Effects of periodontal therapy on GCF cytokines in generalized aggressive periodontitis subjects.

AIM: To examine changes in levels of gingival crevicular fluid (GCF) cytokines, after periodontal therapy of generalized aggressive periodontitis (GAgP). MATERIALS AND METHODS: Twenty-five periodontally healthy and 24 GAgP subjects had periodontal clinical parameters measured and gingival crevicular fluid (GCF) samples collected from up to 14 sites/subject. GCF samples were analysed using multiplex bead immunoassay for: GM-CSF, IFN-γ, IL-10, IL-1ß, IL-2, IL-6 and TNF-α. Aggressive periodontitis subjects were randomly assigned to either scaling and root planing (SRP) alone or SRP plus systemic amoxicillin (500 mg) and metronidazole (400 mg) 3 times a day for 14 days. Clinical parameters and GCF cytokines were re-measured 6 months after treatment. Differences over time were analysed using the Wilcoxon test and between groups using the Mann-Whitney test. RESULTS: Significant reductions in GCF GM-CSF, IL-1ß and the ratio IL-1ß/IL-10 and increases in GCF IL-6 were detected after therapy. The mean change in GCF cytokines did not differ significantly between groups. CONCLUSIONS: Periodontal therapy improved GCF cytokine profiles by lowering IL-1ß and increasing IL-10 levels. The reduction in GCF GM-CSF after therapy implicates this cytokine in the pathogenesis of GAgP. There was no difference between therapies in changes of GCF cytokines.

Clinical and microbiological benefits of strict supragingival plaque control as part of the active phase of periodontal therapy.

AIM: To compare the clinical and microbiological effects of scaling and root planing (SRP) alone or combined with mechanical [professional plaque control (PPC)] or chemical [chlorhexidine rinsing (CHX)] control of supragingival plaque in the treatment of chronic periodontitis. MATERIAL AND METHODS: Sixty subjects were randomly assigned to receive SRP alone or combined with PPC (twice a week) or with CHX rinsing (twice a day). The adjunctive treatments began with SRP and were continued for 42 days. Clinical and microbiological examinations were performed at baseline, 2 and 6 months post-therapy. Subgingival plaque samples were analysed for 38 bacterial species by checkerboard DNA-DNA hybridization. RESULTS: The two test treatments were more effective in improving probing depth and clinical attachment level (CAL) than SRP alone, even in intermediate and deep sites. CAL gain was better maintained in the CHX group. The most beneficial microbiological changes were observed in CHX-treated subjects, who showed a significant reduction in the proportions of red and orange complexes, as well as an increase in the proportions of the host-compatible bacterial species. CONCLUSION: Strict plaque control performed during and after SRP improves periodontal treatment outcomes. The greatest microbiological and clinical benefits were observed with the use of CHX rinsing.

Cirurgia oral em paciente com anemia falciforme: o que o cirurgião-dentista precisa saber. Relato de caso / Oral surgery in patient with sickle cell disease: what the dentist need to know. Case report

Anemia falciforme é uma doença hereditária que se caracteriza por um distúrbio sanguíneo que afeta as células vermelhas, resultando, principalmente, em hemoglobinas alteradas. A doença caracteriza-se pela falta de glóbulos vermelhos saudáveis, causando dificuldade em transpor oxigênio para todos os tecidos. As manifestações sistêmicas e na cavidade oral podem ser variadas, sendo importante estar atento aos sinais clínicos e sintomas. Para o tratamento desses pacientes é necessário atenção aos cuidados e riscos a infecções oriundas das técnicas realizadas pelo cirurgião dentista, e, por esta razão, a antibioticoprofilaxia se faz tão necessária juntamente com a relação multidisciplinar. O objetivo deste trabalho foi apresentar um relato de caso de instalação de implante osseointegrado em paciente portadora de anemia falciforme, enfatizando as características da doença e os cuidados que o cirurgião-dentista deve ter no manejo destes pacientes.(AU)

Sickle cell disease is a hereditary disease characterized by a disorder that affects the blood red cells resulting mainly in altered hemoglobin. The disease results in lack of enough healthy red blood cells causing difficulty in transposing oxygen to all tissues. Systemic and bucal manifestations can be varied and it is very important to be aware of the clinical signs and symptoms. In the treatment of these patients it is necessary to pay attention for the risks of arising infections from the techniques performed by dentists and that´s why antibiotic prophylaxis is done as needed along with the multidisciplinary relationship. The objective of this study was a report of case of osseointegrated implant installation in a female patient with sickle cell anemia, emphasizing the characteristics of the disease and the care that the dentist must have in the management of these patients.(AU)

Time-related increase of staphylococci, Enterobacteriaceae and yeasts in the oral cavities of comatose patients.

