Inflammatory markers in saliva for diagnosis of sepsis of hospitalizes patients.

BACKGROUND: Inflammatory/immunological serum markers are useful for the early detection of organ dysfunction, helping the diagnosis of sepsis. Although the detection of blood biomarkers is a standard practice, the use of noninvasive samples (eg saliva) would be beneficial. AIM: To investigate the saliva of hospitalized patients with and without sepsis and identify the levels of inflammatory markers such as C-reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL-6) and nitric oxide (NO). METHODS: Saliva samples were collected from 26 patients in intensive care unit with diagnosis of sepsis and from 26 without sepsis (control). The levels of CRP were determined by using latex agglutination test, whereas those of procalcitonin and IL-6 by ELISA and NO by the Griess reaction. RESULTS: Of 26 patients with sepsis, 14 were males (54%) with a mean age of 63.81 ± 3.48 years. The control group had the same distribution for gender, with mean age 65.04 ± 4.07 years. Sepsis group showed higher salivary concentrations of CRP, PCT, IL-6 and NO, with only levels of IL-6 being statistically different (P = .0001). CONCLUSIONS: Patients with sepsis had significantly higher levels of IL-6 in their saliva, suggesting that this biological sample could be useful in the diagnosis of this condition.

In Vitro Evaluation of Sodium Hypochlorite, Chlorhexidine, Propolis, and Calcium Hydroxide Effect on Lipoteichoic-Acid-Induced Proinflammatory Cytokines Production.

This study aimed to evaluate the effects of sodium hypochlorite (NaOCl), chlorhexidine (CHX), and the glycolic extract of propolis (GEP) as endodontic irrigants and of calcium hydroxide [Ca(OH)2], CHX, or Ca(OH)2 + CHX as intracanal medications on the capacity of the lipoteichoic acid (LTA) of Enterococcus faecalis in macrophages' proinflammatory cytokines production. Freshly extracted 108 human single-rooted teeth were used in this study. The LTA of E. faecalis was standardized in double-distilled pyrogen-free water (250 µg/mL) and inoculated into the specimens subdivided into nine subgroups (n = 12). Cultures of murine macrophages (RAW 264.7) were treated with 30 µL of each sample collected from root canals and incubated (37 °C, 5% CO2) for 24 h. Lastly, anti-TNF-α, anti-IL-6, anti-IP-10, anti-MIP-1α, anti-G-CSF, and anti-IL-1ß DuoSet kits were used to perform an ELISA assay. Data were analyzed using one-way ANOVA and Tukey test (p ≥ 0.05). It was found that 1% NaOCl was the most effective irrigant in reducing the capacity of LTA in cytokines production, followed by 12% GEP and 2% CHX, respectively. Ca(OH)2 + CHX presented the best results when associated with NaOCl or GEP. Thus, NaOCl or GEP associated with Ca(OH)2 + CHX were effective in reducing the capacity of LTA in different macrophages pro-inflammatory cytokines production.

Stability of antimicrobial activity of peracetic acid solutions used in the final disinfection process.

The instruments and materials used in health establishments are frequently exposed to microorganism contamination, and chemical products are used before sterilization to reduce occupational infection. We evaluated the antimicrobial effectiveness, physical stability, and corrosiveness of two commercial formulations of peracetic acid on experimentally contaminated specimens. Stainless steel specimens were contaminated with Staphylococcus aureus, Escherichia coli, Candida albicans, blood, and saliva and then immersed in a ready peracetic acid solution: 2% Sekusept Aktiv (SA) or 0.25% Proxitane Alpha (PA), for different times. Then, washes of these instruments were plated in culture medium and colony-forming units counted. This procedure was repeated six times per day over 24 non-consecutive days. The corrosion capacity was assessed with the mass loss test, and the concentration of peracetic acid and pH of the solutions were measured with indicator tapes. Both SA and PA significantly eliminated microorganisms; however, the SA solution was stable for only 4 days, whereas PA remained stable throughout the experiment. The concentration of peracetic acid in the SA solutions decreased over time until the chemical was undetectable, although the pH remained at 5. The PA solution had a concentration of 500-400 mg/L and a pH of 2-3. Neither formulation induced corrosion and both reduced the number of microorganisms (p = 0.0001). However, the differences observed in the performance of each product highlight the necessity of establishing a protocol for optimizing the use of each one.

