High prevalence of periodontitis in children and adolescents with type 2 diabetes.

BACKGROUND: The aim of the present study was to determine the prevalence of periodontitis in children and adolescents with type 2 diabetes, and if poor glycemic control is associated with increasing prevalence of the disease. METHODS: This is a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full-mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart. RESULTS: One hundred and twenty one children and adolescents (8-17 years, 11 months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate, and nine (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth, and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (odds ratio [OR] 1.31 [95% CI, 1.13-1.53], p = 0.001) and multivariate (OR, 1.29 [95% CI, 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, body mass index z-score, lack of running water, insulin use, and acanthosis nigricans. CONCLUSIONS: Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable with that seen in previous studies in youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify, and treat periodontitis early.

Guidance for the maintenance care of dental implants: clinical review.

As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and continuous supportive care of the peri-implant tissues. This review article suggests guidelines for maintenance care of dental implants. The preliminary assessment should begin with updating the patient's medical and dental histories. The clinical implant should be examined to evaluate the following: condition of the soft tissues, plaque index, clinical probing depth, bleeding on probing, suppuration, stability of soft-tissue margins, keratinized tissue, mobility and occlusion. If the clinical signs suggest the presence of peri-implantitis, radiography of the site is advisable, to confirm the diagnosis. Appropriate treatment should be pursued according to any diagnosis reached during the examination, including (but not limited to) instructions on oral hygiene, removal of supra- and sub-gingival plaque and calculus, occlusal adjustment, relining of a removable prosthesis or surgery.

A combined regenerative approach for the treatment of aggressive periodontitis: long-term follow-up of a familial case.

This article reports the longitudinal follow-up of a familial case of aggressive periodontitis treated by a combined regenerative approach that consisted of root conditioning, bone grafting, and membrane positioning. Treatment resulted in attachment level gain, reduction of probing depth, absence of bleeding on probing, and complete bone filling of the defect. The short-term results obtained after surgery were maintained after 6 years, suggesting that the combined regenerative approach is able to completely arrest the disease with long-term stability.

Impact of cannabis sativa (marijuana) smoke on alveolar bone loss: a histometric study in rats.

BACKGROUND: Cannabis sativa (marijuana) can interfere with bone physiopathology because of its effect on osteoblast and osteoclast activity. However, its impact on periodontal tissues is still controversial. The present study evaluates whether marijuana smoke affects bone loss (BL) on ligature-induced periodontitis in rats. METHODS: Thirty male Wistar rats were used in the study. A ligature was placed around one of the mandible first molars (ligated teeth) of each animal, and they were then randomly assigned to one of two groups: control (n = 15) or marijuana smoke inhalation ([MSI] for 8 minutes per day; n = 15). Urine samples were obtained to detect the presence of tetrahydrocannabinol. After 30 days, the animals were sacrificed and decalcified sections of the furcation area were obtained and evaluated according to the following histometric parameters: bone area (BA), bone density (BD), and BL. RESULTS: Tetrahydrocannabinol was positive in urine samples only for the rats of the MSI group. Non-significant differences were observed for unligated teeth from both groups regarding BL, BA, and BD (P >0.05). However, intragroup analysis showed that all ligated teeth presented BL and a lower BA and BD compared to unligated teeth (P <0.05). The intergroup evaluation of the ligated teeth showed that the MSI group presented higher BL and lower BD (P <0.05) compared to ligated teeth from the control group. CONCLUSION: Considering the limitations of this animal study, cannabis smoke may impact alveolar bone by increasing BL resulting from ligature-induced periodontitis.

