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.

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.

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.

Prosthetically driven alveolar reconstructions: a retrospective study

Abstract 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.

Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.

Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis.

OBJECTIVE: To analyze the subgingival microflora composition of inflammatory bowel disease (IBD) patients with untreated chronic periodontitis and compare them with systemically healthy controls also having untreated chronic periodontitis. METHOD: Thirty IBD patients [15 with Crohn's disease (CD) and 15 with ulcerative colitis (UC)] and 15 control individuals participated in the study. All patients had been diagnosed with untreated chronic periodontitis. From every patient, subgingival plaque was collected from four gingivitis and four periodontitis sites with paper points. Samples from the same category (gingivitis or periodontitis) in each patient were pooled together and stored at -70 °C until analysis using a checkerboard DNA-DNA hybridization technique for 74 bacterial species. RESULTS: Multiple-comparison analysis showed that the groups differed in bacterial counts for Bacteroides ureolyticus, Campylobacter gracilis, Parvimonas micra, Prevotella melaninogenica, Peptostreptococcus anaerobius, Staphylococcus aureus, Streptococcus anginosus, Streptococcus intermedius, Streptococcus mitis, Streptococcus mutans, and Treponema denticola (P<0.001). CD patients had significantly higher levels of these bacteria than UC patients either in gingivitis or in periodontitis sites (P<0.05). CD patients harbored higher levels of P. melaninogenica, S. aureus, S. anginosus, and S. mutans compared with controls both at gingivitis and at periodontitis sites (P<0.05). UC patients harbored higher levels of S. aureus (P=0.01) and P. anaerobius (P=0.05) than controls only in gingivitis sites. CONCLUSION: Our study showed that even with similar clinical periodontal parameters, IBD patients harbor higher levels of bacteria that are related to opportunistic infections in inflamed subgingival sites that might be harmful for the crucial microbe-host interaction.

Serum levels of long-chain polyunsaturated fatty acids in patients with periodontal disease.

BACKGROUND: Long-chain polyunsaturated fatty acids omega-3 and omega-6 (LC-PUFA n-3 and n-6) can function as important inflammatory modulators and also have a strong effect in the proresolving inflammatory processes. The aim of the authors is to analyze the serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and arachidonic acid (AA) in patients with generalized chronic periodontitis (GCP) and compare these results with serum levels of patients with gingivitis only. METHODS: Twenty-one patients with untreated GCP (mean age: 46.0 ± 8.8 years) and 16 patients with gingivitis only (mean age: 31.5 ± 7.5 years) were investigated. The clinical examination included probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Blood samples were analyzed for the presence of DHA, EPA, DPA, and AA using gas chromatography. RESULTS: Significantly higher levels of DHA, DPA, EPA, and AA were observed in patients with GCP when compared with patients with gingivitis (P = 0.007, P = 0.004, P = 0.033, and P = 0.001, respectively). The differences were still significant even after the adjustments for age and sex. The PD showed a significant positive correlation with DHA (r = 0.5; P = 0.003), DPA (r = 0.6; P <0.001), and AA (r = 0.6; P <0.001). CONCLUSION: The present findings suggest that serum levels of LC-PUFA n-3 and n-6 may be affected by the severity of periodontal disease.

Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases.

BACKGROUND: Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with peptic ulcer, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of H. pylori in the oral cavity of individuals with periodontal disease and gastric diseases. METHODS: 115 individuals, with mean age 49.6 (±5.8) years, were divided in 4 groups: (A) with gastric diseases and periodontal disease; (B) with gastric diseases and no periodontal disease; (C) without gastric diseases and without periodontal disease, (D) without gastric diseases and with periodontal disease. Supra and subgingival plaque samples were collected from posterior teeth of the individuals with sterile paper points, and prepared for Polymerase Chain Reaction analysis. Fisher's exact test was used for detecting statistical differences between groups (p<0.05). RESULTS: H. pylori was detected in supragingival plaque of 9/36 (25%) of group A, 1/31 (0.3%) of group B, 0 (0%) of group C and 3/36 (8.3%) of group D. No subgingival samples were positive for H. pylori. There was a statistically higher prevalence of H. pylori in groups A and D when compared to B and C (p<0.05). CONCLUSION: H. pylori was detected in the supragingival plaque, but not in the subgingival plaque, of individuals with periodontal disease and upper gastric diseases. There was an association between the supragingival colonization of H. pylori and oral hygiene parameters such as the presence of plaque and gingival bleeding.

