Occurrence of periodontal diseases according to the ACES 2018 Classification Framework and the CDC/AAP definition: A cross-sectional study in a major Brazilian city.

AIM: The occurrence of periodontal diseases is still to be determined in large samples of major Brazilian cities. This study aimed to assess the periodontal status of adults from Curitiba, Paraná, Brazil, using periodontitis definitions by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) and the recently published ACES 2018 Classification Framework. MATERIALS AND METHODS: A multi-stage probability sampling technique was applied to draw individuals aged 18 or older. A total of 566 individuals underwent a full-mouth periodontal examination. Periodontitis cases were defined according to the CDC/AAP and the ACES 2018 Classification Framework. Non-periodontitis cases were classified as healthy or gingivitis. The agreement between the two definitions was calculated. RESULTS: Periodontal health was present in 33.6% and 13.8% of individuals, and gingivitis was found in 11.7% and 7.5%, according to CDC/AAP and ACES, respectively. Mild, moderate and severe periodontitis (CDC/AAP) were present in 2.1%, 33.4% and 19.1% of individuals, respectively. Using ACES, 34.3% had Stages I/II and 43.3% had Stages III/IV. The occurrence of periodontitis was higher when a subgroup of individuals aged 30+ were analysed, ranging from 69.6% (CDC/AAP) to 90.1% (ACES). CDC/AAP and ACES agreement for health, gingivitis and periodontitis accounted for 68.8% of the observations. CONCLUSIONS: Periodontal diseases affect more than 66% of the population aged 18+ years. Classic definition by the CDC/AAP and the recently published ACES Framework yielded moderate agreement.

Periodontal grading-estimation of responsiveness to therapy and progression of disease.

OBJECTIVE: To investigate the capability of periodontal grading to estimate the progression of periodontal disease and the responsiveness to therapy. MATERIALS AND METHODS: Eighty-four patients who underwent non-surgical therapy (NST) were included. Direct and indirect evidence of progression were determined according to the current classification. Responsiveness to therapy was examined using mean pocket probing depths reduction (PPDRed), reduction of bleeding on probing (BOPRed), and the rate of pocket closure (%PC) after six months. RESULTS: Statistical analysis revealed no agreement between direct and indirect evidence in grading periodontitis (κ = 0.070). The actual rate of progression as determined by longitudinal data was underestimated in 13% (n = 11), overestimated in 51% (n = 43) and correctly estimated in 30% (n = 36) by indirect evidence. No significant differences in responsiveness to therapy were observed in patients graded according to direct evidence. Using indirect evidence, patients assigned grade C showed more PPDRed but less BOPRed and lower %PC compared to grade B. CONCLUSION: The present data indicate that indirect evidence may lead to inaccuracies compared to direct evidence regarding the estimation of periodontal progression. However, indirect evidence seems to be more suitable in the estimation of responsiveness to therapy than direct evidence, helping to identify cases that are more likely to require additional therapies such as re-instrumentation or periodontal surgery. CLINICAL RELEVANCE: Regarding the estimation of disease progression and responsiveness to periodontal therapy, accuracy and reliability of both direct and indirect evidence are limited when grading periodontitis.

Ease and practicability of the 2017 classification of periodontal diseases and conditions: a study of dental electronic health records.

