Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Possible association of periodontal disease with oral cancer and oral potentially malignant disorders: a systematic review.

Background: Periodontitis has been associated with several systemic diseases and medical conditions, including oral cancer (OC). However, most studies reporting an association between OC and periodontal disease have used different clinical and radiographic criteria to define periodontal disease. This review aimed to evaluate the currently available evidence to determine an association between periodontal disease (extension and severity), OC, and oral potentially malignant disorders (OPMDs).Material and methods: A systematic search of studies published up to August 2018 was performed following the PRISMA guidelines in the electronic databases MEDLINE (PubMed) and COCHRANE (OVID). A methodological evaluation was made using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist.Results: Eight studies (case-control, cross-sectional and cohort) were included. An increased clinical attachment loss, plaque index, bleeding on probing, and radiographic bone loss was found in patients with OC and OPMDs. Differences in the methodological characteristics, case definition used for periodontal diseases, and OC location did not allow estimating the odds ratio required to conduct a meta-analysis.Conclusion: Some studies suggest a positive relationship between periodontal disease, OC, and OPMDs; however, the currently available evidence is insufficient to draw solid conclusions.

Association of metabolic syndrome and chronic periodontitis in Colombians.

BACKGROUND: Metabolic syndrome (MetS) is a common chronic condition that increases the cardiovascular disease risk and is also linked to periodontitis. The study aim was to determine if a relationship exists between MetS and chronic periodontitis in adult Colombians. METHODS: Participants were 220 healthy-gingivitis subjects and 431 periodontitis patients coming from the three largest Colombian cities. Periodontal status and MetS were determined in subjects. Univariate analysis and odds ratio were calculated within the 95 % confidence intervals and chi2 test compared the groups. Variables were compared among the clinical periodontal groups and MetS by Wilcoxon and multivariate analysis, and logistic regression was performed for MetS and periodontitis. RESULTS: MetS had higher prevalence in periodontitis group (6.3 %) versus controls (3.2 %). In multivariate analysis, periodontitis was associated with MetS (adjusted OR = 2.72, 95 % CI 1.09-6.79), glucose intolerance with another component of MetS (adjusted OR = 1.78, 1.16 to 2.72), glucose resistance (adjusted OR = 11.46, 95 % CI 1.41-92.88), smoking (OR = 1.72, 95 % CI 1.09-2.71), and city of origin (2.69, 95 % CI 1.79-4.04). CONCLUSION: The study confirmed the positive association between MetS and periodontitis, being glucose sensitivity the strongly associated component. CLINICAL RELEVANCE: MetS must be taken into account by the dentist when evaluating risk factors for periodontitis, being useful for dentists to evaluate glycemia, lipidic profile, central obesity, and high blood pressure in patients. Interdisciplinary treatment must be recommended when a patient with MetS and periodontitis is being treated.

Is There Still a Role for Irrigation and Debridement With Liner Exchange in Acute Periprosthetic Total Knee Infection?

BACKGROUND: Periprosthetic joint infection (PJI) is an important cause of failure in total knee arthroplasty. Irrigation and debridement including liner exchange (I&D/L) success rates have varied for acute PJI. The purpose of this study is to present results of a specific protocol for I&D/L with retention of total knee arthroplasty components. METHODS: Sixty-seven consecutive I&D/L patients were retrospectively evaluated. Inclusion criteria for I&D/L were as follows: fewer than 3 weeks of symptoms, no immunologic compromise, intact soft tissue sleeve, and well-fixed components. I&D/L consisted of extensive synovectomy; irrigation with 3 L each of betadine, Dakin's, bacitracin, and normal saline solutions; and exchange of the polyethylene component. Postoperatively, all patients were treated with intravenous antibiotics. Infection was considered eradicated if the wound healed without persistent drainage, there was no residual pain or evidence of infection. RESULTS: Forty-six patients (68.66%) had successful infection eradication regardless of bacterial strain. Those with methicillin-resistant Staphylococcus aureus (MRSA) had an 80% failure rate and those with Pseudomonas aeruginosa had a 66.67% failure rate. The success rate for bacteria other than MRSA and Pseudomonas was 85.25%. CONCLUSION: Our protocol for I&D/L was successful in the majority of patients who met strict criteria. We recommend that PJI patients with MRSA or P aeruginosa not undergo I&D/L and be treated with 2-stage revision. For nearly all other patients, our protocol avoids the cost and patient morbidity of a 2-stage revision.

