[Odontogenic foci and systemic diseases. A review]. / Az odontogén góc és a szisztémás betegségek. Irodalmi áttekintés.

The aim of the present review is to provide an up-to-date picture of what we know about the connection between odontogenic foci and non-oral diseases. After a brief historical summary, we give an overview on how the odontogenic focus causes disease in distant areas of the body in general, and then we start the discussion of the particular conditions, such as cardiovascular diseases, pneumonia, diabetes mellitus, metabolic syndrome, rheumatoid arthritis and adverse pregnancy outcomes. The review is centered around the two main odontogenic foci: periodontitis and periapical periodontitis, the latter being a widely recognized but rarely discussed oral focus. Finally, we offer a few considerations that the practicing dentist may find useful when dealing with odontogenic foci. Orv Hetil. 2018; 159(11): 415-422.

[Prevalence and severity of chronic parodontitis and oral mucosal lesions in chronic obstructive lung disease]. / A krónikus parodontitis, illetve szájnyálkahártya-laesiók elofordulása és súlyossága krónikus obstruktív tüdobetegségben.

INTRODUCTION: Chronic parodontitis is a prevalent oral disease that may lead to the loss of teeth independently of caries. Some systemic diseases (e.g., diabetes mellitus, chronic renal failure) may aggravate chronic parodontitis. On the other hand, this oral disease may aggravate other systemic diseases. Earlier studies suggested a correlation between chronic parodontitis and very severe chronic obstructive pulmonary disease (COPD). AIM: The aim of our study was the investigation of the correlation between chronic parodontitis and chronic obstructive pulmonary disease. METHOD: We have recruited patients of the Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, in the study. Volunteers were assigned into a COPD (n = 29) and control group (n = 45). Airflow limitation of the COPD group (FEV1/FVC: 61.52 ± 3.2%) corresponded to GOLD 2 (global initiative for chronic obstructive lung disease; FEV1: 52.66 ± 3.57%). Oral health assessment included mean and maximal clinical attachment loss, mobility of teeth, decayed/filled and missing teeth, Löe-Silness, oral hygiene and bleeding on probing indexes. One-way ANOVA and non-parametric Mann-Whitney tests were used for statistical analysis. RESULTS: Oral health of the COPD group was worse than that of the controls. In this group the mean and maximal clinical attachment loss, mobility of teeth, the Löe-Silness, the oral hygiene and bleeding on probing indexes were higher. CONCLUSIONS: Our results confirm the positive correlation between chronic parodontitis and a moderate level of chronic obstructive pulmonary disease. However, it is not clear whether the COPD-associated systemic inflammation aggravated the oral status or the chronic parodontitis influenced negatively chronic obstructive pulmonary disease. Orv Hetil. 2018; 159(21): 831-836.

The special features of comprehensive treatment of patients with generalized parodontitis in the background of coronary heart disease.

OBJECTIVE: Introduction: According to official statistics, the incidence of coronary artery disease in the working-age population in 2015 is registered in 9.7 per 100 thousand of the population; a significant number of the patients with IHD are the elderly, although there is also a "rejuvenation" of this pathology. Ischemic heart disease tends to occupy a top position amongst the causes of temporary and permanent disability, leading to the complete disability of the population. Numerous clinical and laboratory studies revealed a direct interconnection between the severity of the course of generalized periodontitis and the functional class of stable angina pectoris. The aim of my study was to determine effective comprehensive treatment for the patient with chronical generalized paradontitis, associated with ischemic heart disease. PATIENTS AND METHODS: Materials and methods: The examination and treatment of 42 subjects with chronic generalized periodontitis I-II grade at the age from 45 to 60 years, who suffered from coronary heart disease, with a mean duration of 1.5 to 5 years, was performed.Clinical studies have revealed that in the patients, suffering from coronary artery disease, during the period of in-patient treatment, predominantly generalized periodontitis takes place at the stage of exacerbation (89.5%). RESULTS: Results and conclusions: Exacerbation of HGP I and II in the patients, suffering from stable angina pectoris, is accompanied by significant disorders of metabolic processes; changes of the condition of regional hemodynamics and microcirculation in periodontal tissues, which is proven by alteration in reopardotography rates. It is confirmed that while the administration of antihypoxic therapy in the comprehensive treatment of patients with CGP, suffering from coronary heart disease, it is advisable to take into account the sequence of violations of bioenergetic processes that begin on the substrate region of the respiratory chain with a violation of the ICFA I and extend with the increase of oxygen insufficiency to the terminal cytochrome oxidase site. On the basis of this, the protection of the body from oxygen deficiency with the help of antihypoxic drugs provides, as a mandatory condition, the restoration of the energy-absorbing function. The administration, as part of integrated therapy, of local antihypoxic and coenzyme Q10 in patients with coronary heart disease is accompanied by a significant improvement in the clinical manifestation of subjective and objective characteristics; positive dynamics of periodontal indicators; correction of antioxidant and nitroxydergic systems, which manifested in increasing of the antioxidant potential in the oral liquid as well as optimization of processes of regional hemodynamics and microcirculation.