BACKGROUND: A new classification for Periodontal and Peri-implant Diseases and Conditions was introduced in the 2017 World Workshop. In the past the 1999 Armitage Classification was commonly used in practice. This study aimed to assess the ease and practicability of retroactively diagnosing a subset of patients formerly diagnosed using the 1999 AAP/CDC classification with the 2017 AAP/EFP disease classification. METHODS: A random subset of 10% of all patients referred over a 7-year period (2011-2018) to the Post-Doctoral Periodontics Clinic at Columbia University College of Dental Medicine were reviewed by accessing the Electronic Health Records (EHRs) on axiUm. Patients diagnosed with periodontal disease based on the 1999 AAP/CDC classification (including chronic and aggressive Periodontitis) were reclassified using the 2017 classification (stage: I, II, III and grade: A, B, C). RESULTS: A sample of 336 patient records were examined. 132 were diagnosed with gingivitis, and 204 with periodontitis. Of these 204 patients, 68 (33.3%) were diagnosed with aggressive and 136 (66.7%) with chronic periodontitis. Patients diagnosed with aggressive periodontitis, 10% were reclassified as stage II, 47% as stage III, and 43% as stage IV periodontitis, and 100% were reclassified as grade C. Among patients with chronic periodontitis, 7% were reclassified as stage I, 65% as stage II, 21% as stage III, and 7% as stage IV; 11% of these were reclassified as grade A, 63% grade B, and 26% grade C. CONCLUSIONS: The majority of those originally diagnosed with aggressive (90%) and chronic (80%) periodontitis were reclassified as either molar/incisor pattern stage III grade C or stage IV grade C periodontitis, and stage II or III periodontitis, respectively. The study demonstrated that it is practical to retroactively reassign a diagnosis according to the new 2017 classification using available information included in dental EHRs.

The burden of diagnostic error in dentistry: A study on periodontal disease misclassification.

BACKGROUND: Periodontal disease constitutes a widely prevalent category of non-communicable diseases and ranks among the top 10 causes of disability worldwide. Little however is known about diagnostic errors in dentistry. In this work, by retrospectively deploying an electronic health record (EHR)-based trigger tool, followed by gold standard manual review, we provide epidemiological estimates on the rate of diagnostic misclassification in dentistry through a periodontal use case. METHODS: An EHR-based trigger tool (a retrospective record review instrument that uses a list of triggers (or clues), i.e., data elements within the health record, to alert reviewers to the potential presence of a wrong diagnosis) was developed, tested and run against the EHR at the two participating sites to flag all cases having a potential misdiagnosis. All cases flagged as potentially misdiagnosed underwent extensive manual reviews by two calibrated domain experts. A subset of the non-flagged cases was also manually reviewed. RESULTS: A total of 2,262 patient charts met the study's inclusion criteria. Of these, the algorithm flagged 1,124 cases as potentially misclassified and 1,138 cases as potentially correctly diagnosed. When the algorithm identified a case as potentially misclassified, compared to the diagnosis assigned by the gold standard, the kappa statistic was 0.01. However, for cases the algorithm marked as potentially correctly diagnosed, the review against the gold standard showed a kappa statistic of 0.9, indicating near perfect agreement. The observed proportion of diagnostic misclassification was 32 %. There was no significant difference by clinic or provider characteristics. CONCLUSION: Our work revealed that about a third of periodontal cases are misclassified. Diagnostic errors have been reported to happen more frequently than other types of errors, and to be more preventable. Benchmarking diagnostic quality is a first step. Subsequent research endeavor will delve into comprehending the factors that contribute to diagnostic errors in dentistry and instituting measures to prevent them. CLINICAL SIGNIFICANCE: This study sheds light on the significance of diagnostic excellence in the delivery of dental care, and highlights the potential role of technology in aiding diagnostic decision-making at the point of care.

Revisão crítica da nova classificação das periodontites / Critical review of periodontitis classification

Para o correto diagnóstico e tratamento da doença periodontal precisamos usar as classificações da doença periodontal. A mais recente foi proposta pela Academia Americana de Periodontia em conjunto com a Federação Europeia de Periodontia. Para a assimilação dos conceitos estabelecidos precisamos avaliar criticamente as informações que foram trazidas pelo consenso realizado há quase 6 anos. O objetivo do presente estudo é revisar o tópico periodontite da classificação, de forma a colaborar para o entendimento dessa doença pelos estudantes de graduação.