Periodontal disease in children and adolescents of Latin America.

Periodontal diseases are a group of infectious diseases that mainly include gingivitis and periodontitis. Gingivitis is the most prevalent form of periodontal disease in subjects of all ages, including children and adolescents. Less frequent types of periodontal disease include aggressive periodontitis, acute necrotizing ulcerative gingivitis and various diseases of herpesviral and fungal origin. This review aimed to retrieve relevant information from Latin America on the prevalence of periodontal diseases among children and adolescents of the region. Gingivitis was detected in 35% of young Latin American subjects and showed the highest frequencies in Colombia (77%) and Bolivia (73%) and the lowest frequency in Mexico (23%). The frequency of gingivitis in subjects from other Latin American countries was between 31% and 56%. Periodontitis may affect <10% of the young population in Latin America, but the data are based on only a few studies. A more precise assessment of the distribution and severity of periodontal disease in children and adolescents of Latin America may help policy makers and dentists to institute more effective public health measures to prevent and treat the disease at an early age to avoid major damage to the permanent dentition.

Periodontal microbiology in Latin America.

This review article describes the microbiota associated with periodontal disease in Latin America. This vast territory includes 22 nations, which show great ethnic diversity, with large groups of White people, Black people, Mestizo people and Native people. Widespread poverty and limited access to education and health-care services, including periodontal care, are prominent predisposing factors for destructive periodontal disease in Latin America. Black people and Mestizo people seem to have particularly severe periodontal disease and are frequently colonized by the major periodontal pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The 'red complex' bacterial pathogens and A. actinomycetemcomitans predominate in chronic and aggressive periodontitis, but gram-negative enteric rods and herpesviruses can also play important periodontopathic roles in Latin America. The key to minimizing the risk of periodontal disease is control of the pathogens, and new low-cost periodontal treatments deserve serious consideration in Latin America.

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.

sEMG as complementary tool for VFSS: A synchronized study in patients with neurogenic oropharyngeal dysphagia.

The neurogenic oropharyngeal dysphagia is a prevalent functional swallowing disorder resulting from neurological causes. The conventional diagnosis involves ionizing radiation in Videofluoroscopy Swallowing Studies (VFSS). Surface electromyography (sEMG) offers a non-invasive alternative by recording muscle activity. This research compares bolus passage timing through anatomical structures using VFSS and sEMG-related activation times. Fifty confirmed oropharyngeal dysphagia patients underwent synchronized VFSS and sEMG, evaluating muscle groups during cracker and fluid ingestion. sEMG revealed activation patterns in masseters, suprahyoid, and infrahyoid muscles, occurring before bolus passage through the mandibular line and concluding near the upper esophageal sphincter complex. sEMG identified differences in dysphagia severity (EAT-10 score), age, and diagnosis, contrasting VFSS results. Results indicate potential complementarity between sEMG and VFSS for dysphagia screening, diagnosis, and monitoring.

Factors Associated with the Extent of Clinical Attachment Loss in Periodontitis: A Multicenter Cross-Sectional Study.