Gingival epitheses: forgotten craft or technology with a future? - Case report of a epithesis fabricated with CAD/CAM.

The case in this report presents an alternative, partially CAD/CAM-based fabrication of a gingival epithesis in a 48-years-old female patient. The patient suffered from a periodontits stage III, grade C. After a non-surgical periodontal treatment with adjunctive systemic antibiotics, the patient developed severe circumferential gingival recessions on the upper frontal teeth. Due to social discomfort and esthetic concerns, the indication for a gingival epithesis was made. After taking a conventional impression from the upper jaw, the cast model was scanned and the gingival epithesis was designed virtually at the laboratory. The epithesis was then milled from a block of high performance polymer. Minor adjustments of surface details were added manually. The result was a esthetically sufficient and by the patient well-accepted treatment modality. Further research is necessary to prove the feasibility of a full digital workflow and the long-term stability of CAD/CAMbased gingival epitheses.

The use of hormones indicators in human saliva in diagnosing parodontitis in pregnant women.

AIMS: The purpose of this work- was to study the dynamics of biochemical parameters of human saliva and analyze the features of the chemical composition of the saliva of women with abnormal pregnancy and in periodontitis against pregnancy. MATERIALS AND METHODS: THE STUDY INCLUDED FOUR GROUPS OF WOMEN: a control group of nonpregnant women of childbearing age (10), pregnant women with physiological pregnancy (24-28 weeks) without any signs of periodontal disease (10), pregnant with a generalized periodontitis I--II degrees in remission (10), women with pathological pregnancy with no signs of periodontal inflammation (10). In each of the groups over two samples of saliva were collected, the first collection of saliva in the morning on an empty stomach. Then mouthwash 0.9% sodium chloride solution was assigned and after 30 minutes the second portion of saliva. By enzyme immunoassay in samples of saliva of control groups of nonpregnant and pregnant women, as well as women with signs of a pathological course of pregnancy, the content of estriol, testosterone, and dehydroepiandrosterone sulfate was determined. STATISTICAL ANALYSIS USED: Statistical data analysis was performed by the standard technique using Student's t-test. RESULTS: The results of biochemical analysis of saliva samples collected before rinsing the mouth with saline in groups of healthy nonpregnant and pregnant women were compared. It was established that during pregnancy the concentration of salivary estriol increases, but in pregnant women with periodontitis, the amount of this hormone in the saliva was significantly reduced. The highest content of testosterone in saliva samples, observed in healthy pregnant women, was significantly higher than nonpregnant women. In pregnant women with periodontitis concentration of testosterone in saliva is reduced, while remaining significantly higher than its level in the saliva of nonpregnant women. The highest concentration of testosterone is observed in the saliva of healthy pregnant women with periodontitis, but the smallest concentration of testosterone is found in the saliva of nonpregnant women. Also the nonpregnant group has the lowest levels of DHEA in pregnancy, and its content increases almost threefold when periodontal disease further grows. CONCLUSIONS: It was established that periodontitis against pregnancy is characterized by higher levels of salivary DHEA sulfate and lower estriol, compared with a control group of pregnant women.

[Patient acceptance of «Guided Biofilm Therapy¼]. / Patientenakzeptanz nach Umstellung auf «Guided Biofilm Therapy¼.