IgA antibodies against Streptococcus mutans in breast milk and saliva: Passive Immunity against caries / Anticorpos IgA contra Streptococcus mutans no leite materno e na saliva: Imunidade passiva contra cáries

Objective: The present work aimed to correlate the levels of IgA antibodies reactive with Streptococcus mutans antigens in the saliva and/or in the breast milk and the oral health of lactating. Material and Methods: Breast milk and whole saliva samples were collected from 29 lactating. The oral health was verified using Decayed, Missing, Filled (DMF) scores and the volunteers were separated in three groups: 1) low DMF score; 2) high DMF score with active caries and 3) high DMF score without active caries. The IgA antibodies anti-Streptococcus mutans were analyzed in the samples using ELISA technique. Results: The results showed similar levels of IgA antibodies in all groups, both in milk and saliva. No correlation could be confirmed between the levels of IgA in the saliva and in the breast milk with the oral health of lactating studied. Conclusion: The results suggest that, independently of mother's oral health, the newborn receive the same amounts of anti-Streptococcus mutans IgA by breastfeeding. (AU)

Objetivo: O presente trabalho objetivou correlacionar os níveis de anticorpos IgA reativos com antígenos de Streptococcus mutans na saliva e / ou no leite materno com a saúde bucal de mulheres em lactação. Material e Métodos: Amostras de leite materno e saliva total foram coletadas de 29 lactantes. A saúde bucal foi analisada utilizando os índices de CPO e os voluntários foram separados em três grupos: 1) baixo escore de CPO; 2) alto escore de CPO com cárie ativa e 3) alto escore de CPO sem cárie ativa. Os anticorpos IgA anti-Streptococcus mutans foram analisados pela técnica de ELISA. Resultados: Os resultados mostraram níveis semelhantes de anticorpos IgA em todos os grupos, tanto no leite como na saliva. Nenhuma correlação pôde ser confirmada entre os níveis de IgA na saliva e no leite materno com a saúde bucal das mulheres estudadas. Conclusão: Os resultados sugerem que, independentemente da saúde bucal da mãe, o recém-nascido recebe as mesmas quantidades de IgA anti-Streptococcus mutans pela amamentação. (AU)

Candida spp. adherence to oral epithelial cells and levels of IgA in children with orthodontic appliances.

Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis. Orthodontic and other oral appliances seem to favor candidal presence. The aim of this work was to compare the presence of Candida species in saliva, their adherence to oral epithelial cells, and the levels of anti­C. albicans IgA in children with or without orthodontic appliances. This study included 30 children 5 to 12 years old (9.1 ± 1.7 years old) who were users of removable orthodontic devices for at least 6 months and 30 control children of similar ages (7.7 ± 1.5 years old). The presence of yeast species in the saliva was evaluated by microbiological methods. Candida species were identified using phenotypic methods. Anti­C. albicans IgA levels in saliva were analyzed by ELISA. The yeasts adhering to oral epithelial cells were assessed by exfoliative cytology. No statistically significant differences were observed for saliva yeast counts and anti­C. albicans IgA levels between the studied groups. Children with orthodontic devices exhibited more yeast cells adhering to oral epithelial cells and a higher percentage of non-albicans species relative to the control group. In conclusion, orthodontic appliances may favor the adherence of Candida to epithelial cells but do not influence the presence of these yeasts in saliva, and the levels of anti­C. albicans IgA do not correlate with yeast adherence or presence of Candida in the oral cavity

Effects of probiotic bacteria on Candida presence and IgA anti-Candida in the oral cavity of elderly.

Imbalance in the resident microbiota may promote the growth of opportunistic microorganisms, such as yeasts of Candida genus and the development of diseases, especially in aged people. This study evaluated whether the consumption of the probiotic Yakult LBz(®) (Lactobacillus casei and Bifidobacterium breve) was able to influence on the specific immunological response against Candida and on the presence of these yeasts in the oral cavity of 42 healthy aged individuals. Saliva samples were collected before and after the probiotic use for 30 days, 3 times a week. The samples were plated in Dextrose Saboraud Agar with chloramphenicol, the colony-forming units (CFU/mL) were counted and the Candida species were identified. Anti-Candida IgA analysis was conducted using the ELISA technique. ANOVA and Student's t-test were used for normally distributed data and the Wilcoxon test was used for data with non-normal distribution (α=0.05). The results showed a statistically significant reduction (p<0.05) in Candida prevalence (from 92.9% to 85.7%), in CFU/mL counts of Candida and in the number of non-albicans species after consumption of the probiotic. Immunological analysis demonstrated a significant increase (p<0.05) in anti-Candida IgA levels. In conclusion, probiotic bacteria reduced Candida numbers in the oral cavity of the elderly and increased specific secretory immune response against these yeasts, suggesting its possible use in controlling oral candidosis.

