora estadios y grados de la enfermedad, tiene por objeto vincular la clasificación de la enfermedad con los enfoques preventivos y terapéuticos, ya que no solo describe su gravedad y el alcance, sino también el grado de complejidad y el riesgo de un individuo. Por lo tanto, es necesario contar con directrices clínicas basadas en la evidencia que ofrezcan recomendaciones para tratar la periodontitis. Objetivo: El objetivo del presente proyecto fue desarrollar una Guía de Práctica Clínica (CPG, por sus siglas en inglés, clinical practice guideline) de nivel S3 para el tratamiento de la periodontitis en los estadios I-III. Material y métodos: Estas CPG S3 se elaboraron bajo los auspicios de la Federación Europea de Periodoncia (EFP), siguiendo la orientación metodológica de la Asociación de Sociedades Médico-Científicas de Alemania y la estructura Grading of Recommendations Assessment, Development and Evaluation (GRADE). El proceso, riguroso y transparente, incluyó la síntesis de las investigaciones relevantes en 15 revisiones sistemáticas encargadas de manera específica, la evaluación de la calidad y la solidez de la evidencia, la formulación de recomendaciones específicas, así como lograr un acuerdo, sobre esas recomendaciones, por parte de expertos destacados y una amplia base de partes interesadas. Resultados: Estas CPG S3 abordan el tratamiento de la periodontitis (estadios I, II y III) utilizando un enfoque gradual preestablecido del tratamiento que, según el estadio de la enfermedad, debe ser incremental, incluyendo en cada caso diferentes intervenciones. Se llegó a un acuerdo sobre las recomendaciones relativas a las diferentes intervenciones, dirigidas a: i) cambios de comportamiento, control de biofilm supragingival, inflamación gingival y factores de riesgo; ii) instrumentación supragingival y subgingival, con y sin tratamientos coadyuvantes; iii) diferentes tipos de intervenciones quirúrgicas periodontales; y iv) el mantenimiento periodontal necesario para extender los beneficios a lo largo del tiempo. Conclusión: Esta Guía S3 informa a los clínicos, a los sistemas de salud, a los encargados de formular políticas sanitarias e, indirectamente, al público, sobre las modalidades disponibles y más eficaces para tratar la periodontitis y mantener una dentición sana durante toda la vida, de acuerdo con la evidencia disponible en el momento de su publicación.

Uso de probióticos como adición al tratamiento periodontal no quirúrgico en pacientes con periodontitis / Use of probiotics as an adjunctive therapy to non-surgical periodontal treatment in patients with periodontitis

RESUMEN Introducción: El tratamiento periodontal no quirúrgico corresponde a la terapia estándar para la periodontitis crónica. En este contexto, se ha propuesto que el uso de probióticos orales como complemento al tratamiento estándar podría mejorar los resultados obtenidos clínicamente, sin embargo no existe claridad respecto a su efectividad. Métodos: Se realizó una búsqueda en Epistemonikos: base de datos de revisiones sistemáticas en salud mantenida mediante el cribado de múltiples fuentes de información, la cuál incluye MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas y un análisis de los datos de los estudios primarios. Se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se Identificaron seis revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, todos correspondientes a ensayos aleatorizados. De los resultados analizados se concluye que el uso de probióticos orales como complemento al tratamiento no quirúrgico de periodontitis crónica probablemente resulta en nula o poca diferencia en la reducción de la profundidad de sondaje, el sangrado al sondaje y una ganancia de nivel de inserción clínico en los sitios afectados. Por otro lado, no se encontraron estudios que evaluaran el riesgo de presentar halitosis en pacientes sometidos a terapia periodontal no quirúrgica con adición de probióticos.

ABSTRACT: Introduction: Non-surgical periodontal treatment is the standard treatment to chronic periodontitis. It has been proposed that the use of oral probiotics as an adjunctive therapy may improve clinical outcomes, however there is no clarity regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews including 14 studies overall, of which all were randomized trials. We concluded that the addition of probiotics to non-surgical periodontal treatment probably results in little or no difference in probing depth reduction, clinical attachment level gain and reduction in bleeding on probing. No studies were found evaluating halitosis in patients undergoing non-surgical periodontal treatment with the addition of probiotics.

Manejo interdisciplinario para una óptima rehabilitación oral / Interdisciplinary management for optimal oral rehabilitation

Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)

The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)