Effectiveness of antimicrobial photodynamic therapy in the treatment of peri-implantitis: systematic review and meta-analysis.

The purpose of this study was to evaluate the current scientific evidence on the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to mechanical debridement in the treatment of peri-implantitis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022361684). The search was carried out in seven databases, with no restrictions regarding language or year of publication. Our work included studies that compared clinical periodontal parameters between individuals treated with mechanical debridement associated with aPDT and a control group of patients who had undergone mechanical debridement alone. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. The mean difference (MD) and a 95% confidence interval (CI) were provided. Four hundred and seven-four studies were identified, of which five studies were included. The meta-analysis demonstrated that aPDT adjunctive to mechanical debridement in subjects with peri-implantitis resulted in greater reduction in probing depth 3 months after treatment than among subjects receiving treatment with mechanical debridement. Most of the included studies exhibit a low risk of bias. Adjunctive aPDT to mechanical debridement contributes to the improvement of peri-implant clinical parameters in individuals with peri-implantitis, in particular probing depth.

Prevalence and predictors for clinical attachment loss in adolescents in Latin America: cross-sectional study.

AIM: To describe the prevalence, severity and extension of clinical attachment loss (CAL) and to study the predictors in 15- to 19-year-old adolescents from high schools in the Latin America. MATERIALS AND METHODS: A cross-sectional, epidemiological study was performed. The sample included 1070 high school adolescents 15-19 years of age from Santiago de Chile (Chile), Buenos Aires, Córdoba, Mendoza (Argentina), Montevideo (Uruguay), Quito (Ecuador) and Medellín (Colombia). Calibrated examiners performed full mouth, six sites per tooth clinical examination. RESULTS: There was a response rate of 100%. The prevalence of CAL ≥3 mm in ≥1 site was 32.6%, probing pocket depth ≥4 mm was 59.3% and bleeding on probing (BoP) ≥25% was 28.6%. The logistic regression analysis adjusted for cities revealed that smoking (OR = 1.6), attending public school (OR = 2.3) and having a BoP ≥25% (OR = 4.2) were positively associated with CAL ≥3 mm in ≥ 1 site. CONCLUSION: Clinical attachment loss was prevalent in Latin America adolescents and it is associated with smoking, attendance public school and BoP.

Periodontitis prevalence and associated factors: a comparison of two examination protocols.

The fact that there are different epidemiological definitions of periodontitis and different evaluation protocols affects the estimate of periodontitis prevalence and of the influence of associated factors. The gold standard for periodontal examination is full-mouth record assessing CAL and PD. However, there are not always sufficient human and financial resources available to apply such assessment for epidemiological surveillance systems. AIM: This study was conducted to compare different protocols and definitions of periodontitis for assessing prevalence and the impact of related factors in adult patients who requested care at the School of Dentistry, UdelaR. MATERIALS AND METHOD: This was a cross-sectional study of 410 subjects with a high burden of disease in terms of NCDs and periodontitis. Clinical examination evaluated PD in all teeth and CAL in the CPI sextants (WHO 2013). Four periodontitis criteria were defined based on two examination protocols (WHO 2013 and WHO 1997) and two definitions of epidemiological case. Comparisons were made taking the 2013 WHO protocol as a reference. RESULTS: Comparison of the two examination protocols showed that prevalence was underestimated when the WHO 1997 protocol was used to define moderate-severe and severe periodontitis, by 20% and 60%, respectively. CONCLUSIONS: When the severity of periodontitis was not considered, the WHO 2013 protocol did not provide more information on what factors increase the chance of periodontitis. However, when severity was considered, the associated factors were different. Consequently, in a small population, it would be worth using the WHO 2013 protocol, which is the closest to the full-mouth gold standard criterion.

La variabilidad en la definición epidemiológica de la periodontitis y los protocolos de evaluación afectan la medición de la prevalencia y su asociación con ciertos factores. Si bien, el patrón oro para el examen periodontal es el registro de boca completa, que evalúa la pérdida de inserción (CAL, por sus siglas en inglés) y profundidad de sondaje (PS, por sus siglas en inglés), los recursos no siempre están disponibles para los sistemas de vigilancia epidemiológica. OBJETIVO: En este estudio se compararon diferentes protocolos y definiciones de periodontitis evaluando la prevalencia y la asociación de factores relacionados en pacientes adultos que solicitaron atención en la Facultad de Odontología de la UdelaR. Materiales y Método: Los datos provienen de un estudio transversal de 410 sujetos con una elevada carga de enfermedad en términos de ENT y periodontitis. Se utilizó un examen clínico registrando PD en todos los dientes y CAL en los sextantes CPI (WHO 2013). Se definieron cuatro criterios de periodontitis basados en dos protocolos de examen y dos definiciones epidemiológicas de caso. Las comparaciones se realizaron tomando como referencia el protocolo de la OMS de 2013. RESULTADOS: Al comparar los dos protocolos de examen, se verificó la subestimación de la prevalencia cuando se utilizó el protocolo de la OMS de 1997 para la definición de caso moderado-grave y para la periodontitis grave, siendo en el primer caso del 20% y en el segundo caso tres veces mayor que. CONCLUSIONES: Si no se considera la gravedad de la periodontitis, el uso del protocolo de la OMS 2013 no proporciona más información sobre qué factores aumentan la probabilidad de periodontitis. Sin embargo, al analizar la gravedad, los factores asociados fueron diferentes. En consecuencia, en una población pequeña estaría justificado el esfuerzo de utilizar el protocolo de la OMS de 2013, ya que el criterio de referencia es la boca completa.