Influence of consumption of probiotics on presence of enterobacteria in the oral cavity.

Clinical benefits of probiotics have been clearly reported in different gastrointestinal disorders, many of them caused by enterobacteria. The oral cavity is a port of entry and can be an important reservoir of these microorganisms. This work evaluated whether consumption of probiotics was able to influence the presence of enterobacteria in the oral cavity and the specific secretory response against these microorganisms. Saliva samples of healthy individuals were collected and plated in MacConkey agar. Carriers of Gram-negative, rod-shaped microorganisms in the oral cavity were selected and instructed to use the probiotic Yakult LB for 20 days. Saliva was then collected and enterobacteria species were identified using the API 20 E system and by ELISA using anti-enterobacteria IgA. The results showed reduction in the prevalence of enterobacteria, but no significant changes in enterobacterial counts (log CFU/mL; p = 0.3457). The species most frequently isolated were Enterobacter cloacae and Klebsiella oxytoca, both before and after probiotic consumption. No significant changes were observed in anti-enterobacteria IgA levels. In conclusion, probiotic consumption had some influence on enterobacterial presence in the oral cavity, but did not affect enterobacterial counts or the specific immune secretory response against them.

Gingival crevicular fluid biochemical markers in periodontal disease: a cross-sectional study.

OBJECTIVE: To evaluate the levels of interleukin-1b (IL-1b) and alkaline phosphatase (ALP) in gingival crevicular fluid (GCF) and correlate these measurements with clinical characteristics of healthy patients and patients with gingivitis and periodontitis. METHOD AND MATERIALS: Thirty-six individuals were subdivided into three groups of 12: control, gingivitis, and periodontitis groups. GCF samples were obtained from 2 sites for each patient. GCF volume was measured with the Periotron 8000; IL-1b levels were evaluated using the ELISA technique; ALP was measured by the kinetic method. RESULTS: Mean levels of IL-1b and ALP in the 3 groups were, respectively, 22.34 ± 16.53 ΜL/site and 7.68 ± 2.46 U/L in the control group; 41.46 ± 27.98 ΜL/site and 9.80 ± 1.53 U/L in the gingivitis group; and 105.97 ± 89.26 ΜL/site and 11.56 ± 1.82 U/L in the periodontitis group. The amount of IL-1b in the periodontitis group was significantly higher than in the other groups, but no significant difference was found between the control group and the gingivitis group. The amount of ALP differed significantly among the 3 groups (P < .05). A positive correlation was observed among IL-1b levels, GCF volume, and probing depth. There was no evidence for a correlation between IL-1b and ALP levels. CONCLUSION: Monitoring immune markers may give additional information on healthy or diseased sites.

Stability of antimicrobial activity of peracetic acid solutions used in the final disinfection process

The instruments and materials used in health establishments are frequently exposed to microorganism contamination, and chemical products are used before sterilization to reduce occupational infection. We evaluated the antimicrobial effectiveness, physical stability, and corrosiveness of two commercial formulations of peracetic acid on experimentally contaminated specimens. Stainless steel specimens were contaminated with Staphylococcus aureus, Escherichia coli, Candida albicans, blood, and saliva and then immersed in a ready peracetic acid solution: 2% Sekusept Aktiv (SA) or 0.25% Proxitane Alpha (PA), for different times. Then, washes of these instruments were plated in culture medium and colony-forming units counted. This procedure was repeated six times per day over 24 non-consecutive days. The corrosion capacity was assessed with the mass loss test, and the concentration of peracetic acid and pH of the solutions were measured with indicator tapes. Both SA and PA significantly eliminated microorganisms; however, the SA solution was stable for only 4 days, whereas PA remained stable throughout the experiment. The concentration of peracetic acid in the SA solutions decreased over time until the chemical was undetectable, although the pH remained at 5. The PA solution had a concentration of 500-400 mg/L and a pH of 2-3. Neither formulation induced corrosion and both reduced the number of microorganisms (p = 0.0001). However, the differences observed in the performance of each product highlight the necessity of establishing a protocol for optimizing the use of each one.

