Effect of occlusal equilibration on masticatory muscle activity in females with sleep bruxism: a double-blind randomised controlled trial.

Masticatory muscle activity during sleep has been considered independent of variations in the structural characteristics of the dental occlusion. However, scientific evidence contradicting an occlusal causal role is missing. The purpose of this study was to test the null hypothesis that sleep bruxism (SB) is independent of the presence of occlusal interferences. A total of 17 healthy female subjects (mean [SD] age 24.9 [4.1] years) presenting with SB, and randomly divided into two groups, were evaluated after receiving either elimination of occlusal interferences (Test group) or elimination of sharp margins without change in occlusal contacts (Control group). Audio-video polysomnography (PSG) recordings were undertaken before and after treatment (mean [SD] duration 14.4 [3.8] months). Two subjects in each group (< 2 rhythmic masticatory muscle activity [RMMA]/h) were excluded for statistical analysis. During the total sleep time (TST), the Test group exhibited a higher reduction in frequency of episodes per hour than the Control group (p < 0.05). The reduction in duration of episodes was also higher in the Test group during the TST. The Test group presented an increase in sleep stage N3 (p < 0.05) at the final PSG when compared with the initial PSG, and a higher percentage of N3 (p < 0.05) at the final PSG when compared to the Control group. Elimination of occlusal interferences resulted in a significant reduction of masseter and temporal muscle activity during sleep in females presenting with SB. Based on these results, the null hypothesis is rejected. The hypothesis of occlusal interferences as a risk factor for SB is still patent.

Morphological alterations in tongue epithelial cells infected by SARS-CoV-2: A case-control study.

OBJECTIVE: The aim of the present case-control study was to evaluate the morphological aspects of the epithelial cells from the dorsum of the tongue and the expression of the SARS-CoV-2 Spike protein in these cells, in patients with and without COVID-19 infection. METHODS: 24 individuals with at least one symptom of COVID-19 were recruited among inpatients from Hospital Universitário Pedro Ernesto (Rio de Janeiro, Brazil). 14 patients who tested positive for COVID-19 by RT-PCR were included in the case group, and 10 patients who tested negative were included in the control group. Cytological smears from the dorsum of the tongue were obtained from all patients and analyzed using immunohistochemistry directed against SARS-CoV-2-Spike protein. Morphological changes in epithelial cells were analyzed using light microscopy. RESULTS: Immunohistochemistry showed that 71% of the COVID-19 patients presented epithelial cells positive for the presence of the SARS-CoV-2 Spike protein, and all cells coming from patients in the control group were negative. Cytological analysis showed significant differences when comparing epithelial cells from COVID-19-positive and COVID-19-negative patients. CONCLUSION: COVID-19 may generate dimensional changes in tongue epithelial cells; however, further studies are necessary to understand how this happens.

Reducing the viral load of SARS-CoV-2 in the saliva of patients with COVID-19.

OBJECTIVE: To evaluate the reduction in the salivary viral load using oral antiseptic mouthwashes in patients testing positive for COVID-19. METHODS: Sixty-three individuals were recruited after testing positive for COVID-19 by real-time RT-PCR assay and divided into 5 groups. Group 1 received sterile water, group 2 received 1.5% hydrogen peroxide solution (HP), group 3 received 0.12% chlorhexidine (CHX), group 4 received 0.1% sodium hypochlorite solution (NaClO), and group 5 received sequential rinses using CHX and HP. After collecting the initial saliva sample, individuals were asked to use the designated mouthwash for 1 min. Additional saliva samples were collected immediately after rinsing, 15, and 30 min after rinsing. Real-time RT-PCR assays for RNA detection of SARS-CoV-2 were performed on the saliva samples. RESULTS: There were no significant differences among the experimental groups and the control group in any period. Compared to the baseline values, there was a significant reduction in the number of copies of SARS-CoV-2 after 30 min in group 2 and immediately after the initial mouthwash in group 4. CONCLUSIONS: No experimental group demonstrated a significant reduction in the viral load compared to the control group.

Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation.