Periodontitis has significant public health implications, affecting individuals' overall health, well-being, and quality of life. This study aimed to assess the risk factors associated with the extent of clinical attachment loss (CAL) in a population diagnosed with periodontitis. Six hundred and sixty-seven patients with different degrees of CAL (mild, n = 223; moderate, n = 256; and advanced, n = 188) were enrolled. Socio-demographics, lifestyle, microbiological profiles, specific immune response, obesity, and single-nucleotide polymorphism of the IL1 gene were determined. Unconditional logistic regression models were conducted to determine the factors associated with the extent of CAL. Aging, smoking, microbial factors, plaque index, and IgG2 antibodies against Aggregatibacter actinomycetemcomitans were associated with advanced CAL. IgG2 antibodies against A. actinomycetemcomitans (OR 1.50; CI 95% 1.23-1.81), plaque accumulation (OR 2.69; CI 95% 2.20-3.29), Porphyromonas gingivalis (OR 1.93; CI 95% 1.35-2.76), Tanerella forsythia (OR 1.88; CI 95%1.30-2.70), and current smoking (OR 1.94; CI 95% 1.31-2.87) were associated with advanced CAL. Gene IL polymorphisms, obesity, and stress were not associated with the extent of CAL. Aging, plaque accumulation, smoking, and having antibodies against A. actinomycetemcomitans were the most critical factors associated with advanced CAL. In contrast, obesity, stress, and gene polymorphisms were not associated with the extent of CAL.

Synchronization between videofluoroscopic swallowing study and surface electromyography in patients with neurological involvement presenting symptoms of dysphagia / Sincronización entre la videodeglución y la electromiografía de superficie en pacientes con afectación neurológica y síntomas de disfagia

Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing. Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy. Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously with videofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation. Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete. Conclusión: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study.

Introducción. La disfagia se define como la dificultad para movilizar la comida desde la boca hasta el estómago. La prueba diagnóstica para esta condición es la videofluoroscopia, la cual no es totalmente inocua pues utiliza radiación ionizante. La electromiografía de superficie registra la actividad eléctrica de los músculos de manera no invasiva, por lo que puede considerarse como una alternativa para evaluar la deglución y estudiar la disfagia. Objetivo. Evaluar la relación entre los tiempos relativos de activación de los músculos implicados en la fase oral y faríngea de la deglución, con los movimientos registrados durante la videofluoroscopia. Materiales y métodos. Se analizaron las señales de la electromiografía de superficie de 10 pacientes neurológicos con síntomas de disfagia, captadas en forma simultánea con la videofluoroscopia. Se suministraron 5 ml de yogur y 10 ml de agua, y 3 g de galleta. Se estudiaron bilateralmente los grupos musculares maseteros, suprahioideos e infrahioideos. Se analizó el paso del bolo por la línea mandibular, las valleculas y el músculo cricofaríngeo, correlacionándolo con el tiempo inicial y el final de la activación de cada uno de los grupos musculares. Resultados. El tiempo promedio de la fase faríngea fue de 0,89 ± 0,12 s. En la mayoría de los casos, hubo activación muscular antes del paso por la línea mandibular y las valleculas. La terminación de la actividad muscular parece corresponder al momento en que se completa el paso del bolo alimenticio por el músculo cricofaríngeo. Conclusión. Se determinaron los tiempos de actividad muscular, la duración de la fase faríngea y la secuencia de la activación de los grupos musculares involucrados en la deglución, mediante electromiografía de superficie, validada con la videofluoroscopia.

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

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

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report.

Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

Cambios en los conocimientos sobre la relación periodontitis/enfermedades sistémicas. Estudio transversal no analítico

Introducción: Las enfermedades periodontales tienen efectos locales y sistémicos sobre algunas enfermedades sistémicas. Propósito: Identificar cambios después de una jornada informativa preventiva sobre la relación de las EP y las enfermedades sistémicas en un ambiente universitario de carreras del área de la salud. Materiales y métodos: Estudio transversal no analítico cuyo objeto de estudio fue el cambio de la información obtenida por los participantes de una jornada de educación en salud en una muestra no aleatoria de 264 individuos de facultades de salud diferentes a odontología quienes recibieron encuestas "antes y después". Las variables de los cambios en los conocimientos se evaluaron mediante una escala Likert. Resultados: Antes de la estrategia, el 51,6% consideraban poco importante o que podría ser importante la salud oral como estilo de vida saludable vs un 99.2% al final. El 67.8 % de los sujetos, consideraban que la enfermedad periodontal no compartía factores de riesgo con condiciones sistémicas vs un 92.9%. Se incrementó de un 67.75% a 93.2% el reconocimiento del control del riesgo periodontal como estrategia para incidir en las enfermedades sistémicas. Conclusión: Una estrategia educativa sensibilizar positivamente sobre la importancia de la prevención de las enfermedades periodontales y las condiciones sistémicas.