Candida spp. adherence to oral epithelial cells and levels of IgA in children with orthodontic appliances

Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis. Orthodontic and other oral appliances seem to favor candidal presence. The aim of this work was to compare the presence of Candida species in saliva, their adherence to oral epithelial cells, and the levels of anti-C. albicans IgA in children with or without orthodontic appliances. This study included 30 children 5 to 12 years old (9.1 ± 1.7 years old) who were users of removable orthodontic devices for at least 6 months and 30 control children of similar ages (7.7 ± 1.5 years old). The presence of yeast species in the saliva was evaluated by microbiological methods. Candida species were identified using phenotypic methods. Anti-C. albicans IgA levels in saliva were analyzed by ELISA. The yeasts adhering to oral epithelial cells were assessed by exfoliative cytology. No statistically significant differences were observed for saliva yeast counts and anti-C. albicans IgA levels between the studied groups. Children with orthodontic devices exhibited more yeast cells adhering to oral epithelial cells and a higher percentage of non-albicans species relative to the control group. In conclusion, orthodontic appliances may favor the adherence of Candida to epithelial cells but do not influence the presence of these yeasts in saliva, and the levels of anti-C. albicans IgA do not correlate with yeast adherence or presence of Candida in the oral cavity.

Vinegar as an antimicrobial agent for control of Candida spp. in complete denture wearers.

The use of denture is known to increase the carriage of Candida in healthy patients, and the proliferation of Candida albicans strains can be associated with denture-induced stomatitis. The aim of this study was to evaluate the use of vinegar as an antimicrobial agent for control of Candida spp. in complete upper denture wearers. Fifty-five patients were submitted to a detailed clinical interview and oral clinical examination, and were instructed to keep their dentures immersed in a 10% vinegar solution (pH less than 3) overnight for 45 days. Before and after the experimental period, saliva samples were collected for detection of Candida, counting of cfu/mL and identification of species by phenotypical tests (germ tube formation, chlamidoconidia production, and carbohydrate fermentation and assimilation). The results were analyzed using Spearman's correlation and Student's t-test (p

Condutas de biossegurança relacionadas aos trabalhos protéticos utilizadas por cirurgiões-dentistas de Porto Velho (RO) / Conducts of biosafety related to prosthetic work used by dentists of Porto Velho (RO)

A veiculação de micro-organismos por moldes, modelos e próteses torna essencial adotar medidas de biossegurança. Avaliar as condutas de biossegurança, utilizadas por dentistas de Porto Velho (RO), no trabalho com moldes, modelos e próteses. Questionário relativo às condutas de biossegurança que envolvem trabalhos protéticos. Estavam corretamente vacinados 62,2% dos dentistas, todos utilizavam avental, luva e máscara, mas a adesão aos óculos e gorro foi menor. A desinfecção dos moldes, modelos e próteses era realizada, respectivamente, por 59, 43,66 e 66,38% dos participantes com glutaraldeído, hipoclorito ou álcool em imersão por 10 minutos. A aplicação das normas de biossegurança em Porto Velho está aquém do esperado para que haja redução no risco de infecção cruzada.

The carriage of microorganisms by molds, models and prosthesis makes it essential the adoption of biosecurity measures. To assess biosecurity actions conducted by dentists of Porto Velho (RO) at work with prosthetic devices. The voluntaries were requested to answer a questionnaire regarding their biosecurity actions. All dentists use apron, glove and mask, and with less frequency, glasses and hats; 62.2% were properly vaccinated. Disinfection of prosthetic devices was performed by 59, 43.7 and 66.4% of participants with immersion for ten minutes in glutaraldehyde, hypochlorite and alcohol, respectively. The implementation of biosecurity standards in the Porto Velho was minor than expected to reduce the risk of cross-infection.

[Relationship between Candida in vaginal and oral mucosae and salivary IgA]. / Presença de Candida nas mucosas vaginal e bucal e sua relação com IgA salivar.