Immunologic and microbiologic profiles of chronic and aggressive periodontitis subjects.

BACKGROUND: This study determines the gingival crevicular fluid (GCF) levels of interleukin (IL)-1 beta, IL-2, IL-4, IL-8, interferon (IFN)-gamma and elastase activity in inflamed shallow and deep periodontal sites from patients with generalized chronic (GCP) and generalized aggressive periodontitis (GAgP), and to compare them to shallow sites from subjects with gingivitis. A secondary aim analyzes the microbiologic profile of these subjects. METHODS: Cross-sectional clinical data were obtained from 20 GCP, 17 GAgP, and 10 gingivitis subjects. GCF samples were collected with paper strips and the levels of IL-1 beta, IL-2, IL-4, IL-8, and IFN-gamma were measured using a multiplexed bead immunoassay. Elastase activity was assessed by an enzymatic assay. Subgingival plaque samples were analyzed using checkerboard DNA-DNA hybridization. Significance of differences among groups for immunologic and microbiologic data was examined using Kruskal-Wallis adjusting for multiple comparisons. RESULTS: Mean clinical parameters and GCF volumes were higher in patients with GCP and GAgP compared to the gingivitis group. Higher levels of IL-1 beta and higher elastase activity were found in deep sites compared to shallow sites in both periodontitis groups (P <0.05). The microbiologic data showed significantly higher levels of the red complex species in patients with GCP and GAgP compared to gingivitis (P <0.05). There were no statistically significant differences in levels of GCF biomarkers and in levels of subgingival bacterial species between subjects with GCP and GAgP. CONCLUSION: There were no statistically significant differences in the measured immunologic and microbiologic parameters between subjects with GCP and GAgP.

Níveis elevados de il-6 no fluido gengival de pacientes com periodontite crônica e retrocolite ulcerativa idiopática / High levels of IL-6 in gingival crevicular fluid from patients with chronic periodontitis and ulcerative colitis

O nosso objetivo foi mensurar os níveis de IL-6 no fluido gengival de pacientes com periodontite e doença inflamatória intestinal (DII), comparando-os com pacientes sistemicamente saudáveis, com periodontite. Como objetivo secundário avaliamos a IL-6 no soro desses pacientes. Foram selecionados 15 pacientes com doença de Crohn (DC, idade média 38.2, DP ± 11.4 anos), 15 com retrocolite ulcerativa idiopática (RCUI, 45.0 ± 10.5 anos) e 15 pacientes saudáveis (C, 42.1 ± 7.8 anos). A Profundidade de Bolsa (PB), nível de inserção clínica (NI), presença de placa e de sangramento a sondagem foram avaliados em seis sítios por dente. O fluido gengival foi coletado de 4 sítios comperiodontite (PP: PB > 5mm, NI > 3mm) e 4 sítios com gengivite (GP: PB < 3mm e NI< 1mm) em dentes diferentes, com pontas de papel absorvente pré-fabricadas. O soro destes pacientes também foi coletado. A análise da IL-6 foirealizada pelo LUMINEX®. A quantidade total e concentração da IL-6 estavam significantemente maior no fluido gengival dos sítios PP do grupo RCUI quando comparados ao sitios PP do grupo controle (p=0,028; p=0,044, respectivamente). O grupo DC apresentou a quantidade total de IL-6 significantemente maior no sítio PP do que no GP (p=0,028). Já no soro, a IL-6 não diferiu entre os grupos. Sendo assim, podemos concluir que os indivíduos com retrocolite ulcerativa idiopática apresentavam níveis mais altos de IL-6 nos sítios com periodontite, o que pode indicar um importante papel dessa citocina no estabelecimento e progressão da doença periodontal nesses pacientes.