OBJECTIVES: The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS: Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1ß, IL-6, IL-8, FGF, MIP-1α and ß, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS: The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION: The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE: EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

The effect of periodontal therapy on cardiovascular risk markers: a 6-month randomized clinical trial.

AIM: To determine the influence of non-surgical mechanical periodontal treatment on inflammatory markers related to risk for cardiovascular disease. MATERIAL AND METHODS: A total of 64 patients with severe chronic periodontitis was randomly subjected to immediately periodontal treatment (test group, n = 32) or delayed periodontal treatment, without treatment during the study period (control group, n = 32). Clinical periodontal and laboratory examinations were performed at baseline (T0), 2 months (T2), and 6 months (T6) after the initial examinations (Control group) or completion of periodontal treatment (Test group). RESULTS: After 2 months of periodontal treatment there was a significant reduction of erythrocyte sedimentation rate (ESR) and triglycerides (p = 0.002, p = 0.004, respectively) in the test group. Median values of C-reactive protein, ESR, total cholesterol, and triglycerides were reduced after 6 month of periodontal treatment in the test group (p < 0.001, p < 0.001, p < 0.001, and p = 0.015, respectively). CONCLUSIONS: The non-surgical periodontal treatment was effective in reducing the levels of systemic inflammation markers and improved the lipid profile in subjects with severe chronic periodontitis.

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial.

OBJECTIVE: To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window. MATERIALS AND METHODS: Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis. RESULTS: In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography. CONCLUSION: The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study.

AIM: To evaluate the effects of non-surgical periodontal treatment on left ventricular mass (LVM), arterial stiffness, systolic and diastolic blood pressure and plasma levels of inflammatory markers (C-reactive protein (CRP), fibrinogen and interleukin-6) in refractory hypertension patients. MATERIAL AND METHODS: This interventional prospective cohort pilot study included 26 patients (53.6 ± 8.0 years old) diagnosed with refractory hypertension and generalized chronic periodontitis. Subjects received non-surgical periodontal treatment according to their needs. Plasma levels of systemic inflammation (CRP; fibrinogen and interleukin-6) and established cardiovascular risk factors [systolic and diastolic blood pressure (SBP and DBP), left ventricular mass (LVM) and arterial stiffness] were assessed at three time points (baseline, 3 months after baseline and 6 months after periodontal therapy). RESULTS: Periodontal therapy significantly reduced all cardiovascular risk markers evaluated. Median values of SBP and DBP were reduced by 12.5 mmHg and 10.0 mmHg, respectively, whereas left ventricular mass (LVM) reduced by 12.9 g and pulse wave velocity reduced by 0.9 m/s (p < 0.01). Levels of CRP, IL-6 and fibrinogen lowered by 0.5 mg/dl, 1.4 pg/dl and 37.5 mg/dl (p < 0.01), respectively, 6 months after periodontal therapy. CONCLUSIONS: Periodontal therapy significantly reduced levels of CRP, IL-6, fibrinogen, blood pressure, LVM and arterial stiffness, lowering cardiovascular risk in refractory hypertensive patients.

Social and functional inclusion of an undergraduate student with unilateral upper limb agenesis: a case study.

INTRODUCTION: The inclusion of health professionals who have some type of disability brings benefits, such as the increase in empathy that facilitates the relationship with patients. In this work, we present a case study on the inclusion of an undergraduate Dentistry student with upper limb agenesis. PURPOSE: In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field. This process included the use of assistive technologies to allow the manipulation of instruments used in the practice of dental clinical activities, enabling future Dentists with upper limb agenesis to have an equal education in relation to their academic peers. CASE SELECTION: The case study presented in this work consists of the follow-up of G., a 23-year-old female Dentistry student. The developed adaptations were made using a low-temperature thermoplastic. The expert team that participated in this process was formed by three occupational therapists and three Dentistry professors. The process included several stages, being the last one the integration, in which training sessions were performed. OUTCOMES: The process was accessed using two main tools: quantitative questionnaires and qualitative interviews. After the proposed intervention, the volunteer presented a gradual evolution in her occupational performance with the use of most adaptations, promoting her functional training. DISCUSSIONS: Most adaptations allowed G. to perform the activities satisfactorily, with the precision inherent to these tasks, even with little training time. CONCLUSIONS: This case study demonstrates the high applicability of the proposed technologies.