PURPOSE: to correlate the presence of yeast from the Candida genus in the oral and vaginal cavity of women with and without vulvovaginal candidiasis (VVC), with secretor IgA levels (IgAs) present in the saliva. METHODS: among the 51 women included, 13 presented VVC and 38 were the Control Group. An amount of 2.0 mL of saliva without stimulation was collected from each patient, plus vaginal secretion using a swab, which was then immersed in 2.0 mL of physiological solution. Samples were inseminated in Sabouraud dextrose agar with chloramphenicol for isolation and counting of colonies, and the isolated ones, phenotypically identified. IgA has been quantified in the saliva of the women from both groups, by the ELISA technique. RESULTS: in the 13 patients with clinical and mycological diagnosis of VVC, the mean of Candida colony producing units by milliliter of vaginal secretion (cpu/mL) was 52,723, and 23.8% of the patients presented colonization in the oral mucosa with lower amount of cup/mL (6,030). The levels of IgAs in saliva were lower in the group with VVC (DO mean: 0.3), as compared to the IgA levels of the Control Group (DO mean: 0.6). Eleven patients (37%) from the Control Group presented Candida colonization in the oral cavity, with a lower cup/mL mean, when compared to the VVC Group. The Control Group also presented a lower amount of cpu/mL (1,973) in the vaginal cavity, when compared to the VVC Group (52,942). CONCLUSIONS: these results have demonstrated that patients with clinical diagnosis of vaginal candidiasis presented a higher amount of Candida both in the vaginal and in the oral cavity, and presented lower levels of anti-Candida IgA in the saliva.

Effects of probiotic bacteria on Candida presence and IgA anti-Candida in the oral cavity of elderly

Imbalance in the resident microbiota may promote the growth of opportunistic microorganisms, such as yeasts of Candida genus and the development of diseases, especially in aged people. This study evaluated whether the consumption of the probiotic Yakult LB® (Lactobacillus casei and Bifidobacterium breve) was able to influence on the specific immunological response against Candida and on the presence of these yeasts in the oral cavity of 42 healthy aged individuals. Saliva samples were collected before and after the probiotic use for 30 days, 3 times a week. The samples were plated in Dextrose Saboraud Agar with chloramphenicol, the colony-forming units (CFU/mL) were counted and the Candida species were identified. Anti-Candida IgA analysis was conducted using the ELISA technique. ANOVA and Student's t-test were used for normally distributed data and the Wilcoxon test was used for data with non-normal distribution (α=0.05). The results showed a statistically significant reduction (p<0.05) in Candida prevalence (from 92.9% to 85.7%), in CFU/mL counts of Candida and in the number of non-albicans species after consumption of the probiotic. Immunological analysis demonstrated a significant increase (p<0.05) in anti-Candida IgA levels. In conclusion, probiotic bacteria reduced Candida numbers in the oral cavity of the elderly and increased specific secretory immune response against these yeasts, suggesting its possible use in controlling oral candidosis.

Desequilíbrios na microbiota residente podem promover o crescimento de microrganismos oportunistas, como as leveduras do gênero Candida, e o desenvolvimento de doenças, especialmente na população idosa. Este estudo investigou se o consumo do probiótico Yakult LB® (Lactobacillus casei e Bifidobacterium breve) era capaz de influenciar na resposta imune secretória anti-Candida e na presença destes microrganismos na cavidade bucal de 42 idosas saudáveis. Amostras de saliva foram coletadas antes e depois do consumo do probiótico por 30 dias, 3 vezes por semana. As amostras foram semeadas em Agar Saboraud Dextrose com cloranfenicol, as unidades formadoras de colônias (UFC/mL) foram contadas e as espécies de Candida foram identificadas. A análise de IgA anti-Candida foi realizada pela técnica ELISA. Os resultados demonstraram redução na prevalência de Candida (de 92,9% para 85,7%), na contagem de UFC/mL (p≤0,05) e no número de espécies não-albicans, depois do consumo do probiótico. As análises imunológicas mostraram um aumento significativo dos níveis de IgA anti-Candida (p≤0,05). Concluindo, as bactérias probióticas reduziram significantemente a quantidade de Candida na cavidade bucal dos idosos e aumentaram a resposta imune secretória específica para esta levedura, sugerindo a possibilidade de sua utilização no controle da candidose bucal.