Introduction: Periodontal diseases have local and systemic effects on some systemic diseases. Purpose: Identify changes after a preventive information session on the relationship between PD and systemic diseases in health faculties. Materials and methods: Non-analytical cross-sectional study whose object was the change in the information obtained by the participants of a health education session in a non-random sample of 264 individuals from health faculties other than dentistry who received "before and after" surveys. The variables were evaluated using a Likert scale. Results: Before the strategy, 51.6% considered oral health to be important for a healthy lifestyle vs. 99.2% at the end of the session. 67.8% of the subjects considered that periodontal disease shared risk factors with systemic conditions before the session vs. 92.9% after it. The recognition of periodontal risk control as a strategy to influence systemic diseases increased from 67.75% to 93.2%. Conclusion: An educational strategy raises a positive awareness of the importance of preventing periodontal diseases and systemic conditions.

Prevalence of Peri-implant Disease According to Periodontal Probing Depth and Bleeding on Probing: A Systematic Review and Meta-Analysis.

PURPOSE: To compare changes in the prevalence of peri-implantitis when the unit of analysis is the subject and when the unit of analysis is the implant, by means of meta-analysis with subgroup and sensitivity analyses, according to the case definition and cutoffs. Periodontal probing depth (PPD) and bleeding on probing (BOP) were considered the primary variables. MATERIALS AND METHODS: Electronic and manual searches of observational studies of implants with loading of more than 6 months were conducted. The quality of the studies was evaluated, and finally, a description (qualitative analysis) and a meta-analysis (quantitative analysis) of the available studies were performed. RESULTS: Fifty-five studies were included in this systematic review, 32 of which met the criteria for evaluation of disease based on PPD and BOP. A total of 2,734 subjects and 7,849 implants were evaluated. The prevalence of peri-implantitis, defined by PPD and BOP, was 17% when the unit of analysis was the subject, and 11% when it was the implant. If the clinical criterion was PPD ≥ 4 mm, the prevalence by subject was 34% and by implant 11%. If PPD was ≥ 5 mm, the prevalence by subject was 12% and by implant 10%. Finally, if the clinical criterion was PPD ≥ 6 mm, the prevalence by subject was 18% and by implant 10%. CONCLUSION: The prevalence of peri-implantitis is influenced by the criteria used for the case definition, and the true prevalence may currently be incorrectly estimated.

Sincronización entre la videodeglución y la electromiografía de superficie en pacientes con afectación neurológica y síntomas de disfagia / Synchronization between videofluoroscopic swallowing study and surface electromyography in patients with neurological involvement presenting symptoms of dysphagia

Introducción. La disfagia se define como la dificultad para movilizar la comida desde la boca hasta el estómago. La prueba diagnóstica para esta condición es la videofluoroscopia, la cual no es totalmente inocua pues utiliza radiación ionizante. La electromiografía de superficie registra la actividad eléctrica de los músculos de manera no invasiva, por lo que puede considerarse como una alternativa para evaluar la deglución y estudiar la disfagia. Objetivo. Evaluar la relación entre los tiempos relativos de activación de los músculos implicados en la fase oral y faríngea de la deglución, con los movimientos registrados durante la videofluoroscopia. Materiales y métodos. Se analizaron las señales de la electromiografía de superficie de 10 pacientes neurológicos con síntomas de disfagia, captadas en forma simultánea con la videofluoroscopia. Se suministraron 5 ml de yogur y 10 ml de agua, y 3 g de galleta. Se estudiaron bilateralmente los grupos musculares maseteros, suprahioideos e infrahioideos. Se analizó el paso del bolo por la línea mandibular, las valleculas y el músculo cricofaríngeo, correlacionándolo con el tiempo inicial y el final de la activación de cada uno de los grupos musculares. Resultados. El tiempo promedio de la fase faríngea fue de 0,89 ± 0,12 s. En la mayoría de los casos, hubo activación muscular antes del paso por la línea mandibular y las valleculas. La terminación de la actividad muscular parece corresponder al momento en que se completa el paso del bolo alimenticio por el músculo cricofaríngeo. Conclusión. Se determinaron los tiempos de actividad muscular, la duración de la fase faríngea y la secuencia de la activación de los grupos musculares involucrados en la deglución, mediante electromiografía de superficie, validada con la videofluoroscopia.

Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing. Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy. Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously with videofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation. Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete. Conclusion: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study.

Prevalence of peri-implant disease on platform switching implants: a cross-sectional pilot study.

The objective of this study was to assess the prevalence of mucositis and peri-implantitis associated with the use of two types of implants-conventional versus platform switching after one year of loading. A longitudinal study of 64 implants in 25 patients was performed. Clinical variables, such as clinical pocket depth and bleeding upon probing, plaque, mobility, gingival recession, clinical attachment loss, and radiographic bone loss, were analyzed. The case definition for peri-implantitis was established as pockets of ≥ 5 mm with bleeding and bone loss ≥ 2 mm. One year after implant loading, the prevalence of mucositis and peri-implantitis with conventional implants (CIs) was 81.2% and 15.6%, respectively. For platform switching implants (PSIs) the prevalence was 90% and 6.6%, respectively. These differences were not statistically significant (p = 0.5375). However, there was a trend towards a lower prevalence of peri-implantitis with platform switching Implants.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report

Abstract: Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

A clinical practice guideline for the prevention and treatment of peri-implant diseases / Guía de práctica clínica para la prevención y el tratamiento de enfermedades periimplantares

ABSTRACT Introduction: the incidence of peri-implant diseases is high, and their optimal management is still debated. The purpose was to explore the levels of available evidence and to suggest evidence-based recommendations for the treatment of peri-implant mucositis and peri-implantitis. Methods: a clinical practice guideline was developed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. A search strategy was formulated, and a critical review of the following evidence was performed: 1) prevention of peri-implant diseases, 2) treatment of peri-implant mucositis, and 3) treatment of peri-implantitis. Systematic reviews and randomized controlled clinical trials were the primary study types identified in the literature. Current levels of evidence were established and recommendations were provided. Results: a total of 67 articles were included. Regarding the prevention of peri-implant diseases, there is strong evidence for the involvement of patients in a regular maintenance program according to their risk profile. Regarding the treatment of peri-implant mucositis, infection control measures are recommended; controversy exists over the usefulness of antimicrobial agents, and there is evidence against the use of antibiotics. Selection of the peri-implantitis treatment method depends on the severity of the condition and patient-related factors. Resective and regenerative therapies may be used for treatment. The use of systemic antibiotics favors the response of clinical parameters. There is conditional evidence for the use of other adjunctive therapies. Conclusions: the best way to prevent peri-implantitis is to prevent peri-implant mucositis through adherence to supportive periodontal therapy. Treatment of peri-implant diseases depends on local and systemic conditions that affect the success of other treatment options.

RESUMEN Introducción: la incidencia de las enfermedades periimplantarias es alta, y todavía existe polémica en torno a su óptima administración. El propósito del presente estudio consistió en explorar los niveles de evidencia disponibles y ofrecer recomendaciones basadas en la evidencia para el tratamiento de la mucositis periimplantaria y la periimplantitis. Métodos: se elaboró una guía de práctica clínica utilizando los criterios de la Red de Directrices Intercolegiales Escocesas (Scottish Intercollegiate Guidelines Network, SIGN). Se formuló una estrategia de búsqueda y se realizó una revisión crítica de las siguientes evidencias: 1) prevención de enfermedades periimplantarias, 2) tratamiento de la mucositis periimplantaria y 3) tratamiento de la periimplantitis. Las revisiones sistemáticas y los ensayos clínicos controlados aleatorios fueron los principals tipos de estudio identificados en la literatura. Se establecieron los niveles actuales de evidencias y se ofrecieron recomendaciones. Resultados: se incluyeron 67 artículos. En cuanto a la prevención de enfermedades periimplantarias, hay claras evidencias de la participación de los pacientes en los programas de mantenimiento regular, de acuerdo con su perfil de riesgo. En cuanto al tratamiento de la mucositis periimplantaria, se recomiendan medidas de control de infecciones; existe controversia sobre la utilidad de los agentes antimicrobianos, y hay evidencia en contra del uso de antibióticos. La selección del método de tratamiento de la periimplantitis depende de la gravedad de la afección y de los factores relacionados con el paciente. Para el tratamiento se pueden utilizar terapias resectivas y regenerativas. El uso de antibióticos sistémicos favorece la respuesta de los parámetros clínicos. Hay evidencia condicional en cuanto al uso de otras terapias adyuvantes. Conclusiones: la mejor manera de prevenir la periimplantitis es prevenir la mucositis periimplantar mediante la adherencia a la terapia periodontal de apoyo. El tratamiento de las enfermedades periimplantarias depende de las condiciones locales y sistémicas que afectan el éxito de otras opciones de tratamiento.