«Guided Biofilm Therapy¼ (GBT) represents a systematic, risk and demand-oriented prophylaxis and treatment concept. A significant difference to conventional methods is - above all - the reduced, tissue-friendly and targeted use of ultrasound and hand instruments. The biofilm is consistently shown with suitable color solutions, the oral hygiene instruction and professional tooth cleaning is optimized. The use of suitable powders guarantees a tissue-conserving and targeted removal of biofilm. While individual treatments, techniques and materials have already been well investigated and described, little data is available on patient acceptance. The aim of the present study was to gain an impression of the acceptance of this method in comparison to the conservative-classical recall care mainly based on hand and ultrasound devices in a survey of 100 consecutive patients from the clinic's internal recall system. The overall results were very positive. The powder jet device showed the best acceptance. The aspect fear before/during the recall session was also interesting: At a low level (10%), an additional reduction to 4% occurred, since hand instruments were probably used much less and only very specifically. mConclusion: The use of plaque elevators makes the work in the recall session more efficient, more effective and guarantees ma higher quality control, which is also highly appreciated by patients.

[Misinterpretation of a periapical radiograph: the canalis sinuosus mimicking a root resorption]. / Fehlinterpretation im Röntgenbild. Der Canalis sinuosus als radiologisch-anatomische Vortäuschung einer Wurzelresorption.

There is widespread knowledge that the mental foramen or incisive foramen can be projected onto tooth roots in conventional radiographs, thus simulating apical lesions. In contrast, the anatomical structure of the canalis sinuosus and its branching canals in the anterior maxilla are less known. Sometimes these bone canals mimic a dentino- or osteolysis on conventional radiographs. If these bone canals project onto the roots of the anterior maxillary teeth, there is a risk of misinterpretation as root resorption or apical periodontitis. This case report presents an incidental radiological finding. Due to a radiolucency within the root of tooth 11, root resorption was suspected. Using cone beam-computed tomography, the origin of this radiolucency was clearly identified as an anatomical structure, and the suspected diagnosis was ruled out. This case highlights the importance of the knowledge of anatomical structures to avoid misinterpretations and unnecessary treatments.

Comparison of the cleaning efficiency between interdental brushes and sticks: a laboratory study. / Vergleich der Reinigungseffizienz zwischen Interdentalbürsten und Sticks. Eine Laborstudie.

Studies on interdental cleaning have shown an advantage of interdental brushes (IDB) over other interdental care products. Sticks (STK) made of rubber are often recommended as an alternative, as they are considered user-friendly, gentle but nevertheless effective. This laboratory study aimed to compare the cleaning efficiency with the same application force between IDB and STK. Brushes with different geometries and diameters were tested. Two conical STK from two manufacturers of the sizes "XS/S" (0.7-2.6 mm) and "L" (0.9-3.4 mm) were tested. For the IDB, one conical (2.7-3.4 mm), two cylindrical (1.9 and 2.5 mm) and one waisted brush (4-2-4 mm) were assessed. A geometric model with parallel-walled metal blocks (black and coated with titanium oxide) was used. The brushes were tested with one and five cleaning cycles each in horizontal direction. The test surfaces were measured planimetrically for cleaning efficiency by calculating the areas freed from titanium oxide in relation to the maximum cleanable total area. The maximum cleaning efficiency of the IDB was 45% at 1 mm distance with one cleaning cycle and 95% with five cycles. For the sticks, the cleaning efficiency with one cleaning cycle was 30% and 67% with five cycles. At a distance of 2 mm, the maximum cleaning efficiency was 50% with one cleaning cycle and 87% with five cycles for the IDBs and only 10% for the STKs. Taking into account the limitations of this study, the IDBs showed an overall better cleaning efficiency with the same application force, compared to STKs, with the waisted IDB achieving better cleaning efficiency than the conical IDB. In conclusion, STKs can be used in narrow interdental spaces where app opriate, but overall IDBs are more preferable in narrow and wider contact point conditions.

Autoantibodies against M5-muscarinic and beta1-adrenergic receptors in periodontitis patients.