Our aim was to measure the levels of IL-6 in gingival crevicular fluid (GCF) from pat ients with periodontitis and inflammatory bowel disease (IBD), and compare withsystemically healthy controls with periodontitis. Besides, we measured IL-6 levels in serum. Fifteen patients withCrohn’s disease (CD, mean age 38.2 ± 11.4 years ), 15 with ulcerative colitis (RCUI, 45.0 ± 10.5) and 15 controls (C,42.1 ± 7.8) participated in this study. Probing pocket depth (PPD), attachment loss (CAL), presence of plaque andpresence of bleeding on probing, were assessed in six sites per tooth. In each subject, GCF from 4 sites with gingivits (GP- PPD and CAL < 3mm and NI <1mm) and from 4 sites with periodontitis (PP- PPD > 5mm and CAL > 3mm),on different teeth, were collected with pre-fabricated paper strips. The serum of those patients were also collected. The IL-6 was analyzed in the LUMINEX®. The total amount and the concentration of IL-6 in GCF was significantly higher in PP sites from RCUI than in controls (p=0.028 e p=0.044, respectively). The total amountof IL-6 was significantly higher in PP than GP sites in the DC group (p=0.0 28). In serum, IL-6 does not differ between groups. Therefore we concluded that subjects with ulcerative colitis showed higher levels of IL-6 in periodontitissites, which might indicate an important role of this cytokine in the onset and progression of periodontal disease in suchpatients.

Early proliferation of bone marrow mononuclear cells on collagen membrane, bone graft and tooth cementum / Proliferación temprana de células mononucleares de médula óseasobre membrana de colágeno, injerto óseo y cemento dentario

The ultimate goal of periodontal therapy is to repair the damaged periodontal supporting tissues, permitting regeneration of the periodontal ligament. However, the cell response, the supportive matrix and the bioactive molecules use have not yet been well established. Bone marrow mononuclear cells were extracted from rat femurs and tibiae and cultured on a cross-linked collagen membrane, bone graft, or molar tooth to compare cell attachment and early proliferation on these materials. Cell attachment was quantified by light microscopy at 24, 48 and 72h, and cell proliferation was observed under a SEM after 72h. After 24h, the number of cells on bone graft was similar to that of the control and more than twice compared to collagen membrane (q=7.473 p<0.001) and 1.75 times greater than with tooth cementum (q=5.613 p<0.01). However, the number of cells close to bone graft decreased in the second day compared to the control. SEM examination revealed a significant decrease in the number of cells that attached and proliferated on tooth and bone graft when compared with membrane. The results showed that bone marrow mesenchymal cells offer great potential for colonize a collagen membrane.

El objetivo último de la terapia periodontal es reparar el daño tejidos periodontales de soporte, permitiendo la regeneración del ligamento periodontal. Sin embargo, la respuesta de la célula, la matriz de apoyo y las moléculas bioactivas aún no han sido bien establecidas. Células mononucleares de la médula ósea se extrajeron del fémur y fibula de rata, y fueron cultivadas sobre un reticulado de membrana de colágeno, de injerto de hueso o de un diente molar para comparar la adhesión celular y la proliferación temprana sobre estos materiales. La adhesión celular fue cuantificada por microscopía de luz a las 24, 48 y 72h, y la proliferación celular fue observada bajo MEB después de 72h. Después de 24 horas, el número de células sobre el injerto de hueso fue similar a la del control y más del doble en comparación con la membrana de colágeno (q=7,473 p<0,001) y 1,75 veces mayor que con el cemento dental (q=5,613 p<0,01). Sin embargo, el número de células cerca del injerto óseo disminuyó el segundo día en comparación con el control. El examen al MEB reveló una disminución significativa en el número de células que se unen y proliferan sobre los dientes y el injerto óseo en comparación con la membrana. Los resultados mostraron que las células mesenquimales de la médula ósea tienen un gran potencial para colonizar la membrana de colágeno.

Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.