Self-reported periodontitis in cannabis club members in Montevideo, Uruguay. An exploratory study.

In 2013, the Oriental Republic of Uruguay enacted a law regulating the cannabis market, and since then, an increasing number of users has been registered. Previous reports based on data from other countries link cannabis smokers to worse periodontal health status. The aim of this study is to describe self-reported gingival and periodontal health status and estimate the prevalence of periodontitis among Uruguayan cannabis club members. A cross-sectional study was conducted on a convenience sample of cannabis club members in Uruguay. A survey was used to gather sociodemographic data and information on oral hygiene, use of cannabis and other drugs, and self-reported gingival and periodontal health status. Eight questions validated in Spanish were used to estimate the prevalence of total periodontitis and severe periodontitis, based on two previously implemented predictive models. The survey was completed by 50 people, of whom 68% were male and 78% were in the 20-40 year age range. Based on the first model, estimated prevalence was 12% for total periodontitis and 10% for severe periodontitis. Based on the second model, estimated prevalence was 36% for total periodontitis and 12% for severe periodontitis. These findings suggest that smoking cannabis could potentially have a detrimental effect on oral health status.

En 2013 se aprobó la ley que regula el mercado del cannabis en la República Oriental del Uruguay y desde entonces se ha registrado un creciente número de consumidores. Reportes previos a partir de datos de otros países vinculan un peor estado de salud periodontal en fumadores de cannabis. El objetivo de este estudio es describir el estado gingivo-periodontal auto-reportado y estimar la prevalencia de periodontitis en participantes de clubes cannábicos uruguayos. Se realizó un estudio transversal a partir de una muestra por conveniencia de integrantes de clubes cannábicos en Uruguay. Mediante una encuesta se recolectaron datos socio-demográficos, de higiene oral, de consumo de cannabis y otras drogas, así como de auto-reporte del estado de salud gingivo-periodontal. A partir de 8 preguntas validadas en español se estimó la prevalencia de periodontitis total y severa a través de dos modelos predictivos previamente implementados. Un total de 50 personas completaron la encuesta. El 68% eran hombres y el 78% estaba dentro del rango de 20 a 40 años de edad. Con el primer modelo la prevalencia estimada de periodontitis total fue 12% y de periodontitis severa 10%. Con el segundo modelo fue 36% para periodontitis total y 12% para periodontitis severa. Estos hallazgos sugieren que fumar cannabis podría tener un potencial efecto deletéreo sobre las condiciones de salud bucal.

Periodontal status in cannabis smokers. A systematic review.

Aims: To assess the periodontal status in cannabis smokers in comparison with non-cannabis smokers. Materials and methods: Electronic databases were searched as well as hand searches performed. Eligible studies followed the Population Exposure Comparison Outcome Study (PECOS) structure: P: dentate humans, E: cannabis smoking, C: non-cannabis smoking, O: Primary outcomes: periodontitis case definition, clinical attachment loss, probing depth; Secondary outcomes: bleeding on probing/ gingival inflammation, plaque index and calculus; S: observational studies. Qualitative analyses of the studies were done. The quality of cohort studies was assessed with the Newcastle-Ottawa scale and cross-sectional studies were assessed using a modified Newcastle-Ottawa scale. Results: 2661 records were screened, of which 14 articles were included. Data from a cohort study showed that highly exposed participants were at higher risk of clinical attachment loss progression. Six cross-sectional studies reported worse gingival or periodontal conditions in cannabis smokers. Nevertheless, one did not find such association, neither did three case series. Three studies were of high, two of moderate and six were of low quality. Conclusions: Based on the available data, frequent cannabis smoking could be detrimental for periodontal tissues and this could be dose-dependent. Studies including long-term cannabis smokers, and stratified for periodontal disease etiologic factors and risk factors/indicators are needed.