The periodontal diseases classifications are important for the correct diagnosis and treatment of periodontal diseases. The most recent classification was proposed by the American Academy of Periodontology in a consensus with the European Federation of Periodontology. For the assimilation of the established concepts, a critical evaluation of the information that was brought by the consensus almost 6 years ago, must be performed. The objective of the present study is to review the periodontitis topic of the new classification, in order to contribute to the understanding of this disease by undergraduate students.

Clasificación de las enfermedades periodontales: evolución y cambios futuros / Classification of periodontal diseases: evolution and future changes

El propósito de este trabajo es, en primer término, determinar cuales son los factores más importantes en el diagnóstico periodontal; su evolución en el tiempo y cuál sería el futuro en la clasificación de las enfermedades periodontales en base a los avances que se están realizando en biología molecular. Se está trabajando en la investigación de los biomarcadores salivales como predictores de la enfermedad periodontal, un rápido test de saliva podría diagnosticar dicha patología (21, 22, 27, 28, 29). Las clasificaciones van evolucionando a medida que se conoce más sobre estasenfermedades (2). Aún falta mucha investigación para poder realizar una clasificación basada en la etiología (2).La biología molecular parece ser muy prometedora, ya que podríamos ser másespecíficos en la etiología de la enfermedad y esclarecer muchas de nuestras incertidumbres (21)

The purpose of this essay is to determine which are the most importantfactors in the periodontal diagnosis, its evolution in time and also determinewhich would be the future classification of periodontal diseases based on theadvances being made in molecular biology.Even today determining the causes of periodontal disease remains a complexmatter.Work is being done today in the research of salivary biomarkers as predictorsof periodontal desease, through rapid saliva test could diagnose thisdisease.21, 22, 27, 28, 29Classifications are evolving as we know more about this disease.2There is still way more research to be made in order to be able to establisha classification based in etiology.2Molecular biology seems to be very promising in that we can be more specificin the etiology of the disease and clarify many of our uncertainties.

Nueva clasificación de rebordes atróficos en el sector posterior maxilar para el tratamiento con implantes dentales / A new classification of atrophic ridges in the posterior jaw for the treatment with dental implants

El edentulismo en el sector posterior maxilar es una de las condiciones más comunes que se presenta en la consulta odontológica9, 10, 12. La prevalencia del edentulismo difiere sustancialmente en la mayoría de los países del mundo (4). Algunos de los índices más altos son encontrados en el Reino Unido y Nueva Zelandia, y los más bajos en Estados Unidos.

Efeitos terapêuticos do uso de produtos derivados da romã (punica granatum) como coadjuvante no tratamento das doenças periodontais: uma revisão de literatura / Therapeutic effects of the use of pomegranate products (Punica granatum) as adjuvant in the treatment of periodontal diseases: a review of the literature

A romã (Punica granatum) possui uma vasta história médica conhecida por sua ação antibacteriana, antioxidante e anti-inflamatória. A presente revisão teve como objetivo verificar os potenciais efeitos terapêuticos do uso de produtos derivados da P. granatum como coadjuvante no tratamento das doenças periodontais. Descritores em inglês e português dos termos: "romã", "doença periodontal", "gengivite", "periodontite" e "punica granatum", foram utilizados para consulta nas bases de dados Pubmed, Lilacs e Scielo. Para avaliação dos efeitos anti-inflamatórios, antimicrobianos e clínicos da romã foram incluídos trabalhos clínicos e pré-clínicos, sem restrições de data. Os diferentes estudos selecionados avaliaram P. granatum em diferentes formulações, incluindo bochechos, géis, infusão, dentifrícios, e chips biodegradáveis. Os resultados demostraram que os componentes fitoquímicos de P. granatum, como polifenóis flavonoides, punicalaginas, ácido punícico e antocinas apresentam propriedades relevantes pró-saúde periodontal, que incluem efeitos anti-inflamatórios, antioxidantes, hemostáticos e imunoregulatórios. Estudos in vivo utilizando diferentes formulações da romã em participantes acometidos por gengivite ou periodontite apresentaram reduções nos índices de placa, sangramento gengival e profundidade de sondagem em graus variados. Conclui-se que P. granatum pode ser uma promissora alternativa à terapia antimicrobiana padrão, para auxílio do controle mecânico de placa, com melhora dos sinais clínicos das doenças periodontais. Contudo, mais estudos clínicos ainda são necessários. (AU)

