Contextual and individual determinants of tooth loss in adults: a multilevel study.

BACKGROUND: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. METHODS: This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. RESULTS: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. CONCLUSIONS: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

Antitumor activity and systemic effects of PVM/MA-shelled selol nanocapsules in lung adenocarcinoma-bearing mice.

Selol is a semi-synthetic compound containing selenite that is effective against cancerous cells and safer for clinical applications in comparison with other inorganic forms of selenite. Recently, we have developed a formulation of poly(methyl vinyl ether-co-maleic anhydride)-shelled selol nanocapsules (SPN), which reduced the proliferative activity of lung adenocarcinoma cells and presented little deleterious effects on normal cells in in vitro studies. In this study, we report on the antitumor activity and systemic effects induced by this formulation in chemically induced lung adenocarcinoma-bearing mice. The in vivo antitumor activity of the SPN was verified by macroscopic quantification, immunohistochemistry and morphological analyses. Toxicity analyses were performed by evaluations of the kidney, liver, and spleen; analyses of hemogram and plasma levels of alanine aminotransferase, aspartate transaminase, urea, and creatinine; and DNA fragmentation and cell cycle activity of the bone marrow cells. Furthermore, we investigated the potential of the SPN formulation to cause hemolysis, activate the complement system, provoke an inflammatory response and change the conformation of the plasma proteins. Our results showed that the SPN reduced the area of the surface tumor nodules but not the total number of tumor nodules. The biochemical and hematological findings were suggestive of the low systemic toxicity of the SPN formulation. The surface properties of the selol nanocapsules point to characteristics that are consistent with the treatment of the tumors in vivo: low hemolytic activity, weak inflammatory reaction with no activation of the complement system, and mild or absent conformational changes of the plasma proteins. In conclusion, this report suggests that the SPN formulation investigated herein exhibits anti-tumoral effects against lung adenocarcinoma in vivo and is associated with low systemic toxicity and high biocompatibility.

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly.

OBJECTIVE: To investigate the association of socio-demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. MATERIAL AND METHODS: A cross-sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi-square test and Fisher's exact test. An estimation of prevalence for the covariates was performed using Poisson's regression models. RESULTS: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower-income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60-64 years old and those who are employed had a significant association with periodontal disease. CONCLUSION: Socio-demographic factors were associated with some notable oral diseases in the elderly.

No association between periodontal disease and GHQ-12 in a Brazilian Police population.

OBJECTIVES: We attempt to investigate a possible association between periodontal disease (PD) and mental disorders (MD) in a population of Brazilian Police. STUDY METHOD: From a total study population consisting of 803 policemen, 345 police officers were obtained by a sample calculation using the finite population correction who were randomly selected in Montes Claros, Minas Gerais, Brazil. Patients who had been prescribed steroids or those diagnosed with diabetes and cardiovascular diseases were excluded from this study. The General Health Questionnaire (GHQ-12) was used to assess mental disorders. Odds ratios (ORs) for periodontal diseases severity and their respective 95% confidence intervals (CIs) were estimated. The risk of advanced scores in Clinical Attachment Level (CAL) and Community Periodontal Index (CPI) were estimated using Poisson Regression analyses. RESULTS: Only smoking and age were associated with severity in CAL and CPI index. No relation between MD and PD was observed even in different positions within the police department. CONCLUSIONS: It was not observed relation between GHQ-12 and the incidence of Periodontal Disease in a Brazilian Police population. Classical factors like age and smoking, however, were associated with CAL and CPI index higher scores in this population.

Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats.

OBJECTIVE: Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions. METHODS: Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses. RESULTS: Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05). CONCLUSIONS: Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.

Factors in adult health-related quality of life: a population-based study.