Validación de contenido de un cuestionario para explorar actitudes y prácticas de odontólogos no especialistas en periodoncia

Objetivo: Validar el contenido de un cuestionario de auto-reporte en español para explorar actitudes, prácticas y barreras de odontólogos no especialistas en periodoncia frente al diagnóstico y tratamiento de problemas periodontales y criterios para derivar. Materiales y métodos: Seis especialistas en periodoncia de cinco países latinoamericanos construyeron versión#1 de un cuestionario. 21 expertos de tres áreas disciplinares de 6 países valoraron de 1 a 5 (1: totalmente en desacuerdo, 5: totalmente de acuerdo) cada ítem en su pertinencia, relevancia, claridad y coherencia. Según grado de acuerdo se reformuló cada ítem y se construyó versión#2 que fue piloteada en 60 odontólogos no especialistas en periodoncia, 3 de ellos fueron entrevistados para evaluar la comprensión y semántica. Luego del análisis se elaboró la versión final (versión#3). Resultados: Los ítems formulados de versión#1 tuvieron una valoración promedio de 4,6 (rango 3.7-5). Fueron reformulados evitando palabras confusas y que tuvieran aceptación transversal en países participantes, se eliminó ítem con menor puntuación de acuerdo de expertos. La aplicación de versión#2 tuvo un tiempo de respuesta de 12 minutos, se reformularon opciones y agregaron 4 ítems para obtener la versión final con 44 preguntas. Conclusiones: Se construyó un cuestionario de auto-reporte con validez de contenido para evaluar actitudes y prácticas en salud-enfermedad periodontal en odontólogos generales o no especialistas en periodoncia de habla hispana.

Aim: T o validate the content of a self-report questionnaire in Spanish to explore attitudes, practices and barriers of dentists non-specialized in periodontics when facing the diagnosis and treatment of periodontal problems and criteria for referral. Materials and methods: Six specialists in periodontics from five Latin American countries constructed version#1 of a questionnaire. Twenty-one experts from 3 disciplinary areas from 6 countries rated each item from 1 to 5 (1: totally disagree, 5: totally agree) regarding its appropriateness, relevance, clarity, and coherence. According to the degree of agreement, the item was reformulated, and version #2 was built, which was tested on 60 dentists non-specialized in periodontics. Then, 3 of them were interviewed to assess comprehension and semantics. After analysis, the final version was prepared (version#3). Results: The items formulated in version#1 had an average score of 4.6 (range 3.7-5). Questions and options were reformulated, avoiding confusing words and having transversal acceptance in the participating countries. The items with the lowest degree of expert agreement were eliminated. The application of version#2 had a response time of 12 minutes, options were reformulated, and 4 items were added to obtain the final version with 44 questions. Conclusions: A self-report questionnaire with content validity was constructed to assess attitudes and practices in periodontal health and disease in Spanish-speaking general dentists or non-specialists in periodontics.

Auto-reporte de Periodontitis en diabéticos. Estudio transversal en Montevideo, Uruguay / Self-report of Periodontitis in Diabetes. A cross-sectional study

Objetivo: Conocer la ocurrencia de periodontitis a partir de un cuestionario de auto-reporte en una población de diabéticos en Montevideo, Uruguay. Materiales y métodos: Fueron invitados los participantes del 1er Encuentro de Diabetes en Uruguay, con diagnóstico de diabetes según auto-reporte, con al menos 18 años de edad y que firmaron el consentimiento informado. En todos los casos, fue aplicado un cuestionario con ocho preguntas previamente validadas al español de forma de estimar la ocurrencia de la Periodontits además de identificar indicadores asociados. Resultados: Un total de 37 personas respondieron el cuestionario suministrado, en su mayoría correspondientes al sexo femenino y de 45 años de edad promedio. La ocurrencia de periodontits fue del 68% de los encuestados, no existiendo diferencias significativas para el tipo de diabetes y las franjas etarias consideradas. Sin embargo las personas que presentaban periodontits tuvieron menos dientes naturales (según auto-reporte) al ser comparados con quienes no tenían periodontitis (27.5 vs. 20.4, p=0.01). Conclusiones: Los resultados del estudio permiten apreciar una condición oral deficitaria en aquellos diabéticos con periodontitis auto-reportada debido a la ocurrencia elevada de la misma así como la menor cantidad de dientes naturales.

Objective: To determine the occurrence of periodontitis from a self-report questionnaire in a population of diabetics in Montevideo, Uruguay. Materials and methods: Participants of the 1st Diabetes Meeting in Uruguay, with a diagnosis of diabetes according to self-report, with at least 18 years of age and signed the informed consent, were invited. In all cases, a questionnaire with eight questions previously validated in Spanish was applied in order to estimate the occurrence of Periodontits in addition to identifying associated indicators. Results: A total of 37 people answered the supplied questionnaire, mostly corresponding to the female sex and an average age of 45 years. The occurrence of periodontitis was 68%, with no significant differences for the type of diabetes and the age groups considered. However, people with periodontitis had fewer natural teeth (according to self-report) when compared to those who did not have periodontitis (27.5 vs. 20.4, p = 0.01). Conclusions: The results of the study allow us to appreciate a poor oral condition in those diabetics with self-reported periodontitis due to its high occurrence as well as the lower number of natural teeth.