BACKGROUND: Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. METHODS: Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. RESULTS: The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. CONCLUSION: Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.

Índice elevado de CPOD em pacientes com doença inflamatória intestinal / Elevated DMFT index in patients with inflammatory bowel disease

O objetivo deste estudo foi o de avaliar a presença de lesões cariosas, restauradas, elementos perdidos por cárie (CPOD) e a condição da mucosa oral em pacientes com Doença Inflamatória Intestinal e compará-los com pacientes saudáveis sistemicamente. Foram examinados 99 pacientes com Doença de Crohn (DC), 80 com Colite Ulcerativa (UC) e 74 controles (C). No exame clínico, foram registrados o índice CPOD, o índice de placa e a presença de lesões no tecido mole oral. A idade média, em anos, foi de 38,99 (DP± 12,90); 43,33 (DP ± 13,21) e 40,28 (DP ± 12,87) para os grupos DC, UC e C, respectivamente. Houve aumento significante na prevalência do índice de CPOD no grupo DC (p = 0,016) e UC (<0,0001), quando comparado ao C. A porcentagem de placa foi menor no grupo DC 44,04 (DP± 30,49) que no C 54,10 (DP ±26,4), p= 0,017, mas não houve diferença entre UC e C. Com relação ao número total de lesões orais, foi observada diferença significante entre os grupos DC (p= 0.041) e UC (p= <0.0001) e o grupo C, sendo a pioestomatite a lesão significantemente diferente entre esses grupos. Assim, conclui-se que, quando as doenças inflamatórias intestinais (DC e UC) são avaliadas separadamente, elevado índice de CPOD foi observado em relação ao grupo de controle; e pacientes com comprometimento intestinal apresentam mais lesões bucais que os pacientes do grupo de controle, sendo que, quando as lesões são observadas separadamente, a pioestomatite vegetante é a única que se mostra significantemente prevalente naqueles grupos.

Higher elastase activity associated with lower IL-18 in GCF from juvenile systemic lupus patients.

PURPOSE: Our aim was to evaluate the expression of interleukin-18 (IL-18), interleukin-l-beta (IL-1beta) and the amount of elastase activity in gingival crevicular fluid (GCF) from inflamed gingival sites in patients with juvenile systemic lupus erythematosus (JSLE), and compare these to the expression in GCF from inflamed sites in generally healthy controls. In addition, the local inflammation in periodontal tissues was related to systemic inflammation by the assessment of IL-18 levels in plasma. MATERIALS AND METHODS: GCF from 16 patients with JSLE and 14 controls were collected using a washing device. Elastase activity was measured with a specific substrate, and IL-18 and 11-1 were measured by ELISA. RESULTS: The percentage of visible plaque index, gingival bleeding index and attachment level were similar in JSLE and controls, while the percentage of probing depth greater or equal to 3 mm was significantly higher in the controls. The total amount of IL-1beta and IL-18 in GCF were significantly decreased in JSLE, while the total amount and the percentage of free elastase activity were significantly higher in JSLE when compared with the controls. The plasma levels of I1-18 and the erythrocyte sedimentation rate were significantly higher in JSLE patients. CONCLUSION: We found more active elastase in GCF from inflamed sites in JSLE patients even in the presence of significantly lower levels of IL-18 and IL-13. The increased elastase activity suggests a hyperactivity of neutrophils in JSLE, possibly generated by a priming effect caused by the higher plasma levels of IL-18 found in these JSLE patients.