The pomegranade (Punica granatum) has a vast medical history know by its antibacterial, antioxidant and antiinflammatory action. The presente review aimed at verifying the potential therapeutic effects of products derived from P. granatum as adjuvant in the treatment of periodontal diseases. English and Portugueses descriptors of the terms "pomegranate", "periodontal disease", "gingivitis", "periodontitis" and "Punica granatum" were used for search in Pubmed, Lilacs and Scielo databases. To assess the anti-inflammatory, antimicrobial and clinical effects of pomegranate, clinical and preclinical were included, with no date restrictions. The different studies evaluated P. granatum in different formulations, including mouthwash, gels, infusion, dentifrices, and biodegradable chips. Results showed that the phytochemical components of P. granatum, such as polyphenois flavonoids, punicalagins, punicic acid and antocines, demonstrated relevant periodontal prohealth properties, including anti-inflammatory, antioxidant, hemostatic and immunoregulatory effects. In vivo studies, using different pomegranade formulations in individuals affected by gingivitis or periodontitis, showed reductions in plaque index, gingival bleeding and probing depth in different levels. It was concluded that P. granatum could be a promising alternative to the standard antimicrobial therapy in order to aid the mechanical control of plaque, with improvement of clinical signs of periodontal diseases. However, more clinical studies are still necessary. (AU)

Presencia de factores sistémicos en los distintos estados periodontales / The presence of systemic factors in the different periodontal conditions

Se escribe sobre la importancia de la infección que representa la enfermedad periodontal como iniciación o agravamiento de las alteraciones en losdistintos sistémas que conforman nuestro organismo, como también a la inversa las enfermedades sistémicas pueden facilitar la acción de la placa bacteriana al disminuir las defensas de los tejidos de soporte. El objetivo de éste trabajo es conocer la existencia de éstos factores sistémicos en cada unode los grados de evolución de la enfermedad gingivoperiodontal

Enfermedad periodontal e infección por VIH: estado actual / Periodontal disease and HIV infection: up to date

La infección por el virus de la inmunodeficiencia humana (VIH) puede tener influencia a nivel periodontal. El deterioro del sistema inmune por una disminución de los linfocitos TCD4+ puede comprometer las defensas del huésped a nivel sistémico por lo que se puede aumentar la susceptibilidad a padecer diferentes patologías en la cavidad oral. En este trabajo de revisión se recoge el estado actual de la enfermedad periodontal en pacientes VIH+ y trata de abordar como el VIH puede influir en la microbiota subgingival aumentando el riesgo de padecer periodontitis. La presencia de otros factores coadyuvantes podría favorecer la aparición de patología o incluso agravarla independiente de la presencia del VIH (AU)

Human immunodeficiency virus (HIV) infection can be related with the periodontal status. The damage of the immunological system by decreasing TCD4+ lymphocytes may compromise host defenses therefore the susceptibility of suffering from several diseases in the oral cavity can also be increased. This review manuscript addresses the current aspects concerning to the periodontal disease in HIV infected patients and tries to explain how HIV may influence the subgingival microflora, increasing the risk of suffering periodontal problems. Others concomitant factors, not related with HIV infection, might help either the onset or increase the severity of the disease (AU)

Nueva clasificación de las enfermedades periodontales / New classification of periodontal diseases

Este artículo resume la nueva clasificación de enfermedades periodontales propuestas recientemente por la Academia Americana de Periodontología. El sistema de clasificación es necesario para que en un marco de referencia científico se permita ordenar las entidades por sus propias características etiológicas y patogénicas que deriven a un plan tratamiento moderno basado en las actuales evidencias de enfermedad periodontal