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Periodontitis prevalence and associated factors: a comparison of two examination protocols / Prevalencia y factores asociados a periodontitis: comparación de dos protocolos de examen WHO

ABSTRACT The fact that there are different epidemiological definitions of periodontitis and different evaluation protocols affects the estimate of periodontitis prevalence and of the influence of associated factors. The gold standard for periodontal examination is full-mouth record assessing CAL and PD. However, there are not always sufficient human and financial resources available to apply such assessment for epidemiological surveillance systems. Aim: This study was conducted to compare different protocols and definitions of periodontitis for assessing prevalence and the impact of related factors in adult patients who requested care at the School of Dentistry, UdelaR. Materials and Method: This was a cross-sectional study of 410 subjects with a high burden of disease in terms of NCDs and periodontitis. Clinical examination evaluated PD in all teeth and CAL in the CPI sextants (WHO 2013). Four periodontitis criteria were defined based on two examination protocols (WHO 2013 and WHO 1997) and two definitions of epidemiological case. Comparisons were made taking the 2013 WHO protocol as a reference. Results: Comparison of the two examination protocols showed that prevalence was underestimated when the WHO 1997 protocol was used to define moderate-severe and severe periodontitis, by 20% and 60%, respectively. Conclusions: When the severity of periodontitis was not considered, the WHO 2013 protocol did not provide more information on what factors increase the chance of periodontitis. However, when severity was considered, the associated factors were different. Consequently, in a small population, it would be worth using the WHO 2013 protocol, which is the closest to the full-mouth gold standard criterion.

RESUMEN La variabilidad en la definición epidemiológica de la periodontitis y los protocolos de evaluación afectan la medición de la prevalencia y su asociación con ciertos factores. Si bien, el patrón oro para el examen periodontal es el registro de boca completa, que evalúa la pérdida de inserción (CAL, por sus siglas en inglés) y profundidad de sondaje (PS, por sus siglas en inglés), los recursos no siempre están disponibles para los sistemas de vigilancia epidemiológica. Objetivo: En este estudio se compararon diferentes protocolos y definiciones de periodontitis evaluando la prevalencia y la asociación de factores relacionados en pacientes adultos que solicitaron atención en la Facultad de Odontología de la UdelaR. Materiales y Método: Los datos provienen de un estudio transversal de 410 sujetos con una elevada carga de enfermedad en términos de ENT y periodontitis. Se utilizó un examen clínico registrando PD en todos los dientes y CAL en los sextantes CPI (WHO 2013). Se definieron cuatro criterios de periodontitis basados en dos protocolos de examen y dos definiciones epidemiológicas de caso. Las comparaciones se realizaron tomando como referencia el protocolo de la OMS de 2013. Resultados: Al comparar los dos protocolos de examen, se verificó la subestimación de la prevalencia cuando se utilizó el protocolo de la OMS de 1997 para la definición de caso moderado-grave y para la periodontitis grave, siendo en el primer caso del 20% y en el segundo caso tres veces mayor que. Conclusiones: Si no se considera la gravedad de la periodontitis, el uso del protocolo de la OMS 2013 no proporciona más información sobre qué factores aumentan la probabilidad de periodontitis. Sin embargo, al analizar la gravedad, los factores asociados fueron diferentes. En consecuencia, en una población pequeña estaría justificado el esfuerzo de utilizar el protocolo de la OMS de 2013, ya que el criterio de referencia es la boca completa.

Efectos psicosociales de la enfermedad periodontal en la calidad de vida de pacientes de la Facultad de Odontologia (UdelaR) Un estudio cuali-cuantitativo / Efeitos psicossociais da doença periodontal na qualidade de vida de pacientes da Faculdade de Odontologia (UdelaR). Um estudo qualitativo-quantitativo / Psychosocial impact of periodontal disease on the quality of life of patients of the school of dentistry (Udelar). A qualitative-quantitative study

Resumen Objetivos: Identificar los aspectos psicosociales de la enfermedad periodontal y su incidencia en la calidad de vida de las personas que la padecen. Métodos: Se realizó un estudio mixto cuanti-cualitativo en pacientes de la facultad de odontología UdelaR. Los instrumentos utilizados fueron: entrevista (semiestructurada) con base en la teoría fundamentada y la aplicación del cuestionario OHIP-14 (Oral Health Impact Profile) que mide el grado de afectación en la calidad de vida (modelo teórico de Locker). Resultado: Se identifican los factores psicosociales que presenta esta población, así como la afectación emocional y a nivel social que provoca el diagnóstico de enfermedad periodontal. Los resultados muestran una afectación en la calidad de vida de la población de 1,46 en una escala de 0-4, donde 4 es la máxima afectación. Las participantes femeninas mostraron mayor nivel de afectación en la calidad de vida (1,54) en comparación con los hombres (1,36). A mayor grado de instrucción más afectación en la calidad de vida. Conclusiones: Existe una limitación en el enfoque biomédico en la atención de pacientes odontológicos, y por tanto la necesidad de realizar un abordaje integral en pacientes con enfermedad periodontal. Los profesionales odontólogos deben tener un enfoque biopsicosocial en la atención debido a la complejidad que presenta la enfermedad periodontal.