Association between periodontal disease and plasma levels of cholesterol and triglycerides.

OBJECTIVE: untreated periodontal disease seems to cause low grade systemic inflammation and blood lipid alteration leading to increased cardiovascular disease risk. To start testing this hypothesis in colombian patients, a multicentre study was conducted including the three main state capitals: bogota, medellin and cali. METHODS: in this study 192 (28.4%) advanced and 256 (37.8%) moderate periodontitis patients were investigated for socio-demographic variables, city of precedence, periodontal parameters, smoking, red complex periodontopathic bacteria, serum antibodies against porphyromonas gingivalis and aggregatibacter actinomycetemcomitans and blood lipids including total cholesterol, hdl, ldl and triglycerides (tg). Those parameters were compared to 229 (33.8%) controls having periodontal health or gingivitis. RESULTS: advanced periodontitis had worst periodontal indexes, than moderate periodontitis and controls. Interestingly, higher hdl and tg levels were present in periodontitis. Bmi <30 and smoking were associated with increased hdl, hdl-35, ldl and tg, while glycemia >100 mg/dl associated with hdl, hdl-35 and tg. Tannerella forsythia showed a significant association with hdl-35 in bivariate analysis and serum igg1 against p. Gingivalis associated with hdl-35 and serum igg1 against t. Forsythia associated with tg and serum igg2 against a. Actinomycetemcomitans correlated with levels of hdl y hdl-35. In logistic regression the periodontitis patients from cali presented reduced hdl levels as compared to bogota and medellin patients. Presence of igg1 antibodies against p. Gingivalis and a. Actinomycetemcomitans correlated with reduced hdl levels. CONCLUSION: this study confirmed that untreated periodontitis generates alteration in serum lipid levels and systemic bacterial exposure against important periodontopathic bacteria could be the biological link.

OBJETIVO: La periodontitis no tratada parece causar inflamación sistémica, así como alteración de los niveles sanguíneos de lípidos, lo que conduce a un mayor riesgo de enfermedades cardiovasculares. Para empezar a probar esta hipótesis en pacientes Colombianos, se realizó un estudio multicéntrico que incluyó las tres ciudades principales: Bogotá, Medellín y Cali. MÉTODOS: Se estudiaron 192 pacientes con periodontitis avanzada (2.,4%) y 256 (37.8%) con periodontitis moderada, para medir variables sociodemográficas, ciudad de procedencia, parámetros periodontales, fumar, presencia de bacterias periodontopáticas, anticuerpos séricos contra Porphyromonas gingivalis y Aggregatibacter actinomycetemcomitans, así como niveles de lípidos en sangre incluyendo colesterol total, HDL, LDL y triglicéridos (TG). Estos parámetros se compararon con 229 (33.8%) pacientes controles sanos/gingivitis. RESULTADOS: Los pacientes con periodontitis avanzada tuvieron peores índices periodontales que los de periodontitis moderada y los controles. Mayores niveles de HDL y TG estuvieron presentes en pacientes con periodontitis. El índice de masa corporal >30 y el hábito de fumar se asociaron con aumento de HDL, HDL-35, LDL y TG, mientras la glicemia >100 mg/dL se asoció con HDL, HDL-35 y TG. En el análisis bivariado Tannerella forsythia mostró asociación significativa con HDL-35 e IgG1 sérica contra P. gingivalis estuvo asociada a HDL-35 así como IgG1 contra T. forsythia con TG y la IgG2 contra A. actinomycetemcomitans se correlacionó con los niveles de HDL y HDL-35. En la regresión logística se observó que la región de Cali tuvo niveles menores de HDL en comparación con los pacientes de Bogotá y Medellín. La presencia de anticuerpos IgG1 contra P. gingivalis y A. actinomycetemcomitans se asoció con niveles reducidos de HDL. CONCLUSIÓN: Este estudio confirmó que la periodontitis no tratada genera alteración en los niveles de lípidos séricos y la exposición bacteriana sistémica a las bacterias periodontopáticas podría ser el vínculo biológico.