This study aimed to investigate factors associated with the physical health components (PHC) and mental health components (MHC) of health-related quality of life in adults. It is a population-based study, with household cluster sampling. The dependent variables were the PHC and MHC scores in the 12-Item Short-Form Health Survey (SF-12); the independent variables were social-demographic characteristics relating to health and behaviors. A multiple regression was made by the General Linear Model. Of the 841 interviewees, 31% had PHC adversely affected, and 37.2% had MHC adversely affected; 57% had adverse score in at least one domain. The average scores were 49.9 for the physical health component and 47.1 for the MHC. Higher scores on the PHC were associated with: being male (ß = 1.94), having a car in the family (ß = 0.89), having recently used dental services (ß = 1.86), not having a chronic disease (ß = 4.60), not using any medication (ß = 2.09), not being a smoker (ß = 2.04) and practicing physical activities (ß = 1.73). Higher scores on the MHC were associated with not using medication (ß = 1.91) and not being a smoker (ß = 1.26). There is a need for further studies and policies aimed at maintaining and/or recovery of the physical and mental wellbeing of adults without specific diseases.

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey.

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Bioinformatics, interaction network analysis, and neural networks to characterize gene expression of radicular cyst and periapical granuloma.

INTRODUCTION: Bioinformatics has emerged as an important tool to analyze the large amount of data generated by research in different diseases. In this study, gene expression for radicular cysts (RCs) and periapical granulomas (PGs) was characterized based on a leader gene approach. METHODS: A validated bioinformatics algorithm was applied to identify leader genes for RCs and PGs. Genes related to RCs and PGs were first identified in PubMed, GenBank, GeneAtlas, and GeneCards databases. The Web-available STRING software (The European Molecular Biology Laboratory [EMBL], Heidelberg, Baden-Württemberg, Germany) was used in order to build the interaction map among the identified genes by a significance score named weighted number of links. Based on the weighted number of links, genes were clustered using k-means. The genes in the highest cluster were considered leader genes. Multilayer perceptron neural network analysis was used as a complementary supplement for gene classification. RESULTS: For RCs, the suggested leader genes were TP53 and EP300, whereas PGs were associated with IL2RG, CCL2, CCL4, CCL5, CCR1, CCR3, and CCR5 genes. CONCLUSIONS: Our data revealed different gene expression for RCs and PGs, suggesting that not only the inflammatory nature but also other biological processes might differentiate RCs and PGs.

Prevalence of oral mucosal lesions in a brazilian military police population.

BACKGROUND: Data obtained from oral health surveys are very important for identifying disease-susceptible groups and for developing dental care and prevention programs. So, the purpose of the current article was to investigate the prevalence of oral mucosa lesions (OMLs) in a population of Brazilian police. MATERIAL AND METHODS: Interviews and oral cavity examinations were performed on a sample of 395 police officers who were randomly selected by the calibrated researcher. The number of individuals was obtained by a sample calculation using the finite population correction. The diagnostic criteria were based on the WHO (1997) criteria and adapted to Brazilian surveys. RESULTS: In total, 8.61% of the population presented some OML. Traumatic injuries and benign migratory glossitis (BMG) were the most prevalent lesions. CONCLUSIONS: The prevalence of potentially malignant disorders was lower than among the Brazilian population.The most prevalent lesion among the police officers was related to trauma. Patients dissatisfied with oral health had a higher risk of presenting OMLs. Key words:Mouth disease, mouth mucosa, military personnel, public health, oral pathology, oral leukoplakia.

[Access to information on oral hygiene and tooth loss due to caries among adults]. / O acesso à informação sobre higiene bucal e as perdas dentárias por cárie entre adultos.

This study sought to establish the association between tooth loss due to dental caries and variables related to access to information on oral health in adults aged 35-44 years (n = 780) who participated in a large epidemiological study. The dependent variable was total tooth loss due to caries. The independent variables were grouped into blocks: demographic and socio-economic characteristics, use of dental service, access to oral health information (about how to prevent oral problems; oral hygiene; and diet), and behaviors. The analysis was conducted using hierarchical multiple linear regression. The mean number of lost teeth due to caries was 7.03. High numbers of lost teeth were higher among females and older adults; low levels of education; adults who rarely/never received oral hygiene information; those who brushed their teeth once a day or less; and those adults who did not use dental floss (p < 0.05). Adults who rarely/never received oral hygiene information from dental services lost 2.15 more teeth due to caries than those who always/often received such information (p = 0,000). Thus, it is suggested that access to information should be encouraged to contribute to greater equity in oral health.