Resumo Objetivos: Identificar os aspectos psicossociais da doença periodontal e sua incidência na qualidade de vida das pessoas que sofrem com a doença. Métodos: Foi realizado um estudo quantitativo e qualitativo misto. Os instrumentos utilizados foram: entrevista (semiestruturada), fundamentada na teoria fundamentada em dados, e aplicação do questionário OHIP-14 (Perfil de Impacto na Saúde Oral), que mede o grau de comprometimento da qualidade de vida (modelo teórico de Locker). Resultado: são identificados os fatores psicossociais que essa população apresenta, bem como a afetação emocional e social que causa o diagnóstico de doença periodontal. Os resultados mostram uma afetação na qualidade de vida da população de 1,46 em uma escala de 0-4, onde 4 é a afetação máxima. As participantes do sexo feminino apresentaram maior nível de comprometimento da qualidade de vida (1,54) em comparação aos homens (1,36). Quanto maior o grau de escolaridade, mais a qualidade de vida será afetada. Conclusões: A limitação da abordagem biomédica no cuidado de pacientes odontológicos e a necessidade de realizar uma abordagem abrangente em pacientes com doença periodontal são evidentes. Os profissionais de odontologia devem ter uma abordagem biopsicossocial ao atendimento devido à complexidade da doença periodontal.

Abstract Objectives: To identify the psychosocial factors of periodontal disease and their impact on the quality of life of patients. Methods: A mixed quantitative and qualitative study was conducted at the School of Dentistry, UdelaR. The instruments used were a semi-structured interview based on grounded theory and the application of the OHIP-14 (Oral Health Impact Profile) questionnaire that measures the degree of impairment of quality of life (Locker's theoretical model). Results: This population's psychosocial factors are identified, as well as the emotional and social effects of periodontal disease diagnosis. The results show a 1.46 impact on people's quality of life on a scale of 0-4, where 4 is the maximum impact. Women showed a higher level of impairment in quality of life (1.54) than men (1.36). The higher the educational level, the more the quality of life is affected. Conclusions The limitations of the biomedical approach to dental patient care and the need for a comprehensive approach in periodontal disease patients are clear. Dental professionals need a biopsychosocial care approach given the complexity of periodontal disease.

Self-reported periodontitis in cannabis club members in Montevideo, Uruguay. An exploratory study

In 2013, the Oriental Republic of Uruguay enacted a law regulating the cannabis market, and since then, an increasing number of users has been registered. Previous reports based on data from other countries link cannabis smokers to worse periodontal health status. The aim of this study is to describe self-reported gingival and periodontal health status and estimate the prevalence of periodontitis among Uruguayan cannabis club members. A cross-sectional study was conducted on a convenience sample of cannabis club members in Uruguay. A survey was used to gather sociodemographic data and information on oral hygiene, use of cannabis and other drugs, and self-reported gingival and periodontal health status. Eight questions validated in Spanish were used to estimate the prevalence of total periodontitis and severe periodontitis, based on two previously implemented predictive models. The survey was completed by 50 people, of whom 68% were male and 78% were in the 20-40 year age range. Based on the first model, estimated prevalence was 12% for total periodontitis and 10% for severe periodontitis. Based on the second model, estimated prevalence was 36% for total periodontitis and 12% for severe periodontitis. These findings suggest that smoking cannabis could potentially have a detrimental effect on oral health status.

En 2013 se aprobó la ley que regula el mercado del cannabis en la República Oriental del Uruguay y desde entonces se ha registrado un creciente número de consumidores. Reportes previos a partir de datos de otros países vinculan un peor estado de salud periodontal en fumadores de cannabis. El objetivo de este estudio es describir el estado gingivo-periodontal auto-reportado y estimar la prevalencia de periodontitis en participantes de clubes cannábicos uruguayos. Se realizó un estudio transversal a partir de una muestra por conveniencia de integrantes de clubes cannábicos en Uruguay. Mediante una encuesta se recolectaron datos socio-demográficos, de higiene oral, de consumo de cannabis y otras drogas, así como de auto-reporte del estado de salud gingivo-periodontal. A partir de 8 preguntas validadas en español se estimó la prevalencia de periodontitis total y severa a través de dos modelos predictivos previamente implementados. Un total de 50 personas completaron la encuesta. El 68% eran hombres y el 78% estaba dentro del rango de 20 a 40 años de edad. Con el primer modelo la prevalencia estimada de periodontitis total fue 12% y de periodontitis severa 10%. Con el segundo modelo fue 36% para periodontitis total y 12% para periodontitis severa. Estos hallazgos sugieren que fumar cannabis podría tener un potencial efecto deletéreo sobre las condiciones de salud bucal.

Efficacy of a triclosan formula in controlling early subgingival biofilm formation: a randomized trial.

The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the test versus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.

Periodontal conditions and associated factors among adults and the elderly: findings from the first National Oral Health Survey in Uruguay.

The aims of this study were to assess the prevalence of periodontal conditions in the Uruguayan adult and elderly population and its association with socioeconomic and behavioral characteristics. Data from adults (35-44, n = 358) and elderly (65-74, n = 411) who participated in the first National Oral Health Survey, Uruguay, 2011, were used. The survey included a household questionnaire addressing socioeconomic characteristics, and tobacco use. Bleeding on probing (BOP), periodontal pockets (CPI) and clinical attachment loss (CAL) were measured by clinical examination. A multivariable analysis was carried out. Considering both age groups, the prevalence of mild/severe periodontal disease was 21.8% and 9.12% for severe periodontal disease. Adjusted analyses revealed an association between high education and all outcomes. Attendance at dental services was negatively associated with BOP and mild to severe periodontitis. Periodontal outcomes were higher in disadvantaged socioeconomic groups. Tobacco consumption has a strong association with periodontal disease in the elderly.