Prevalencia de periodontitis crónica en Iberoamérica / Chronic periodontitis in Latin America

La prevalencia de las enfermedades periodontales es alta y está relacionada con la biopelícula oral y otros factores de riesgo como la edad, el hábito de fumar, diabetes, factores hereditarios, etc. Objetivo El objetivo de esta revisión fue explorar la evidencia publicada sobre la prevalencia de periodontitis crónica en Iberoamérica. Métodos Se llevó a cabo una búsqueda de los estudios de corte trasversal y cohortes con el fin de comparar la prevalencia de periodontitis crónica en Iberoamérica. Se identificaron las características clínicas de las enfermedades periodontales usadas en cada estudio, como: profundidad clínica de sondaje, nivel clínico de inserción y sangrado al sondaje. También se analizaron los índices clínicos utilizados. Resultados Aunque se han realizado consensos para unificar la definición de caso de la periodontitis, no siempre son utilizados en estudios de prevalencia de la enfermedad. Por tal razón la comparación entre los diferentes estudios es difícil. La evidencia sobre la prevalencia de periodontitis en Iberoamérica encontrada en Pubmed y otros buscadores es limitada. Solo en Argentina, Brasil, Chile, Colombia, España, República Dominicana y Guatemala fue posible encontrar información. Existen pocos estudios poblacionales y los criterios diagnósticos utilizados son heterogéneos. No fue posible hacer un metaanálisis. Estas dificultades no permiten una comparación exacta entre los países. Igualmente algunos estudios utilizan índices actualmente no reconocidos en consensos periodontales para determinar la verdadera prevalencia de enfermedades periodontales (Índice Periodontal Comunitario). Conclusiones La mayoría de los estudios en Iberoamérica demuestran que la prevalencia de la periodontitis crónica es alta y que existe un incremento en la extensión y la severidad de la pérdida de inserción y la profundidad de sondaje relacionado con la edad.

The prevalence of periodontal diseases is high, and is related to oral biofilm and other risk factors such as age, smoking, diabetes, hereditary factors, etc. Objective The objective of this review was to examine studies on the prevalence of chronic periodontitis in Latin America. Methods A search was conducted for cross sectional and cohort studies to determine the prevalence of chronic periodontitis in Latin America. The clinical features of the periodontal diseases used for diagnosis in epidemiologic studies were identified, such as clinical probing depth, clinical attachment level, and bleeding on probing. An analysis was also performed on the periodontal indices used. Results Although consensus criteria have been formed to unify the case definition of periodontitis, they are not always used in studies of periodontal disease prevalence. For this reason the comparison between different studies is difficult. The evidence on the prevalence of periodontitis in Latin America found in PubMed and other Scientific data bases is limited. Only in Argentina, Brazil, Chile, Colombia, Spain, Dominican Republic and Guatemala was it possible to find information. There are few population studies in Latin America, and the diagnostic criteria used are heterogeneous. It was not possible to perform a meta-analysis. All this makes it difficult to make an accurate comparison between countries. Also, some studies use indices that are not currently recognised in periodontal consensus in order to determine the true prevalence of periodontal diseases (Community Periodontal Index). Conclusion Most studies show that the prevalence of chronic periodontitis in Latin America is high, and the extent and severity of insertion loss and increased probing depth increases with age.