Analysis of the normative conditions of oral health, depression and serotonin-transporter-linked promoter region polymorphisms in an elderly population.

AIM: To investigate the association between depression, the normative conditions of oral health and serotonin-transporter-linked promoter region (5-HTTLPR) polymorphisms in a community-dwelling elderly sample. METHODS: Elderly adults living in a community (n=200) were submitted to an oral clinical examination. Depression was assessed using the 15-item Geriatric Depression Scale. The 5-HTTLPR was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Associations between the biomarkers and clinical covariates were assessed by bivariate and multivariate statistical tests. Statistical significance was set at P<0.05. RESULTS: The prevalence of dental caries, periodontal disease, edentulism and oral mucosal lesions was 51.2%, 20.8%, 58.0% and 21.5%, respectively. The prevalence of depression was 21.5%. A higher frequency of the S allele was recorded in older individuals with depression (P=0.017). The present findings showed no significant association between depression and the normative conditions of oral health. The observed allelic polymorphisms were 44% S and 56% L, respectively. Genotypic variants were 33.5% LL, 45.0% SL and 21.5% SS. Individuals carrying the SS genotype showed a significantly high prevalence of periodontal disease (prevalence ratio=3.077, CI 95%=1.008-9.393, P=0.048). CONCLUSION: The present findings suggest that depressive community-dwelling older individuals did not show any association with alterations of oral health normative conditions. However, the SS genotypic polymorphic variant of 5-HTTLPR seems to contribute to the occurrence of periodontal disease in the elderly.

miR-15a/16-1 influences BCL2 expression in keratocystic odontogenic tumors.

BACKGROUND: A keratocystic odontogenic tumor (KCOT) is a benign destructive recurrent odontogenic cystic neoplasm. The microRNAs (miRNAs) miR-15a and miR-16-1 function as negative regulators of the anti-apoptotic gene BCL2 at the post-transcriptional level. Notably, high Bcl-2 immunoexpression is found in the epithelial lining of KCOTs, while the loss of Bcl-2 immunopositive cells is observed in marsupialized cysts. The purpose of this study was to investigate whether the transcription of miR-15a and miR-16-1 is altered in KCOTs and whether it is associated with BCL2 gene expression in such lesions. METHODS: Using qRT-PCR and immunohistochemical analyses, we examined miR-15a/16-1 and BCL2 gene expression in KCOTs. The impact of miR-15a/16-1 expression on BCL2 gene translation was investigated by in vitro studies using primary KCOT culture cells. RESULTS: Using qRT-PCR, we observed miR-15a and/or miR-16-1 downregulation in the majority of the KCOT samples (24 of 28). We also observed higher BCL2 mRNA expression in 19 of 20 KCOT frozen samples and moderate to high Bcl-2 immunopositivity in the basal layer cells of 16 of 18 paraffin embedded KCOTs (median: 42.6 %). In vitro over-expression of miR-15a/16-1 in human KCOT-1 primary cell cultures resulted in a decrease in Bcl-2 protein expression. Furthermore, all five paired KCOTs collected before and after marsupialization treatment exhibited an increase in miR-15a after the procedure. CONCLUSIONS: Our results suggest that KCOT neoplastic cells exhibit an anti-apoptotic profile that may be related to lower miR-15a/16-1 expression. Additionally, we demonstrated that miRNA expression increases after marsupialization, implicating an etiological and therapeutic role of miRNAs in KCOT.

Low expression of MSH2 DNA repair protein is associated with poor prognosis in head and neck squamous cell carcinoma

OBJECTIVE: This study aimed to investigate the expression of the MSH2 DNA repair protein in head and neck squamous cell carcinoma (HNSCC) in order to analyze its association with clinicopathologic factors and overall survival of patients. MATERIAL AND METHODS: Clinical data and primary lesions of HNSSC were collected from 55 patients who underwent surgical resection with postoperative radiotherapy in Montes Claros, state of Minas Gerais, Brazil, between 2000 and 2008. Immunohistochemical reactions were performed to analyze MSH2 protein expression. RESULTS: Bivariate analysis showed no significant correlation or association between MSH2 expression and clinicopathologic parameters by Mann-Whitney and Kruskal-Wallis tests. Patients with locoregional metastatic disease (OR=4.949, p<0.001) and lower MSH2 immunohistochemical expressions (OR=2.943, p=0.032) presented poorer survival for HNSCC by Cox regression models. CONCLUSIONS: Our data demonstrated that lower MSH2 expression might contribute to a higher clinic aggressiveness of HNSCC by promoting an unfavorable outcome. .