In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field, as assessed in this study caseThe inclusion process of Dentistry students can include the use of assistive technology to allow the manipulation of instruments for the practice of clinical activitiesOur study suggests that the assistive adpatations promote a gradual evolution in the students' occupational performance, functional training and motor qualification.

Salivary Metabolomic Analysis Reveals Amino Acid Metabolism Shift in SARS-CoV-2 Virus Activity and Post-Infection Condition.

The SARS-CoV-2 virus primarily infects salivary glands suggesting a change in the saliva metabolite profile; this shift may be used as a monitoring instrument during SARS-CoV-2 infection. The present study aims to determine the salivary metabolomic profile of patients with and post-SARS-CoV-19 infection. Patients were without (PCR-), with SARS-CoV-2 (PCR+), or post-SARS-CoV-2 infection. Unstimulated whole saliva was collected, and the 1H spectra were acquired in a 500 MHz Bruker nuclear magnetic resonance spectrometer at 25 °C. They were subjected to multivariate analysis using principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA), as well as univariate analysis through t-tests (SPSS 20.0, IL, USA), with a significance level of p < 0.05. A distinction was found when comparing PCR- subjects to those with SARS-CoV-2 infection. When comparing the three groups, the PLS-DA cross-validation presented satisfactory accuracy (ACC = 0.69, R2 = 0.39, Q2 = 0.08). Seventeen metabolites were found in different proportions among the groups. The results suggested the downregulation of major amino acid levels, such as alanine, glutamine, histidine, leucine, lysine, phenylalanine, and proline in the PCR+ group compared to the PCR- ones. In addition, acetate, valerate, and capronic acid were higher in PCR- patients than in PCR+. Sucrose and butyrate were higher in post-SARS-CoV-2 infection compared to PCR-. In general, a reduction in amino acids was observed in subjects with and post-SARS-CoV-2 disease. The salivary metabolomic strategy NMR-based was able to differentiate between non-infected individuals and those with acute and post-SARS-CoV-19 infection.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective.

The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

SARS-COV-2 detection in saliva and nasopharyngeal swabs using RT-PCR was similar.

The World Health Organization has declared the widespread spread of SARS-CoV-2 and its associated disease (COVID-19) a public health emergency. The standard gold test for detecting the virus is the RT-PCR, performed from nasopharyngeal swab (NPS) samples. However, this test may be uncomfortable for the patient and requires specific training and attire from the health professional responsible for collecting the sample. Therefore, the search for alternative ways to collect samples that may be used in the diagnosis of COVID-19 is relevant. This study aimed to compare the results obtained from NPS and saliva samples. NPS and saliva samples were collected from 189 symptomatic outpatients suspected of COVID-19, who came to Piquet Carneiro Polyclinic. RNA extraction was performed using the Bio-Gene DNA/RNA Viral Extraction kit (Bioclin®). Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) reactions used the Molecular SARS-CoV-2 (E / RP) kit (Bio-Manguinhos). The results indicated that 142 showed a non-detectable result (ND), while 47 showed a detectable result (D). Among the 142 "ND", 137 (94.4%) saliva samples obtained the same result, while 5 samples (3.4%) were "D". Among the 47 "D" swab samples, 35 (74.4%) showed the same result in the saliva samples. The sensitivity of the saliva test was 0.74 and the specificity was 0.97. The positive predictive value was 0.88 while the negative predictive value was 0.92. The results showed that detection of Sars-CoV-2 using saliva samples showed high sensitivity and specificity compared to nasopharyngeal swabs.

[Humoral immunity against SARS-CoV-2 in workers of social health care centers of Castilla y León after vaccination with the BNT162b2 mRNA vaccine from Pfizer/Biontech.] / Inmunidad humoral frente a SARS-CoV-2 en trabajadores de centros sociosanitarios de Castilla y León después de la vacunación con la vacuna de ARNm BNT162b2 de Pfizer/Biontech.