Hipersensibilidade ao hipoclorito de sódio em intervenções endodônticas / Hypersensitivity to sodium hypochlorite in endodontic interventions

A redução do número de microrganismos presentes na luz dos canais e túbulos dentinários é fundamental para o sucesso da terapia endodôntica. Entre as principais substâncias químicas utilizadas com esse objetivo, a de primeira escolha ainda é o Hipoclorito de Sódio (NaOCl), que possui ação antimicrobiana e grande poder de dissolução de matéria orgânica, além de baixo custo. Embora durante o tratamento endodôntico as soluções irrigantes devam se restringir ao canal radicular, casos de extrusão ocorrem, ainda que o dente seja completamente maduro e com ápice completamente fechado. Relatos de acidentes graves provocados pela injeção inadvertida de hipoclorito são encontrados na literatura, tendo como consequências alterações teciduais e reações de hipersensibilidades que podem culminar até mesmo em problemas respiratórios. As reações alérgicas ao hipoclorito de sódio geralmente são pouco reconhecidas, investigadas e, consequentemente, pouco diagnosticadas por clínicos gerais e endodontistas. Assim, este trabalho tem por finalidade elaborar uma revisão de literatura com o intuito de esclarecer o profissional da área sobre as reações de hipersensibilidade ao NaOCl. Foi discutido que os poucos relatos de casos da literatura eram compatíveis com hipersensibilidade tipo I e variavam desde uma sensação de ardência até uma dor severa com manifestações sistêmicas, sendo necessária a transferência para terapia intensiva. Os relatos reforçam a importância da anamnese para prevenção dessas ocorrências e, quando inevitáveis, o rápido diagnóstico e interferência podem ser fundamentais para a sobrevivência do paciente.

The reduction of the number of microorganisms in the lumen of root canal and dentin tubules is critical to the success of endodontic therapy. Among the chemicals substances used for this purpose, the first choice is still the sodium hypochlorite (NaOCl), which has antimicrobial action, great power of dissolution of organic matrix and low cost. Although the endodontic irrigating solutions should be restricted to the root canal, extrusion cases occur, even if the tooth is mature and with apex closed. Reports of serious accidents caused by inadvertent injection of sodium hypochlorite are found in the literature, with the consequence of tissue Changes and hypersensitivity reactions, with even respiratory problems. Allergic reactions to sodium hypochlorite are often under recognized, investigated and thus underdiagnosed by general practitioners and endodontists. This study aimed to develop a literature review in order to clarify the health professional about the occurrence of hypersensitivity reactions to NaOCl. It was discussed that the few case reports in the literature were consistent with type I hypersensitivity and ranged from a burning sensation to severe pain and with systemic manifestations, requiring the transfer to intensive care. The reports reinforce the importance of the amnanese in the prevention of such occurrences and, when unavoidable, early diagnosis and interference can be critical to the survival of the patient.

Influence of consumption of probiotics on presence of enterobacteria in the oral cavity

Clinical benefits of probiotics have been clearly reported in different gastrointestinal disorders, many of them caused by enterobacteria. The oral cavity is a port of entry and can be an important reservoir of these microorganisms. This work evaluated whether consumption of probiotics was able to influence the presence of enterobacteria in the oral cavity and the specific secretory response against these microorganisms. Saliva samples of healthy individuals were collected and plated in MacConkey agar. Carriers of Gram-negative, rod-shaped microorganisms in the oral cavity were selected and instructed to use the probiotic Yakult LB for 20 days. Saliva was then collected and enterobacteria species were identified using the API 20 E system and by ELISA using anti-enterobacteria IgA. The results showed reduction in the prevalence of enterobacteria, but no significant changes in enterobacterial counts (log CFU/mL; p = 0.3457). The species most frequently isolated were Enterobacter cloacae and Klebsiella oxytoca, both before and after probiotic consumption. No significant changes were observed in anti-enterobacteria IgA levels. In conclusion, probiotic consumption had some influence on enterobacterial presence in the oral cavity, but did not affect enterobacterial counts or the specific immune secretory response against them.