Laser de baixa intensidade na cicatrização periodontal / Low energy laser in periodontal healing

O objetivo deste estudo foi avaliar os resultados e a metodologia de trabalhos sobre os potenciais efeitos da irradiação por lasers de baixa intensidade (LBI) na cicatrização dos tecidos periodontais, tendo como base o banco de dados MEDLINE, de 1992 a 2007. Basicamente, dois tipos de lasers de baixa potência são utilizados: hélio - neônio(HeNe), com comprimento de onda de 633nm e lasers diodo, como o Arseniato de gálio e alumínio (AsGaAl), Arseniato de gálio(AsGa) e o fosfato de arsênio índio gálio (InGaAlP), cujos comprimentos de onda variam entre 635-950 nm. Um total de 59 estudos foi observado e, desses, nove foram selecionados e mostram que os LBI são associados à cicatrização, pelo seu potencial em reduzir os níveis locais de prostaglandinas, aumentar os níveis de beta endorfinas, estimular a produção de ATP celular e a liberação de fatores de crescimento, bem como propiciar a proliferação celular e a síntese de colágeno, e a diminuição do sangramento à sondagem. Concluindo, o LBI parece apresentar benefícios para o processo de cicatrização tecidual. No entanto, a análise dos estudos e a sugestão de um protocolo para a utilização dos LBI são dificultadas pela diversidade da metodologia empregada, como, por exemplo, diferenças nos comprimentos de onda, dosimetrias, tipos de estudo e desenhos experimentais.

Prevalência de periodontite em pacientes com doença inflamatória intestinal / Prevalence of periodontits in patients with inflammatory bowel disease

O objetivo deste estudo foi avaliar a prevalência de periodontite em pacientes com doenças inflamatórias intestinal (DII), e compará-los a pacientes saudáveis sistemicamente. Foram examinados 99 pacientes com Doença de Crohn (DC) (39 DP ± 12,9 anos), 80 com Retocolite Ulcerativa (RCUI) (43,3 ± 13,2 anos) e 74 no grupo controle (C ) (40,3 ± 12,9 anos). A condição periodontal foi avaliada através da placa visível, do sangramento à sondagem, da profundidade de sondagem (OS) e do nível clínico de inserção (NCI). Indivíduos que apresentavam pelo menos quatro sítios com NCI ≥ 3 mm foram considerados como portadores de periodontite. Havia mais pacientes com periodontite nos grupos RCUI (92,6%, p=0,004) e DC (91,9%, p=0,019), comparado ao grupo C (79,7%). O grupo com DC apresentava significativamente menos placa (p=0,017), menos sangramento à sondagem (p-0,038) e menos sítios com os ≥ 4mm (p=0,02) quando comparado ao grupo controle. Nenhuma relação de significância ocorreu nestes índices entre os grupos RCUI e C. Conclui-se que tanto os pacientes com DV quanto com RCUI apresentaram maior prevalência de periodontite do que o grupo controle.

Decreased interleukin-1beta and elastase in the gingival crevicular fluid of individuals undergoing anti-inflammatory treatment for rheumatoid arthritis.

BACKGROUND: The primary aim of this study was to compare the inflammatory activity in the gingival crevicular fluid (GCF) in a group of patients with rheumatoid arthritis (RA) and a group of matched controls. Secondarily, we aimed to evaluate the effect of rheumatologic treatment on periodontal inflammation. METHODS: Seventeen individuals with RA with a mean duration of disease of 12.1 (+/- 9.9) years and the same number of systemically healthy individuals matched for age, gender, periodontal status, and tobacco use were selected. Medication data were registered, and GCF was collected by means of an intracrevicular washing method. Besides clinical registrations, periodontal inflammation was assessed by analysis of the cytokines interleukin (IL)-1beta and -18 and of elastase activity. RESULTS: Amounts of IL-1beta and total elastase were significantly lower in the patient group. IL-1beta and total elastase had a significant and strong correlation in the RA group (r(s) = 0.883). This correlation was not observed in the control group. CONCLUSION: The anti-inflammatory treatment taken by RA patients might influence the periodontal inflammation status represented by IL-1beta and elastase in the GCF.

Effect of periodontal treatment on oral anticoagulation in patients with heart disease.