OBJECTIVE: Workers and residents of care facilities for elder people/people with disabilities were particularly hit by the COVID-19 pandemic. Workers from these centres were included as a priority group for vaccination against SARS-CoV-2. The Family Ministry of Castilla y León realized a seroprevalence survey measuring the humoral immunity of its workers after the vaccination against SARS-CoV-2. METHODS: In February and March 2021, IgM/IgG antibodies were measured in 7 social health care centers in a total of 1,085 workers at least 15 days after completing the vaccination with the BNT162b2 vaccine from Pfizer/BioNtech. Using the ELISA technique for anti-nucleocapsid (N) IgM and CLIA S-RBD SARS-CoV-2 for anti-spicule (S) IgG, titers were compared between vaccinated with cero, one or two doses, and differentiating in these subgroups between having passed or not COVID-19. Means and percentages were compared using Student's t and Chi2 (EPIDAT 3.1). RESULTS: Among the 1,085 workers studied, there were 54 workers with a single dose of vaccine, of which 51 (94%) had a positive IgG (average titers of 459 AU/mL), 951 workers with 2 doses, of which 949 (99.8%) showed positive IgG (mean titers of 677 AU/mL), and 80 unvaccinated workers, of which 51 (64%) had positve IgG (mean titers of 49 AU/mL). 7 cases of COVID-19 were notified at least 15 days after full vaccination. The titers were significantly higher if COVID-19 had been passed in the group vaccinated with 1 and 2 doses (259 vs 894 and 601 vs 1,085 AU/mL respectively, p<0.05), but not in the unvaccinated group (53 vs 34 AU/mL, p<0.05). CONCLUSIONS: 99.8% of social health workers who received 2 doses of the BNT162b2 vaccine from Pfizer/BioNtech, and 94% of those who received 1 single dose, presented humoral immunity with high IgG titers, with high clinical effectiveness expressed in the absence of cases. 64% of unvaccinated workers presented humoral immunity. The history of having passed COVID-19 produces an important booster effect both after one and after two doses of vaccine. Measurement of humoral immunity against SARS-CoV-2 could be considered as a parameter for sufficient immunity.

OBJETIVO: La pandemia de COVID-19 ha golpeado especialmente a trabajadores y residentes de centros sociosanitarios. Los trabajadores de estos centros fueron considerados como grupo prioritario para la vacunación frente al SARS-CoV-2. La Consejería de Familia de Castilla y León realizó un estudio de seroprevalencia en trabajadores de centros sociosanitarios tras la vacunación anti-COVID-19, midiendo la inmunidad humoral frente a SARS-CoV-2. METODOS: En febrero y marzo de 2021 se midieron en 7 centros sociosanitarios anticuerpos IgM/IgG a un total de 1.085 trabajadores al menos 15 días tras completar la vacunación con vacuna BNT162b2 de Pfizer/BioNtech. Mediante técnica ELISA para IgM anti-nucleocápside(N) y CLIA S-RBD SARS-CoV-2 para IgG anti-espícula(S) se compararon los títulos entre vacunados con cero, una o dos dosis, y diferenciando en estos subgrupos entre el haber pasado o no la COVID-19. Se compararon medias y porcentajes mediante t de Student y Chi2, respectivamente (EPIDAT 3.1). RESULTADOS: Entre los 1.085 trabajadores estudiados hubo 54 trabajadores con 1 sola dosis de vacuna, de los que 51 (94%) presentaron una IgG positiva (títulos promedios de 459 UA/mL), 951 trabajadores con dos dosis, de los que 949 (99,8%) mostraron una IgG positiva (títulos promedios de 677 UA/mL), y 80 trabajadores no vacunados, de los que 51 (64%) presentaron IgG positiva (títulos promedio de 49 UA/mL). Se notificaron 7 casos de COVID-19 una vez pasados al menos 15 días tras completar la vacunación. Los títulos de IgG fueron significativamente más elevados si se ha pasado la COVID-19 en el grupo de vacunados con una y dos dosis (259 vs 894 y 601 vs 1.085 UA/mL respectivamente, p<0,05), pero no en el grupo de no vacunados (53 vs 34 UA/mL, p<0,05). CONCLUSIONES: El 99,8% de trabajadores sociosanitarios que recibieron dos dosis de la vacuna BNT162b2 de Pfizer/BioNtech, y el 94% de los que recibieron una sola dosis, presentó inmunidad humoral con títulos elevados de IgG, con una alta efectividad clínica expresada en ausencia de casos. Un 64% de trabajadores no vacunados presentó inmunidad humoral. El antecedente de haber pasado COVID-19 produce un importante efecto booster tanto tras una como tras dos dosis de vacuna. La medición de la inmunidad humoral frente a SARS-CoV-2 podría contemplarse como parámetro de inmunidad suficiente.