Autoantibodies against muscarinic and beta1-adrenergic receptors are considered a potential cause and/or risk factor for chronic heart failure. Association of periodontitis with such autoantibodies and with impaired heart function has been observed in patients exposed to endemic Chagas' disease, which triggers by itself cardiomyopathy and receptor immunization.Here we studied the association between periodontitis, markers of cardiac injury and receptor autoimmunization in periodontitis patients (n = 147) not exposed to Chagas' disease. The autoantibodies were determined by IgG binding to native intact muscarinic and beta1-adrenergic receptors or to a cyclic peptide mimicking the disease-relevant conformational autoepitope presented by the active beta1-adrenergic receptor. Possible cardiac injury and inflammatory status were judged by serum levels of proBNP/Troponin I and CRP/IL-6, respectively. These parameters were analysed in healthy and periodontally diseased individuals as well as before and after periodontal therapy.Patients with periodontitis had significantly (p < 0.001) higher levels of autoantibodies against M5-muscarinic and beta1-adrenergic receptors, which further increased following periodontal therapy. Receptor autoantibodies were associated with increased inflammatory status but not with increased markers of cardiac injury. Thus, our data indicate that periodontitis triggers systemic inflammation, which is associated with receptor autoimmunization, and, independently thereof, with cardiac injury.

Influence of periodontitis on pregnancy and childbirth / Einfluss der Parodontitis auf Schwangerschaft und Geburt

For two decades, in periodontology, the effects of periodontal disease on pregnancy, low birth weight or premature birth have been investigated. Even hypertensive diseases during pregnancy have an influence on pregnancy possibly leading to the death of the untreated mother. Due to the stable increase in birth rates,in addition to women's employment and careers, this topic has become more relevant in dentistry than ever before. Rates of prematurity and reduced birth weight are both increasing worldwide and are the main cause of neonatal morbidity and mortality. The need for action regarding the prevention, education and health care of pregnant women is given worldwide. This article first gives an overview of the topic and further discusses the necessary interdisciplinary gynecological and dental therapy. In the daily practice, dentists will be able to make a small but not insignificant contribution to improving the situation of affected women and their children.

[Periodontal disease, a risk factor for atherosclerotic cardiovascular disease]. / A fogágybetegség mint az atheroscleroticus cardiovascularis betegség rizikófaktora.

Cardiovascular disease is recognized as the leading cause of death and disability in the world. The majority of these deaths can be attributed to atherosclerotic disease and thromboembolic events leading to ischemic heart disease and stroke. The role of inflammation is well recognized in the pathogenesis of atherosclerosis and atherothrombosis. Increasing number of studies support the hypothesis that periodontal disease, specifically periodontitis, is a potential risk factor for atherosclerosis and thus cardiovascular disease. Chronic infections of periodontal pockets act as reservoirs for pathogenic microorganisms, their toxins and degradation products, raising the overall systemic inflammatory burden. Entering the circulation and atherosclerotic lesions themselves, they lead to further local and systemic inflammatory response, in all contributing to atherosclerosis progression, potentially increasing cardiovascular risk. Along these lines, good oral health in general and the periodontal treatment in more severe cases may play a role in cardiovascular risk reduction, primary and secondary prevention. The present review summarizes the possible pathophysiological mechanisms linking periodontal and cardiovascular pathology, lists clinical evidence between periodontitis and specific forms of cardiovascular disease and looks forward at the potential role of periodontal treatment in cardiovascular disease prevention and treatment. Orv Hetil. 2019; 160(11): 419-425.

Elusive cranial lesions severely afflicting young endangered Patagonian huemul deer.

OBJECTIVES: Most subpopulations of endangered huemul deer (Hippocamelus bisulcus) fail to recover, frequently due to osteopathology. Equivalent pathology was detected only postmortem in an additional deer 365 km further north, stressing the need to improve clinical evaluations of live huemul. RESULTS: Captured on a farm and attended by authorities in charge of huemul, the deer was considered apt for relocation and release. Delays with attendance and lack of reversal drugs resulted in his death. The subsequent necropsy revealed severe osteopathology particularly in mandibles and maxillae. Such disease in another southern population affected 57+ % among dead adults, and 86% among live adults. The present case stems from a new subpopulation, isolated 365 km further north. Such severe pathology demands that individuals be rehabilitated, especially relevant with severely endangered species, because liberations will cause premature death and loss of reproductive lifetime. Live huemul must be examined utmost professionally especially regarding this pathophysiognomy. This incidence represents the typical situation of extant huemul, being displaced from their traditional migratory behavior to utilize fertile low-elevation habitat. This young male may have been dispersing, but reaching valleys usually leads to death due to locally intense anthropogenic activities.