Eosinofilia tecidual na região do fronte invasivo do carcinoma de células espinocelulares de boca: correlação com parâmetros clínico-patológicos / Tissue eosinophilia in invasive front of oral squamous cell carcinoma: correlation with clinicopathologic paameters

Tem sido reconhecido que muitos cânceres são acompanhados por um infiltrado de células inflamatórias de intensidades variáveis. Atenção tem sido direcionada para o possível papel de eosinófilos no comportamento biológico de lesões neoplásicas malignas. Objetivo Avaliar a influência da quantificação de eosinófilos localizados no infiltrado inflamatório da região do fronte invasivo de amostras de carcinoma espinocelular de boca (CEC), categorizados de acordo com o tamanho das lesões primárias; a ocorrência de metástases regionais e com a severidade morfológica da região do fronte de invasão das lesões. Material e método Amostras de 38 espécimes de CEC foram investigadas nesse estudo. O sistema de gradação de malignidades para a região do fronte invasivo empregado no estudo foi idealizado por Bryneet al.9. Para a contagem de eosinófilos, foi utilizada uma lente ocular com um retículo milimetrado de25 pontos. Doze campos microscópicos corados em H&E foram avaliados de forma aleatória, em um aumento de 400x. Apenas as regiões localizadas no fronte invasivo de cada lesão primária e que apresentavam um evidente componente inflamatório foram selecionadas para análise. A avaliação morfométrica empregada foi baseada no método de Fisher et al.29. Resultado Concordância entre patologistas quanto a gradação da severidade morfológica do fronte de invasão revelou valores de kappa de 0,81 e 0,71 para os exames intra e interobservador, respectivamente. Foi encontrada uma menor quantificação de eosinófilos nas lesões de maiores tamanhos clínicos. Os demais resultados não demonstraram a presença de correlações estatisticamente significativas. Conclusões O tamanho clínico das lesões primárias e a ocorrência de metástases cervicais não parecem ser influenciados pela severidade da gradação morfológica da região do fronte invasivo do CEC. Uma menor quantificação de eosinófilos nas lesões de maiores tamanhos clínicos parece demonstrar uma provável ação inibitória da atividade....

It has been long recognized that many cancers are accompanied by infiltrates of inflammatory cells of varying intensity. Attention has been directed to the possible role of eosinophils in the biologic behavior of malignant neoplastic lesions. Objective To evaluate the influence of number of eosinophils in samples of oral squamous cell carcinoma (OSCC) with different morphological and clinical parameters. Material and method Tumor tissues of 38 cases of OSCC were investigated in this study. The malignancy grading system of tumour invasive front (Bryne et al.9) was used. An ocular grid in twelve high-power fields in each specimen of primary tumor was used in haematoxylin and eosin stained slides for eosinophils counting. These counting was made in the inflammatory infiltrated in the most invasive areas of the tumour parenchyma. The morphometric analysis employed was based in the method of Fisher et al.29. Result Agreement between pathologists for grading of invasive front showed kappa values of 0.81 and 0.71 for intra and interobserver exams, respectively. Our results did not show a statistically meaningful correlation among the clinical and morphological variables (size of the lesions, cervical metastasis and grading of tumour invasive front). It was found a statiscally meaningful association between the eosinophils counting was statistically associated to the size of the lesions. It was found the smaller number of eosinophils counts in the bigger size lesions (T3/T4). Conclusions Clinical size of the lesions and cervical metastasis of the OSCC do not seem to be directly influenced by morphological grading of the tumour invasive front. A smaller eosinophils counting in bigger size lesions may demonstrate an inhibitory action of the chemotactic activity and/or their antineoplastic activities. Futures advances in the understanding of molecular control of these cells and its citokynes produced may bring a better understanding of biologic behavior of the OSCC.