What grafting materials produce greater alveolar ridge preservation after tooth extraction? A systematic review and network meta-analysis.

A systematic review and network meta-analysis was conducted to compare different bone-substitute materials used for alveolar ridge preservation after tooth extraction. The electronic search was carried out on Embase, PubMed, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature up to March 22, 2020 (registration number INPLASY202030005). Only randomized controlled trials were included to answer the following PICOS question: 'What grafting materials produce greater alveolar ridge preservation after tooth extraction?' The primary outcomes were the alveolar width resorption 1 mm below the alveolar crest and buccal height resorption in millimeters. Of the 4379 studies initially identified, 31 studies involving 1088 patients were included in the quantitative analyses. Out of 25 revised biomaterials, eight showed a statistically significant difference compared with unassisted healing in both alveolar width and height measurements (mean width differences: ApatosⓇ, 2.27 [1.266-3.28]; Bio-OssⓇ, 0.88 [0.33-1.42]; Bio-Oss CollⓇ, 0.53 [0.04-1.01]; Bond-apatiteⓇ, 2.20 [1.30-3.11]; freeze-dried bone allograft, 1.35 [0.44-2.26]; Gen-OsⓇ, 1.90 [0.60-3.20]; platelet-rich fibrin, 1.66 [0.66-2.67]; and MP3Ⓡ, 2.67 [1.59-3.75]). Overall, xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction.

Repair of Critical Size Bone Defects Using Synthetic Hydroxyapatite or Xenograft with or without the Bone Marrow Mononuclear Fraction: A Histomorphometric and Immunohistochemical Study in Rat Calvaria.

Bone defects are a challenging clinical situation, and the development of hydroxyapatite-based biomaterials is a prolific research field that, in addition, can be joined by stem cells and growth factors in order to deal with the problem. This study compares the use of synthetic hydroxyapatite and xenograft, used pure or enriched with bone marrow mononuclear fraction for the regeneration of critical size bone defects in rat calvaria through histomorphometric (Masson's staining) and immunohistochemical (anti-VEGF, anti-osteopontin) analysis. Forty young adult male rats were divided into five groups (n = 8). Animals were submitted to critical size bone defects (Ø = 8 mm) in the temporoparietal region. In the control group, there was no biomaterial placement in the critical bone defects; in group 1, it was filled with synthetic hydroxyapatite; in group 2, it was filled with xenograft; in group 3, it was filled with synthetic hydroxyapatite, enriched with bone marrow mononuclear fraction (BMMF), and in group 4 it was filled with xenograft, enriched with BMMF. After eight weeks, all groups were euthanized, and histological section images were captured and analyzed. Data analysis showed that in groups 1, 2, 3 and 4 (received biomaterials and biomaterials plus BMMF), a significant enhancement in new bone matrix formation was observed in relation to the control group. However, BMMF-enriched groups did not differ from hydroxyapatite-based biomaterials-only groups. Therefore, in this experimental model, BMMF did not enhance hydroxyapatite-based biomaterials' potential to induce bone matrix and related mediators.

What is the future of Periodontal Medicine?

In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.

Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol ratio.