UNLABELLED: In recent decades, there have been several studies on the correlation between periodontal disease (PD) and cardiovascular disease, but the influence of PD on the effect of oral anticoagulant drugs has not been reported. OBJECTIVE: To assess the influence of PD on oral anticoagulation in patients with heart disease. METHODS: Dental treatment for patients of the Anticoagulation Clinic of the Instituto Nacional de Cardiologia Laranjeiras (INCL), receiving warfarin as a prophylactic treatment for thromboembolic events, was performed without suspending the drug and according to the INCL's "Protocol of dental treatment for patients with acquired coagulopathy". A therapeutic anticoagulation level was maintained and was assessed using the international normalized ratio (INR) on the of the patient's visit. The patient was thus protected against thromboembolic events and could undergo dental treatment, even oral surgery. Our study comprised 40 patients who underwent prospective oral assessment and were divided into two groups: Group I--20 patients with PD; and Group II--20 patients without PD. Dental treatment was performed in the two groups as follows: PD control in Group I and treatment of dental caries in Group II. The INR of the patients was assessed before each dental consultation, to guarantee hemostasis during the procedures and to monitor the anticoagulation level obtained. INR prior to the dental intervention was then compared with that after the intervention in both groups. An INR increase of > or =50% was considered significant. RESULTS: In Group I, all patients showed an increase in INR after the dental treatment, which was significant in 15 (75%). In Group II, only 8 patients had increased INR, which was significant in 5 (25%) (p = 0.002). Considering the oral health of the two groups,. the extent of tissue injury in the oral cavity was not significant compared to the INR increase; however, comparison between the two groups showed significant INR increase mainly in patients with PD (p = 0.002). CONCLUSION: This study showed that dental treatment in patients with any type of PD significantly increases INR.

Decreased Interleukin-1ß and Elastase in the Gingival Crevicular Fluid of Individuals Undergoing Anti-Inflammatory Treatment for Rheumatoid Arthritis.

BACKGROUND: The primary aim of this study was to compare the inflammatory activity in the gingival crevicular fluid (GCF) in a group of patients with rheumatoid arthritis (RA) and a group of matched controls. Secondarily, we aimed to evaluate the effect of rheumatologic treatment on periodontal inflammation. METHODS: Seventeen individuals with RA with a mean duration of disease of 12.1 (± 9.9) years and the same number of systemically healthy individuals matched for age, gender, periodontal status, and tobacco use were selected. Medication data were registered, and GCF was collected by means of an intracrevicular washing method. Besides clinical registrations, periodontal inflammation was assessed by analysis of the cytokines interleukin (IL)-1ß and -18 and of elastase activity. RESULTS: Amounts of IL-1ß and total elastase were significantly lower in the patient group. IL-1ß and total elastase had a significant and strong correlation in the RA group (rs = 0.883). This correlation was not observed in the control group. CONCLUSION: The anti-inflammatory treatment taken by RA patients might influence the periodontal inflammation status represented by IL-1ß and elastase in the GCF.

Changes in periodontal and rheumatological conditions after 2 years in patients with juvenile idiopathic arthritis.

BACKGROUND: The aim of this study was to monitor changes in periodontal inflammation in patients with juvenile idiopathic arthritis (JIA) for 2 years. We investigated the influence of rheumatic disease activity and antirheumatic medication on clinical and immunological parameters of periodontal inflammation in these individuals. METHODS: Two years after a baseline examination, the periodontal and rheumatological conditions of 18 adolescents with JIA and 14 control subjects were described. The clinical periodontal inflammation was monitored by registration of visual plaque, marginal bleeding, probing depth, and clinical attachment loss (AL). Periodontal inflammation was also assessed by analysis of the cytokines interleukin (IL)-1beta and IL-18 and the collagenase matrix metalloproteinase (MMP)-8 by enzyme-linked immunosorbent assay. RESULTS: The erythrocyte sedimentation rate and clinical rheumatological parameters were significantly improved at the 2-year follow-up. The number of sites with plaque decreased, and the number of pockets >/=4 mm increased, whereas bleeding levels and the extension of AL remained unchanged. IL-1beta in gingival crevicular fluid decreased significantly in the JIA group after 2 years. No differences were observed for IL-1beta, MMP-8, or IL-18 levels between groups after 2 years. CONCLUSION: Two years after the baseline examination, no clinical or laboratory differences in periodontal inflammation could be found between JIA patients and control subjects.