Influencia del consumo de cannabis en la enfermedad periodontal: una Scoping Review / Influence of cannabis use on periodontal disease: a scoping review

Recientes publicaciones plantean la posible asociación del cannabis (Cannabis sativa) con el desarrollo de la periodontitis. Objetivo: Analizar la influencia del consumo de cannabis en la enfermedad periodontal, relevando la evidencia disponible e identificando las variables asociadas en los estudios . Material y método: se realizó una Scoping Review a partir de una búsqueda estructurada en PubMed/ MEDLINE, Science Direct, LILACS, SciELO hasta mayo de 2017 .Resultados: Estudios "In vivo" mostraron una mayor pérdida ósea en animales expuestos a Cannabis. Los casos clínicos muestran que el uso crónico de cannabis puede resultar en agrandamientos gingivales y periodontitis crónica severa localizada. Los estudios epidemiológicos demuestran una asociación estadística entre Cannabis y periodontitis. Conclusiones:El consumo del Cannabis parece estar asociado con una mayor presencia de periodontitis. Sin embargo, se desconoce el mecanismo específico por el cual actúa en los tejidos gingivales.

Recent publications suggest the possible association between cannabis (Cannabis sativa) and periodontitis. Objective: To analyze the possible influence of cannabis use on periodontal disease, highlighting the available evidence and identifying the associated variables in the studies. Materials and methods: We conducted a scoping review applying a structured search method in PubMed/MEDLINE, Science Direct, LILACS, SciELO including publications until May 2017. Results: In vivo studies showed greater bone loss in animals exposed to cannabis. Clinical cases show that chronic cannabis use may result in gingival enlargement (with clinical features similar to phenytoin induced enlargement) and localized severe chronic periodontitis. Most of the epidemiological studies confirmed the possible association between cannabis and periodontitis. Conclusions: The consumption of cannabis seems to be associated with a greater presence of periodontitis. However, the specific mechanism by which cannabis acts in the gingival tissues is unknown.

Fibrina Rica en Plaquetas y Leucocitos en el tratamiento de defectos intra-óseos: Revisión Narrativa / Leucocyte and Platelet Rich Fibrin in the treatment of intra-bony defects. Narrative Review

RESUMEN: Diferentes técnicas quirúrgicas periodontales han surgido a lo largo del tiempo con el objetivo de lograr una regeneración periodontal y mejorar su predictibilidad. La Fibrina Rica en Plaquetas y Leucocitos (L-PRF) se ha posicionado como una alternativa para cumplir este objetivo, debido a que no requiere anticoagulantes en su preparación y muestra liberación sostenida de factores de crecimiento durante por lo menos 7 días. El objetivo de esta revisión narrativa es describir la evidencia disponible sobre el uso de L-PRF en defectos intra-óseos. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane Library, exploración manual y páginas web. De un total de 494 artículos recuperados, fueron seleccionados 12 publicaciones para esta revisión. Los resultados sugieren que L-PRF muestra beneficios al ser utilizada en el tratamiento periodontal regenerativo de defectos intra-óseos. Sin embargo, son necesarios ensayos clínicos con diseño metodológico estandarizado que permitan comparar L-PRF con biomateriales habitualmente empleados en el tratamiento de estos defectos.

ABSTRACT: Periodontal surgical techniques have emerged over time with the aim of achieving periodontal regeneration and improving its predictability. Leukocyte and Platelet-Rich Fibrin (L-PRF) has been proposed as an alternative, for not requiring anticoagulants in its preparation and for performing sustained release of growth factors for at least 7 days. The aim of this narrative review is to describe the available evidence on the use of L-PRF in periodontal intra-bony defects. An electronic and hand search was conducted in MEDLINE and Cochrane Library databases. Of 494 papers retrieved, 12 were selected for this review. The results suggest that even if L-PRF shows benefits when used in regenerative periodontal treatment of intra-bony defects, clinical trials with standardized methodological design are necessary to compare L-PRF with biomaterials usually used in these defects.