Avaliação histométrica em ratos do efeito da fumaça da cannabis sativa (maconha) no reparo ósseo ao redor de implantes de titânio / A histometric study in rats about the effects of Cannabis sativa (marijuana) in bone filling around titanium implants

[Objetivos] Este estudo visa fazer uma revisão de literatura sobre os principais aspectos relacionados à ação da fumaça da Cannabis sativa (maconha) no reparo ósseo. [Material e métodos] Após anestesia geral, um implante de titânio com superfície usinada (2,2mm x 4,0mm) foi posicionado em uma das tíbias de 30 ratos machos e adultos da raça Wistar. Os animais foram aleatoriamente e igualmente divididos em 2 grupos experimentais. O Grupo A foi utilizado como controle e os ratos receberam apenas a colocação dos implantes. O Grupo B foi submetido ao mesmo procedimento, contudo sofreu também exposição à fumaça da Cannabis sativa durante três períodos diários de 8 minutos durante 60 dias. Os animais foram mortos 60 dias após a colocação dos implantes. As secções não descalcificadas da tíbia foram dissecadas e avaliadas histometricamente quanto ao preenchimento ósseo nos limites das roscas de cada implante; à extensão de contato direto osso-implante e em relação à densidade óssea a 500μm do implante. Médias representativas de cada grupo foram obtidas e comparadas estatisticamente pelo teste T Student (α=0,05). [Resultados] Os achados demonstraram um efeito deletério significante da fumaça da maconhano reparo ósseo ao redor de implantes, levando a uma diminuição na quantidade de tecido ósseo em contato direto com o implante, assim como na área óssea dentro dos limites das roscas dos implantes e na área de tecido ósseo a 500μm do implante. [Conclusões] Considerando as limitações do presente estudo, a inalação da fumaça de Cannabis sativa tem uma repercussão deletéria no reparo ósseo ao redor de implantes de titânio colocados em tíbias de ratos. Esses efeitos podem ser considerados durante a avaliação dos resultados sucesso/fracasso dos implantes.

[Purpose] This study aims to make a review of literature on the majors aspects related to the action of the smoke of Cannabis sativa (marijuana) in bone repair. [Materials and Methods] After general anesthesia, one screw-shaped pure titanium implant (2,2mm x 4,0mm), was placed in one tibia of 30 male Wistar rats. The animals were randomly and equally divided in two experimental groups. Group A was used as control and the rats received only the placing of implants. Group B was submitted to the same procedure and also was exposed to Cannabis sativa’s smoke inhalation for 8 minutes, three times a day during 60 days. The animals were sacrificed 60 days after implant placement. Undecalcified tibia’s sections were dissected and appraised histometrically considering bone filling around each spiral’s limit of every implant, extension of direct contact between bone and implant and bone density in a 500μm wide-zone lateral to the implant. [Results] Representative means of each group were obtained and compared statistically using Student-t test (α=0,05). [Results] The findings showed a significant negative impact of marijuana smoke inhalation on bone filling around titanium implants leading to a decrease in bone density, as well as in the extension of bone to implant contact and on bone area whitin the limits of threads. [Conclusions] Considering the limitations of the present study, the Cannabis sativa smoke inhalation may represent a deleterious impact on bone healing around titanium implants in rats tibiaes.These effects should be a new concern for implant success/failure.

Uso de antimicrobianos locais em periodontia: uma abordagem crítica / Use of local antimicrobials in periodontics: A critical approach

A presença da placa bacteriana representa o principal fator etiológico envolvido na iniciação e progressão da doença periodontal inflamatória. O tratamento instituído para esta patologia baseia-se essencialmente na eliminação dos patógenos periodontais, através do debridamento mecânico. Entretanto, nem sempre a raspagem e alisamento radicular promovem resultados clínicos satisfatórios, guiando o profissional a buscar meios alternativos para este tratamento. Neste sentido surgiram os antimicrobianos de ação local, sendo atualmente empregados: gel de metronidazol, chip de clorexidina, fibra de tetraciclina, esferas de minociclina e gel de doxiciclina Diversos relatos na literatura sustentam o emprego desses dispositivos e comprovam a sua eficácia clínica.No entanto, aspectos como custo e acessibilidade vêm sendo discutidos a fim de avaliar a real aplicabilidade.O objetivo desta revisão de literatura é fazer uma abordagem crítica a respeito da utilização de antimicrobianos locais no tratamento da doença periodontal enfatizando as suas indicações, vantagens, desvantagens, custo, viabilidade clínica e eficácia terapêutica.