Influência da ciclosporina a nos tecidos periodontais e na osseointegração de implantes: revisão de literatura / Influence of cyclosporine a on periodontal tissue and osseointegration of implants: review of literature

A Ciclosporina A é um potente imunossupressor utilizado no tratamento de diversas patologias mediada imunologicamente. É indicado principalmente no tratamento preventivo da rejeição de órgãos em indivíduos transplantados. Efeitos adversos relacionados com o uso do fármaco como a indução de osteopenia, desequilíbrio no processo de remodelação óssea, desenvolvimento de osteoporose e o aumento gengival são descritos na literatura. O objetivo do presente estudo foi revisar através da literatura os efeitos da ciclosporina A no metabolismo do tecido gengival, ósseo e sua influência como possível fator de risco na osseointegração de implantes. Empregando-se os termos cyclosporine AND dental implants; cyclosporine AND osseointegration; e cyclosporine AND gingival overgrowth como palavras chave, foram levantados artigos na base de dados Pubmed, publicados entre os anos de 2000 a 2016, na língua inglesa e portuguesa. Conclui-se que os efeitos adversos causados pela ciclosporina A podem interferir na saúde bucal dos indivíduos e no sucesso do tratamento odontológico. É fundamental que o cirurgião dentista conheça os mecanismos de ação do medicamento, seus efeitos adversos e interações medicamentosas, a fim de desenvolver estratégias de prevenção e tratamento para usuários do medicamento (AU)

Cyclosporine A is a potent immunosuppressive drug used in the treatment of various immunologically mediated pathologies. It is mainly indicated in the preventive treatment of organ rejection in transplant recipients. Adverse effects associated with using the drug such as the induction of osteopenia, imbalance in bone remodeling, development of osteoporosis and gingival enlargement are described in literature. The aim of this study was to review, through literature, the effects of cyclosporine A in the metabolism of gingival tissue, bone and its influence as a possible risk factor in osseointegration of implants. Using the terms cyclosporine AND dental implants; cyclosporine AND osseointegration; and cyclosporine AND gingival overgrowth as keywords, a search was conducted for articles published in the Pubmed database between the years 2000-2016, in English and Portuguese. It was concluded that the adverse effects caused by cyclosporine A may interfere in the oral health of individuals and the success of the dental treatment. It is essential that the dentist is aware of the action mechanisms of the drug, its side effects and medicinal interactions in order to develop prevention and treatment strategies for users of the drug (AU)

Effects of immunization with Streptococcus mutans surface antigens in auto-reactivity of BALB/c mice/ Efeitos da imunização com antígenos de superfície de Streptococcus mutans naauto-reatividade de camundongos BALB/c mice

BALB c mice were hiperimmunized with surface antigens of Streptococcus mutans, GS5 strain. The immunization increased significantly anti-heart and anti-myosin IgG, free and present in immunecomplexes. In Western-blotting, the autoantibodies displayed a notable reactivity with cardiac myosin and cardiac tissue proteins, mainly with a 35 kDapeptide. The histological analysis of hearts demonstrated absence of significant damage in valves and myocardium, and immunohistochemistry showed absence of antibodies linked in cardiac tissue. The treatment with cyclophosphamide was able to reduce autoantibody levels but did not alter de histological aspect of heart. These findings demonstrated that surface antigens S. mutans, GS5 strain, were able to induce autoantibody synthesis without potential to initiate cardiac damage.

Camundongos BALB/c foram hiperimunizados com antígenos de superfície de Streptococcus mutans, cepa GS5. Observamos que a imunização elevou significativamente os níveis de IgGs anticoração e antimiosina livres e presentes em imunocomplexos. No Western-blotting, estes auto-anticorpos reagiam com miosina cardíaca e principamente umabanda de 35 kDa do extrato cardíaco. A análise histológica dos corações demonstrou ausência de alterações significativas nas válvulas ou miocárdio. Também não foram encontrados anticorpos ligados ao tecido cardíaco. O tratamento com ciclofosfamida foi capaz de reduzir os níveis de auto-anticorpos, não alterando porém o aspecto histológico do coração. Os resultados deste trabalho mostraram que os antígenos de superfície desta cepa de S. mutans não foram capazes deiniciar uma lesão cardíaca em camundongos BALB/c, embora elevassem consideravelmente o nível de anticorpos livres e ligados em imunocomplexos para coração e miosina.