Evaluación del estado periodontal en una población afro-uruguaya residente en Montevideo. Estudio transversal / Evaluation of the periodontal status in an Afro-Uruguayan population living in Montevideo: a cross-sectional study

El enfoque de diversidad en la salud se refiere a reconocer y atender especialmente los distintos intereses, demandas, necesidades y procesos de salud-enfermedad específicos de las personas. La consideración étnico-racial en estos casos se torna fundamental. En Uruguay datos censales muestran que el 8,1% de la población (cerca de 255.000 personas) se reconocen como afrodescendientes, constituyendo la "principal minoría étnico - racial del país". Hasta el presente no existen relevamientos sobre la condición periodontal de la población afrodescendiente de nuestro país. Objetivo: valorar el estado buco-dental y periodontal a través de indicadores del proceso salud-enfermedad. Material y Método: estudio descriptivo de corte transversal no representativo de la población afrouruguaya. Criterios de inclusión: rango etario de 15 a 35 años con residencia en Montevideo. Criterios de Exclusión: estar embarazada, haber recibido terapia periodontal o tratamiento con antibióticos en los últimos 6 meses. El tamaño de cada muestra de población con o sin origen afro fue de 40 individuos, mitad hombres y mitad mujeres. Fue aplicada la Historia Clínica Rediente conjuntamente con un registro periodontal clínico, usando periodontímetro calibrado por milímetro examinando seis sitios por pieza dentaria en boca completa. Resultados: el grupo afrodescendiente tiene un diente menos en promedio que el grupo no afrodescendiente, particularmente primeros molares inferiores. Registra también mayor prevalencia, extensión y severidad de pérdida de inserción respecto al grupo control. No se observaron diferencias estadísticamente significativas en referencia a la profundidad de sondaje entre ambas poblaciones. Conclusiones: La población afrodescendiente se integró a los sectores populares de la sociedad determinando mayor vulnerabilidad de la misma. En la franja etaria considerada (15 - 35 años) en el grupo de afrodescendientes hay mayor prevalencia, extensión y severidad de Pérdida de Inserción Periodontal en relación a los no afrodescendientes. Por otra parte, no se encontraron diferencias significativas en relación a la Profundidad de Sondaje en las poblaciones examinadas.

The diversity approach in health focuses on recognizing and paying special attention to the different interests, demands, needs and health-disease processes specif to certain people. Ethnic-racial considerations in these cases become fundamental.In Uruguay, census data show that 8.1% of the population (approximately 255,000 people) consider themselves Afrodescendants, which makes them the main ethnic-racial minority of the country. To date, there are no surveys on the periodontal condition of Afrodescendant population in our country. Objective: to evaluate the oral and periodontal status of patients through health-disease process indicators. Materials and methods: descriptive, cross-sectional study of the Afro-Uruguayan population. Inclusion criteria: age range from 15 to 35, living in Montevideo. Exclusion criteria: pregnancy, having received periodontal treatment or treatment with antibiotics in the last 6 months. The size of each population sample with or without African origin was of 40 individuals each, half men, half women. The Rediente Clinical History was used, the periodontal parameters were recorded using a periodontal probe calibrated by millimeter, and six sites per tooth were examined in a full mouth. Results: the group of Afrodescendants have one less tooth, on average, than non-Afrodescendants, especially the first mandibular molars. They also show higher prevalence, depth and severity of attachment loss compared to the control group. No statistically significant differences were found in probing depth between the two groups. Conclusions: Afrodescendants became part of the popular sectors of society, which makes them more vulnerable. In the age range considered (15-35), Afrodescendants have higher prevalence, extension and severity of clinical attachment loss than non-Afrodescendants. No statistically significant differences were found in the considered age range regarding probing depth in the populations examined.

Epidemiología de las enfermedades periodontales en el Uruguay. Pasado y presente / Epidemiology of periodontal diseases in Uruguay: past and present

El objetivo del artículo fue realizar una revisión sobre la Enfermedad Periodontal en Uruguay. Fueron consultadas bases de datos internacionales (PUBMED, SCOPUS, EBSCO, SciELO). Paralelamente la búsqueda abarcó fuentes nacionales (Biblioteca Nacional de Odontología, Centro de documentación de la Facultad de Odontología, Ministerio de Salud Pública, Dirección Nacional de Sanidad de las Fuerzas Armadas), complementado por búsqueda manual. Los estudios hallados aportaron información epidemiológica útil, además de permitir un repaso histórico sobre conceptos de epidemiología, etio-patogenía y corrientes hegemónicas de la periodoncia. La Enfermedad Gingival representa la patología más prevalente, mientras que los cuadros periodontales destructivos afectan fundamentalmente a los adultos. La edad, el origen geográfico, la clase social y el hábito de fumar son indicadores fuertemente asociados con dichos trastornos. De la lectura pormenorizada de los artículos recopilados se plantean sugerencias a ser consideradas en los próximos relevamientos epidemiológicos.

This article aims to review periodontal disease in Uruguay. International databases (PUBMED, SCOPUS, EBSCO, SciELO) were consulted. The search also included national sources (National Library of Dentistry, Documentation Center of the School of Dentistry, Ministry of Public Health, National Directorate of Health of the Armed Forces) which were searched manually. The studies found provided useful epidemiological information and allowed us to conduct a historical review of epidemiology concepts, etiopathogenesis and hegemonic currents in periodontics. Gingival disease is the most prevalent disease, while destructive periodontal conditions mainly affect adults. Age, geographical origin, social class and smoking are indicators strongly associated with these disorders. From the close reading of the articles collected we can make suggestions to be considered in future epidemiological surveys

Aceites esenciales: una opción quimioterapéutica en Periodoncia / Essential-oils: a chemotherapeutic option in periodontics