Troubling disease syndrome in endangered live Patagonian huemul deer (Hippocamelus bisulcus) from the Protected Park Shoonem: unusually high prevalence of osteopathology.

OBJECTIVE: The last 1500 endangered Patagonian huemul deer (Hippocamelus bisulcus) exist in > 100 groups which are not recovering. Prevalence of osteopathology in dead huemul was 57+% (Argentina), whereas similar cases in Chile were accompanied by selenium deficiency. The first clinical cases from live wild huemul confirm widespread osteopathology which explains short life spans, low recruitment, and thus absence of population recovery. RESULTS: The first-ever radio-collaring of 3 male huemul in Argentina and 3 females, plus a fresh female carcass allowed examination of 7 huemul. Of these, 86% were diseased and clinical pathophysiognomy included lameness, affected hoof, exfoliation of 2-7 incisors, other cranial osteopathologies, and muscle atrophy. The parsimonious explanation for absent population recovery is high prevalence of osteopathology as evidenced earlier in carcasses, and now by these clinical cases. Areas currently used by huemul have reduced selenium bioavailability, very deficient soil levels, and overt selenium deficiency in local livestock and plants. These areas are known to result in primary iodine deficiency which is aggravated by selenium deficiency. The nexus to nutritional ecology of huemul likely is inaccessibility to most fertile lowlands and traditional winter ranges, elimination of migratory traditions, and concomitant elimination of source populations.

Immune response in chronic periapical parodonititis.

The purpose of our study was to investigate the immune response in chronical periapical parodontitis (CPP) by using multidisciplinary approach. 30 CPP samples were obtained after surgical removal - apicoectomy. Each CPP sample was examined by histological, bacteriological and flow cytometrical (FC) analysis of lymphocytes infiltrating CPP samples. Ten percent of bacteriological samples were sterile, others had significant aerobic and anaerobic growth. We used patohistologic and microbiologic findings and compare them to the results of imunological analysis. By FC we found a significant increase in proportions of T lymphocytes expressing interleukin-2 receptors and ICAM-1 compared to peripheral blood lymphocytes. Proportions of T helper cells that produce interferon-gama (IFN-gamma) was higher in CPP samples predominantly colonized by anaerobic bacteria. There were no differences in IL-4 expression by T cells in both groups (anaerobic and streptoccoccal). Among anaerobic CPP samples differences in proportion of T cells that express IL-2 receptors expression was also found between samples colonised by P. acnes and Bacteroides sp. Oral streptococci cause relatively limited tissue destruction and induce Th2 type of immune response accompanied by non-cytotoxic inflammatory reaction. On the contrary, anaerobic bacteria induce Th1 type of immune response that cause more severe inflammatory reaction (type 4 of hypersensitivity that damage the tissue by the action of cytotoxic T cell activation.

Algunas plantas usadas en México en padecimientos periodontales / A look at a number of plants used in Mexico in the treatment of periodontal disorders

Un padecimiento con gran incidencia en la población son las alteraciones periodontales, comúnmente conocidas como “sangrado de encías, aflojada de la dentadura, dientes flojos, flojedad de dientes o movilidad dental”, etc., las que corresponden con: gingivitis y periodontitis. Para tratar dichas alteraciones, se emplean diversas plantas y preparaciones comerciales. Nuestro objetivo es mostrar alternativas de tratamiento usadas en la medicina tradicional, específicamente en la herbolaria mexicana. Se presentan 49 especies vegetales que se emplean en México en el tratamiento de dichas enfermedades. Las partes de las plantas empleadas son muy variadas, incluyendo el vegetal completo. Las formas de uso mayormente reportadas fueron las infusiones y los cocimientos. La vía de administración es: local, tópica o por medio de enjuagues o bien ingiriendo la infusión o el cocimiento. Las plantas enlistadas elaboran compuestos como: Aceites esenciales, ácidos orgánicos, alcaloides, carotenos, fenoles, fitoesteroles, flavonoides, glicósidos, lactonas (cumarinas), lignanos, mucílagos, pectinas, polisacáridos, quinonas, saponinas, taninos, terpenos (mono, di, tri y sesquiterpenos), entre otros, los que poseen diferentes actividades, como antimicrobianos o propiedad antiinflamatoria o astringente.