BACKGROUND: Periodontitis and the Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio have both been associated with cardiovascular disease, metabolic syndrome, and obesity. Additionally, the ratio is a possible substitute for predicting insulin resistance. This study investigated the association between periodontitis, its severity levels (exposures), and the TG/HDL-C ratio (outcome). METHODS: A cross-sectional study of public health service users in Brazil considered socioeconomic-demographic characteristics, lifestyle behavior, and general and oral health conditions. Anthropometric measurements and blood pressure were also measured. Systemic biomarker data were obtained, as well as assessment of periodontal diagnosis and its severity. The TG/HDL-C ratio was calculated using the serum triglyceride level over HDL cholesterol and the cut-off point, TG/HDL-C ≥2.3 serving as the cutoff indicting dyslipidemia. Logistic and linear regressions were used to statistically analyze the data. RESULTS: A total of 1011 participants were included, with 84.17% having periodontitis and 49.85% having a TG/HDL-C ratio ≥2.3. For individuals with periodontitis, the odds of TG/HDL-C ratio ≥2.3 were 1.47 times greater than in those without periodontitis (ORAdjusted  = 1.47, 95% CI: 1.02-2.14). Similar results were found for those with moderate and severe periodontitis, with a slight increase in the measurement magnitude with disease severity. CONCLUSION: A positive relationship between periodontitis and the TG/HDL-C ratio ≥2.3 was found, suggesting a possible association with periodontal disease severity.

Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis.

Gingivitis and periodontitis are associated with a negative impact on Oral Health Related Quality of Life (OHRQoL), exerting a significant influence on aspects related to the patients' function and esthetics. Periodontitis has been associated with several systemic conditions, including adverse pregnancy outcomes, cardiovascular diseases, type 2 diabetes mellitus (DM), respiratory disorders, fatal pneumonia in hemodialysis patients, chronic renal disease and metabolic syndrome. The aim of this paper was to review the results of different periodontal treatments and their impacts on patients' OHRQoL and systemic health. Non-surgical and surgical periodontal treatments are predictable procedures in terms of controlling infection, reducing probing pocket depth and gaining clinical attachment. In addition, the treatment of periodontitis may significantly improve OHRQoL and promote a reduction in the levels of systemic markers of inflammation, including some cytokines associated with cardiovascular diseases. Studies have also suggested that periodontal treatment may improve glycemic control in patients with DM. Strategies and actions for preventing the onset and recurrence of periodontitis, and the challenges facing the field of periodontology in the XXI century are presented in this review.

Higher Prevalence of Periodontitis and Decayed, Missing and Filled Teeth in Patients with Psoriasis.

OBJECTIVE: The aim of this study is to describe the prevalence and severity of periodontitis and decayed, missing and filled teeth (DMFT) index in patients with psoriasis. As a secondary aim, verify if periodontitis was a risk indicator for psoriasis. MATERIALS AND METHODS: A total of 69 patients diagnosed with psoriasis (48.7 ± 14.6 years) and 74 healthy controls (40.3 ± 12.9 years) participated in the study. Probing pocket depth, clinical attachment loss (CAL), bleeding on probing, plaque index, and DMFT index were measured in all subjects. Periodontitis was defined as the presence of at least three interproximal sites with CAL ≥3 mm in different teeth and severe periodontitis should involve at least two interproximal sites in different teeth with CAL ≥5 mm. STATISTICAL ANALYSIS: The Mann-Whitney test was used to analyze the demographics and the clinical data. The significance level was 5%. A multivariate logistic regression was conducted, and the odds ratio were calculated to express the risk to develop psoriasis. RESULTS: Patients with psoriasis had significantly more sites with CAL ≥3 mm (p < 0.03) and CAL ≥5 mm (p < 0.0001), less sites with plaque (p < 0.0001), fewer teeth (p < 0.0001), and a high DMFT index (p < 0.02) as compared with controls. Severe periodontitis was significantly more frequent (87.1% × 58.1%) and was a risk indicator for psoriasis after adjusting for sex, age, race, and smoking habits (odds ratio: 3.7, 95% confidence interval: 1.5-9.0, p < 0.003). CONCLUSION: Patients with psoriasis have higher prevalence of severe periodontitis and higher DMFT than control patients. Severe periodontitis may be a risk indicator for psoriasis.

Prosthetically Driven Alveolar Reconstructions: A Retrospective Study.

This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.