BACKGROUND/PURPOSE: The composition of oral microbiota in comatose patients remains uncertain. Some pulmonary pathogens may be found in dental biofilms or as part of the saliva microbiota. It is supposed that some pneumopathogenic microorganisms may overgrow in the mouths of comatose patients and spread to their lungs. METHODS: The oral colonization dynamics of staphylococci, Enterobacteriaceae and yeasts in nine comatose patients (group 1), and in 12 conscious patients that brushed their teeth at least twice a day (group 2) was evaluated. Both groups were followed up for 7 days after hospitalization. Daily samples of saliva were obtained, dispersed and plated on selective culture media and colony forming units of each microbial group were obtained. RESULTS: For patients in group 1, the counts of total viable bacteria, staphylococci, Enterobacteriaceae and yeasts progressively increased in a time-dependant manner. For the conscious patients of group 2, there was no increase. CONCLUSION: It would appear that concomitant consciousness and brushing teeth are determinants in controlling the selected pneumopathogen counts in resting saliva. The increase in microbial counts in comatose patients is understandable because these microorganisms could spread to the lungs.

The role of candidal histolytic enzymes on denture-induced stomatitis in patients living in retirement homes.

MATERIAL AND METHODS: Fifty nine elders wearing complete dentures and living in retirement homes in Curitiba (southern Brazil), were divided into two groups: group #1, 26 patients with denture-induced stomatitis and group #2, 33 patients without denture-induced stomatitis. The two groups were evaluated in relation to the degree of denture-induced stomatitis, salivary fungal loads, and secretion of some histolytic enzymes. RESULTS: Patients from group #1 showed higher degrees of colonisation by Candida albicans (p = 0.031). Candida krusei, Candida tropicalis, and Candida parapsilosis were also isolated, but there were no differences between the groups (p > 0.05). Secretory aspartyl protease (Sap) and chondroitinase did not show significant differences among the isolated Candida spp. in the two groups. Phospholipase secretion rates were higher among the strains of C. albicans from group #2 (p = 0.036). The same behaviour was not detected for non-albicans Candida species. CONCLUSIONS: The results could infer that differences in the secretion rates of candidal histolytic enzymes should not be imputed as imperative for the progress of denture-induced stomatitis.

Scaling and root planing and chlorhexidine mouthrinses in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial.

OBJECTIVE: Evaluation of the clinical and microbiological effects of scaling and root planing (SRP) alone or in combination with 0.12% chlorhexidine (CHX) rinsing. METHODS: A blind, placebo-controlled, parallel-design, randomized clinical trial was conducted in 29 subjects with chronic periodontitis. Subjects were assigned to two therapeutic groups: control (SRP+placebo) and test (SRP+CHX during and up to 42 days post-therapy). Clinical and microbiological [N-benzoyl-dl-arginine-2-naphthylamide (BANA test)] examinations were performed at baseline, 42 and 63 days post-therapy. RESULTS: Initially, intermediate sites (4-6 mm) in the test group showed less plaque accumulation, gingival bleeding, bleeding on probing and a greater reduction in attachment level and probing depth (PD) at 63 days after treatment. The initially deep sites (>6 mm) in the CHX group also showed a better reduction in plaque accumulation and in PD compared with the control group. Both therapies led to a microbiological improvement; however, the test subjects showed a higher frequency of BANA-negative sites after treatment, which was sustained over time (p<0.001). At 63 days, the control group presented 25 BANA-negative sites and 65 positive sites, and the test group 58 and 26, respectively. CONCLUSION: The combination of CHX rinses and SRP leads to clinical benefits and to a better reduction in BANA-positive species.