Vinegar as an antimicrobialagent for control of Candida spp. in complete denture wearers

The use of denture is known to increase the carriage of Candida in healthy patients, and the proliferation of Candida albicans strains can be associated with denture-induced stomatitis. The aim of this study was to evaluate the use of vinegar as an antimicrobial agent for control of Candida spp. in complete upper denture wearers. Fifty-five patients were submitted to a detailed clinical interview and oral clinical examination, and were instructed to keep their dentures immersed in a 10%vinegar solution (pH less than 3) overnight for 45 days. Before and after the experimental period, saliva samples were collected for detection of Candida, counting of cfu/mL and identification of species by phenotypical tests (germ tube formation, chlamidoconidia production, and carbohydrate fermentation and assimilation). The results were analyzed using Spearman's correlation and Student's t-test (p£0.05). Candida yeasts were present in 87.3% of saliva samples before the treatment. A significant reduction was verified in CFU/mL counts of Candida after treatment. A positive correlation between Candida and denture stomatitis was verified, since the decrease of cfu/mL counts was correlated with a reduction in cases of denture stomatitis. Although it was not able to eliminate C. albicans, the immersion of the complete denture in 10% vinegar solution, during the night, reduced the amounts (cfu/mL) of Candida spp. in the saliva and the presence of denture stomatitis in the studied patients.

Presença de Candida nas mucosas vaginal e bucal e sua relação com IgA salivar / Relationship between Candida in vaginal and oral mucosae and salivary IgA

OBJETIVO: correlacionar a presença de leveduras do gênero Candida na cavidade bucal e vaginal de mulheres com e sem candidíase vulvovaginal (CVV) com os níveis de IgA secretora (IgAs) presentes na saliva. MÉTODOS: cinqüenta e uma mulheres foram incluídas; 13 apresentaram CVV e 38 formaram o Grupo Controle. De cada paciente, foram coletados 2,0 mL de saliva sem estimulação e secreção vaginal com o auxílio de swab, que foi imerso a seguir em 2,0 mL de solução fisiológica. As amostras foram semeadas em ágar Sabouraud dextrose com cloranfenicol para isolamento e contagem de colônias, e os isolados foram identificadas fenotipicamente. Na saliva de ambos os grupos foi quantificada IgA pela técnica ELISA. RESULTADOS: nas 13 pacientes com diagnóstico clínico e micológico de CVV, a média de unidades formadoras de colônias de Candida por mililitro de secreção vaginal (ufc/mL) foi de 52.723 e 23,8 por cento dos pacientes apresentaram colonização na mucosa bucal com menor quantidade de ufc/mL (6.030). Os níveis de IgAs na saliva foram mais baixos no grupo com CVV (média de densidade: 0,3) quando comparados aos níveis de IgA do Grupo Controle (média de DO: 0,6). Onze pacientes (37 por cento) do Grupo Controle apresentaram colonização por Candida na cavidade bucal, com média de ufc/mL mais baixa quando comparada ao grupo com CVV. O Grupo Controle também apresentou menor quantidade de ufc/mL (1.973) na cavidade vaginal quando comparado com o Grupo CVV (52.942). CONCLUSÕES: os resultados demonstraram que os pacientes com diagnóstico clínico de candidíase vulvovaginal apresentaram maior quantidade de Candida, tanto na cavidade vaginal quanto na bucal, e apresentaram menores níveis de IgA anti-Candida na saliva.

PURPOSE: to correlate the presence of yeast from the Candida genus in the oral and vaginal cavity of women with and without vulvovaginal candidiasis (VVC), with secretor IgA levels (IgAs) present in the saliva. METHODS: among the 51 women included, 13 presented VVC and 38 were the Control Group. An amount of 2.0 mL of saliva without stimulation was collected from each patient, plus vaginal secretion using a swab, which was then immersed in 2.0 mL of physiological solution. Samples were inseminated in Sabouraud dextrose agar with chloramphenicol for isolation and counting of colonies, and the isolated ones, phenotypically identified. IgA has been quantified in the saliva of the women from both groups, by the ELISA technique. RESULTS: in the 13 patients with clinical and mycological diagnosis of VVC, the mean of Candida colony producing unities by milliliter of vaginal secretion (cpu/mL) was 52,723, and 23.8 percent of the patients presented colonization in the oral mucosa with lower amount of cup/mL (6,030). The levels of IgAs in saliva were lower in the group with VVC (DO mean: 0.3), as compared to the IgA levels of the Control Group (DO mean: 0.6). Eleven patients (37 percent) from the Control Group presented Candida colonization in the oral cavity, with a lower cup/mL mean, when compared to the VVC Group. The Control Group also presented a lower amount of cpu/mL (1,973) in the vaginal cavity, when compared to the VVC Group (52,942). CONCLUSIONS: these results have demonstrated that patients with clinical diagnosis of vaginal candidiasis presented a higher amount of Candida both in the vaginal and in the oral cavity, and presented lower levels of anti-Candida IgA in the saliva.