La lesión de furcación, un fantasma periodontal / The furcation lesion, a periodontal ghost

El objetivo de este trabajo es considerar la relevante importancia de detectar y diagnosticar las lesiones periodontales que involucran las furcaciones de las piezas dentarias multirradiculares, porque ellas condicionan el plan de tratamiento a seguir. Si bien estas lesiones responden a la misma etiología y características generales de todas las enfermedades gingivoperiodontales, conforman una situación especial debido a la particular anatomía de la región y a la ubicación de estas piezas en la arcada. Se consideran los diferentes parámetros a tener en cuenta para lograr un correcto diagnóstico que permita llegar a un plan de tratamiento preciso, condiciones esenciales ambas para lograr el éxito a largo plazo. Se llega a la conclusión que, si bien el manejo de un diente multirradicular con su furcación afectada periodontalmente sigue siendo un complejo desafío terapéutico, existen hoy múltiples recursos que bien indicados y utilizados nos posibilitan tratar con cierto éxito estas lesiones y mantener así las piezas dentarias propias que a veces, a priori, parecerían perdidas.

Tratamiento periodontal y rehabilitación mediante implantes en un paciente con periodontitis agresiva: caso clínico / Periodontal treatment and rehabilitation by means of implants in a patient with aggressive periodontitis: clinical report

La periodontitis agresiva es una forma de enfermedad periodontal de evolución rápida, donde la destrucción de tejido de soporte es desproporcionada en relación a la presencia de placa bacteriana y cálculo. Presentamos el caso de un paciente diagnosticado con periodontitis agresiva que fue exitosamente tratado periodontalmente en la clínica y rehabilitado mediante implantes dentales y prótesis de función inmediata (AU)

Aggressive periodontit is is a form of periodontal disease with rapid evolution, when the support tissue destruction is disproportionate in relation to the presence of dental plaque and tartar. The following case illustrates the comprehensive treatment planning and successful rehabilitation with dental implants and immediate functioning of a patient who presented with generalized aggressive periodontitis (AU)

Why not revisiting tinidazole as potential treatment of odontogenic infections?

Tinidazole is a 5-nitroimidazole initially introduced intoclinical medicine in 1969 for the treatment of unicellular parasites.Tinidazole offers selective bactericidal activity, not influencedby the inoculum size, against anaerobic bacteria,that make it of theoretical interest against periodontopathogeninfections. This article reviews the required characteristicsof an antibiotic directed to odontogenic anaerobic infections,as well as the pharmacodynamic pitfalls of commonantibiotic treatments. In addition the in vitro, pharmacokineticand pharmacodynamic properties of tinidazole are reviewed,assessing the degree of its adhesion to the required characteristics,as well as identifying the gaps to be fulfilled priorto its use in this medical field. Tinidazole offers interestingcharacteristics making worthy investigations as a candidatefor the treatment of anaerobic odontogenic infections (AU)

El tinidazol es un 5-nitroimidazol que se introdujo en1969 en la clínica para el tratamiento de infestaciones porparásitos unicelulares. El tinidazol ofrece una actividadbactericida selectiva, no influida por el tamaño del inóculo,frente a bacterias anaerobias, por lo que presenta un interésteórico en infecciones producidas por odontopatógenos. Esteartículo revisa las características que requiere un antibióticodirigido al tratamiento de infecciones odontogénicas por bacterias anaerobias, así como las carencias farmacodinámicasde los antibióticos habitualmente utilizados en estetipo de infecciones. Asimismo se revisan las propiedades invitro, farmacocinéticas y farmacodinámicas de tinidazol,valorándose el grado de adhesión de este compuesto a lascaracterísticas requeridas para un antibiótico dirigido a estetipo de infecciones. También se identifican las lagunas deconocimiento sobre tinidazol que deben resolverse antes desu utilización en este campo. Tinidazol ofrece unas característicasinteresantes que posibilitan realizar investigacionescomo candidato al tratamiento de infecciones odontogénicasanaerobias (AU)