Las enfermedades periodontales representan un conjunto de patologías que afectan los tejidos de soporte dentario. La remoción del biofilm diaria y efectiva es suficiente para prevenirlas. La dificultad de los individuos en desarrollar hábitos de higiene oral adecuados valiéndose solamente de elementos mecánicos llevó al desarrollo de coadyuvantes químicos con el objetivo de maximizar el control del biofilm por el paciente. Los aceites esenciales son eficaces y superiores en el control de la placa supragingival y la inflamación en comparación con placebo y cloruro de cetilpiridinio. Sin embargo, fueron similares en el control de la inflamación e inferiores en el control de placa en comparación con la clorhexidina, generando menos efectos adversos. La evidencia sugiere que para el cuidado oral a corto plazo la clorhexidina es la primera opción y que los aceites esenciales muestran utilidad al ser indicados a largo plazo cuando el cuidado oral antiinflamatorio sea beneficioso.

Periodontal diseases are a group of pathologies that affect the tissues that support teeth. The efficient control of daily oral biofilm can prevent these diseases. Most individuals have difficulty in developing good oral hygiene habits and use only mechanical elements. This has led to the development of chemical adjuvants so that patients can maximize biofilm control. Essential oils (EOs) are effective and more efficient at controlling supragingival plaque and inflammation compared to a placebo and to cetylpyridinium chloride. Nevertheless, EOs were similar in their anti-inflammatory effectiveness and less efficient in plaque control than chlorhexidine, causing fewer adverse effects. Current evidence suggests that chlorhexidine remains the first choice for short-term oral health care and that essential-oils are best indicated for long-term treatments.

Efficacy of a triclosan formula in controlling early subgingival biofilm formation: a randomized trial

The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the testversus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.

Periodontal conditions and associated factors among adults and the elderly: findings from the first National Oral Health Survey in Uruguay / Enfermedad periodontal y factores asociados en la población adulta y adulta mayor: primer Relevamiento Nacional de Salud Bucalen Uruguay / A doença periodontal e fatores associados entre adultos e idosos: dados da Pesquisa Nacional de Saúde Bucal no Uruguai

Abstract The aims of this study were to assess the prevalence of periodontal conditions in the Uruguayan adult and elderly population and its association with socioeconomic and behavioral characteristics. Data from adults (35-44, n = 358) and elderly (65-74, n = 411) who participated in the first National Oral Health Survey, Uruguay, 2011, were used. The survey included a household questionnaire addressing socioeconomic characteristics, and tobacco use. Bleeding on probing (BOP), periodontal pockets (CPI) and clinical attachment loss (CAL) were measured by clinical examination. A multivariable analysis was carried out. Considering both age groups, the prevalence of mild/severe periodontal disease was 21.8% and 9.12% for severe periodontal disease. Adjusted analyses revealed an association between high education and all outcomes. Attendance at dental services was negatively associated with BOP and mild to severe periodontitis. Periodontal outcomes were higher in disadvantaged socioeconomic groups. Tobacco consumption has a strong association with periodontal disease in the elderly.

Resumen El objetivo del estudio fue conocer la prevalencia de enfermedad periodontal en la población adulta y anciana uruguaya y su asociación con factores comportamentales y socioeconómicos. Se utilizaron datos de adultos (35-44, n = 358) y ancianos (65-74, n = 411) participantes en el primer Relevamiento Nacional de Salud Bucal en Uruguay. El relevamiento incluyó un cuestionario sobre factores de riesgo, incluyendo tabaco. Sangrado al sondaje bolsa periodontal (IPC) y pérdida de inserción (PIP) fueron valorados mediante examen clínico. Considerando las dos edades, la prevalencia de enfermedad moderada/severa fue de 21,8% y 9,12% para severa. En el análisis multivariado, se observó asociación entre nivel universitario de educación y todas las variables de respuesta. La asistencia odontológica estuvo negativamente asociada con la enfermedad periodontal moderada a severa. La prevalencia fue mayor en el grupo con menor nivel socioeconómico. En los ancianos, el hábito de fumar estuvo fuertemente asociado con la enfermedad periodontal.

Resumo O objetivo do estudo foi determinar a prevalência da doença periodontal em adultos e idosos uruguaios e sua associação com fatores comportamentais e socioeconômicos. Foram utilizados dados de adultos (35-44, n = 358) e de idosos (65-74, n = 411) participantes da primeira Pesquisa Nacional de Saúde Bucal, no Uruguai, em 2011. A pesquisa incluiu um questionário sobre fatores de risco, incluindo fumo. Sangramento ao sandagem bolsa periodontal (IPC) e perda de inserção (PIP) foram avaliados por meio de exame clínico. Considerando-se as duas idades, a prevalência da doença moderada/grave foi de 21,8% e 9,12%. Na análise multivariada, foi observada associação entre a educação de nível universitário e todas as variáveis de resposta. O atendimento odontológico foi negativamente associado com a doença periodontal moderada e grave. A prevalência foi maior no grupo com menor nível socioeconômico. Dentre os idosos, o tabagismo foi fortemente associado à doença periodontal.