Controle da placa bacteriana supragengival na terapia periodontal não-cirúrgica / Supragingival plaque control on non-surgery periodontal therapy

O tratamento periodontal está relacionado diretamente aos microrganismos envolvidos nos processos de saúde e doença, sendo assim, as terapias devem ser direcionadas para o controle desses microrganismos. A raspagem e o alisamento radicular (RAR) são uma terapia inespecífica que tem capacidade de alterar microbiologicamente o ambiente subgengival e proporcionar resultados clínicos positivos. Todavia, tais resultados não persistem a longo prazo devido à recolonização dos sítios tratados pelas bactérias remanescentes da região subgengival ou por agentes bacterianos provenientes da região supragengival. Nesse contexto, por meio de uma revisão de literatura, este estudo visa a esclarecer a importância da remoção mecânica da placa supragengival e a influência de tal procedimento nos resultados clínicos e microbiológicos da terapia periodontal. Diferentes metodologias clínicas e microbiológicas, tais como métodos de cultura, de microscopia de campo escuro e técnicas mais apuradas de biologia molecular foram utilizadas com o objetivo de avaliar o efeito do controle de placa supragengival associado ou não a RAR. Esses resultados têm demonstrado melhoras adicionais clínicas e microbiológicas quando é realizado um meticuloso controle da placa supragengival associado à RAR. O reconhecimento de novas metodologias microbiológicas faz do controle de placa supragengival um assunto em discussão e novos estudos precisam ser realizados na tentativa de aprimorar o conhecimento sobre a recolonização a longo prazo por periodontopatógenos nos sítios tratados

The periodontal treatment is relationship directly with the microorganism involved on the health and diseases status, and consequently, the therapies must focus the control of these microorganisms. The scaling and root planning (SRP) is an unspecific therapy that are able not only to change the microbial composition of the subgingival area but also to offer positive clinical results. Nevertheless, these positive results are not longer observed due to re-colonization of the treated periodontal sites by the pathogens remained either in the sub- or in the supragingival area. Therefore, by means of a review of literature this study aims to clarify the importance of both mechanic removal of the subgingival dental plaque and the influence of the SRP on the microbiological and clinical results. Different clinic and microbiologic methodologies such as cultivable techniques, dark-field electron microscopy, and molecular biology were used with the purpose to evaluate the effect of the supragingival plaque control associated or not with the SRP. These results have shown better clinical and microbiological additional results when there is and association between meticulous supragingival plaque control and SRP. The recognize of new microbiological methodologies demonstrate that the control of the supragingival plaque is a field in currently discussion and further investigations must be conducted to try arise the knowledge about the long term re-colonization of treated periodontal sites by periodontal pathogens

Efeitos da profilaxia profissional repetida como terapia adjunta à raspagem e alisamento radicular / The efect of professional supragengival plaque control as part of the active phase of periodontal therapy

O objetivo deste estudo foi avaliar os efeitos clínicos e microbiológicos da terapia de raspagem e alisamento radicular (RAR) isoladamente ou em combinação com o controle profissional da placa supragengival (CPP). Foram selecionados 30 indivíduos com periodontite crônica e, posteriormente, distribuídos aleatoriamente em dois grupos terapêuticos: controle (RAR) e teste (RAR + CPP). Os exames clínicos (índice de placa, índice gengival, profundidade de sondagem, nível clínico de inserção, sangramento à sondagem e supuração) e microbiológico (Teste BANA) foram realizados no momento inicial, 40 e 60 dias após a terapia de RAR. A terapia de RAR foi realizada em 21 dias e o CPP foi iniciado juntamente com a RAR, duas vezes semanais, e prosseguiu durante 40 dias após o término desta. Os parâmetros clínicos foram reduzidos significativamente aos 60 dias pós-terapia em ambos os grupos terapêuticos (p6 mm) no grupo CPP tiveram melhores resultados em relação à redução do acúmulo de placa e na profundidade de sondagem em comparação ao grupo controle. Ambas as terapias levaram a melhora microbiológica durante o período experimental (p0,05). Em conclusão, a combinação do CPP com a RAR promove benefícios clínicos em comparação com a RAR isolada.

The purpose of the present study was to evaluate the clinical and microbiological effects of scaling and root planing (RAR) alone or in combination with professional supragingival pla- que control (CPP). Thirty subjects with chronic periodontitis were assigned into two therapeutic groups: Control (RAR) and Test (RAR + CPP). Clinical (visible plaque, gingival bleeding, probing depth, clinical attachment levei, bleeding on probing and suppuration) and microbiological (BANA Test] examinations were performed at baseline, 40 and 60 days post-SRP. The CPP treatment was made twice a week and began with SRP and was continued for 40 days post-SRP. The clinical pa- rameters were significantly reduced at 60 days post-therapy in both treatment groups (p6mm) in the PPC group also had a better reduction in the percentage of sites with bleeding on probing and in probing depth and in the gain of clinical attachment compared to the control group. Both therapies led to a microbiological improvement overtime (p0.05). In conclusion, the combination of CPP and RAR leads to clinical benefits in comparison to RAR alone.