Imunolocalização das proteínas dos genes supressores de tumores TP53 e p16CDKN2 no front invasivo do carcinoma epidermóide de cavidade bucal / Immunolocalization of TP53 and p16CDKN2 tumour suppressor genes proteins in invasive front of oral epidermoid carcinoma

INTRODUÇÃO: A carcinogênese bucal é um processo multipassos no qual eventos genéticos promovem o rompimento de vias regulatórias normais que controlam funções celulares básicas. O carcinoma epidermóide de cavidade bucal (CECB) surge como conseqüência de múltiplos eventos moleculares induzidos pelos efeitos de vários carcinógenos influenciados por fatores ambientais contra um quadro de resistência ou suscetibilidade herdada geneticamente. OBJETIVO: Avaliar a importância clínica e morfológica da imunoexpressão das proteínas p53 e p16 na região do front invasivo de uma série de 35 casos rotineiramente processados de CECB. MATERIAL E MÉTODOS: Amostras de CECB primários tratados exclusivamente por cirurgia foram investigadas. O sistema TNM foi empregado para o estadiamento clínico dos pacientes. Para a gradação morfológica das lesões foi adotado o sistema de gradação do front invasivo. A técnica de imuno-histoquímica foi realizada nas lesões fixadas em formalina tamponada a 10 por cento e emblocadas em parafina para identificação das proteínas p53 e p16. As contagens foram realizadas e submetidas a tratamentos estatísticos específicos. RESULTADOS: As taxas de imunolocalização para as proteínas p53 e p16 foram de 63 por cento e 66 por cento, respectivamente, nas 35 amostras de carcinoma estudadas. Não houve relação entre as expressões das proteínas p53 e p16 com os parâmetros clínico-morfológicos analisados. Não houve correlação entre a expressão imuno-histoquímica das proteínas p53/p16. CONCLUSÃO: A expressão das proteínas p53 e p16 não influenciou os parâmetros clínico-morfológicos analisados neste estudo e aparentemente não representa base molecular para o significado biológico da região do front invasivo tumoral. A ausência de forte correlação entre as expressões imuno-histoquímicas das proteínas p53 e p16 sugere que as mesmas podem participar de atividade biológicas do controle do ciclo celular por vias moleculares independentes.

BACKGROUND: Oral carcinogenesis is a multistep process in which genetic events lead to the disruption of the normal regulatory pathways that control basic cellular functions. Epidermoid carcinoma of oral cavity (ECOC) appears as a consequence of multiple molecular events induced by the effects of several carcinogens influenced by environmental factors against a background of genetic resistance or susceptibility. Consequent genetic damage affects many chromosomes and genes, and the accumulation of these changes seems to lead to ECOC. OBJECTIVES: The aim of the present study was to assess the clinical and morphological value of p53 and p16 immunolocalization at the invasive tumor front in a representative series of 35 routinely processed ECOC. MATERIAL AND METHODS: Samples of ECOC were investigated in this study. TNM system was employed for clinical staging and the invasive front grading system was employed for morphological grading of the lesions. Immunohistochemical technique in paraffin-embedded and formalin-fixed tissues was utilized to immunolocalization of p53 and p16 proteins. Counts were performed and submitted to specific statistical treatments. RESULTS: p53 and p16 immunolocalizations were detected in 63 percent and 66 percent, respectively, of 35 carcinomas studied. No correlation was found between p53 and p16 expressions and clinico-morphological parameters statistically analyzed. No correlation was found between the relationship p53/p16 expressions. CONCLUSION: p53 and p16 immunolocalization did not influence the clinico-morphological parameters analyzed in this study and apparently do not represent a molecular basis for the biologic significance of the invasive tumor front. Lack of a strong correlation between p53 and p16 immunolocalization suggests that both could participate in biological activities in the cell cycle control by independent molecular pathways.