Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk biomarkers in patients with stable coronary artery disease: Preliminary findings of 3 months.

AIM: To assess the effect of periodontal therapy (PT) on cardiovascular blood biomarkers. MATERIALS AND METHODS: This single-blind, parallel-design, randomized controlled trial included patients with stable coronary artery disease and periodontitis. The test group (TG) received non-surgical PT, whereas the control group (CG) received one session of plaque removal. Plasma levels of C-reactive protein (CRP), glycated haemoglobin, lipids and cytokines (IL-1ß, IL-6, IL-8, IL-10, IFN-γ and TNF-α) were measured at baseline and after 3 months. RESULTS: Eighty-two patients (74.4% women, mean age 59.6 years) were analysed. TG had significantly better periodontal parameters than CG after 3 months, but no significant differences in blood markers were observed between them. In a post hoc subgroup analysis in patients with baseline CRP <3 mg/L, a significant increase in CRP was observed in CG (1.44 ± 0.82 mg/L to 4.35 ± 7.85 mg/L, p = 0.01), whereas CRP remained unchanged in TG (1.40 ± 0.96 mg/L to 1.33 ± 1.26 mg/L, p = 0.85), resulting in a significant difference between groups at 3 months. In patients with CRP ≥3 mg/L, a significant reduction in CRP was observed only in TG (11.3 ± 12.8 mg/L to 5.7 ± 4.1 mg/L, p = 0.04). Levels of IL-6 and IL-8 were significantly lower in TG than CG at 3 months. CONCLUSIONS: PT leads to lower levels of CRP, IL-6 and IL-8 in cardiovascular patients with high CRP levels.

Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial.

OBJECTIVE: To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS: A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS: The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION: Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease.

MATERIAL AND METHODS: This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1ß, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. RESULTS: CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). CONCLUSION: Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

Impacto da Doença Periodontal no Perfil Lipídico de Pacientes com Doença Arterial Coronariana Crônica: uma Coorte Retrospectiva de 3 anos / Impact of Periodontal Disease in the Lipid Profile of Patients With Chronic Coronary Artery Disease: a 3-Year, Retrospective Cohort

Fundamento: A inflamação tem sido reconhecida como um importante fator de risco para as doenças cardiovasculares. A doença periodontal pode acarretar alterações de alguns marcadores plasmáticos envolvidos no processo aterogênico. Objetivo: Avaliar a associação entre a doença periodontal e os níveis lipídicos ao longo do tempo em pacientes com doença arterial coronariana crônica. Métodos: Este estudo de coorte retrospectivo incluiu uma amostra de pacientes cardiopatas crônicos recebendo atendimento em um ambulatório de atenção terciária de cardiopatia isquêmica. Dos 239 pacientes elegíveis, foram incluídos 80 que apresentavam dados retrospectivos de perfil lipídico entre 2009 e 2011. Foram realizados exames periodontais de todos os dentes presentes em 2011. Modelos múltiplos de equações de estimação generalizada foram aplicados para avaliar a associação entre parâmetros periodontais e alterações ao longo do tempo nos seguintes desfechos: triglicerídeos, colesterol total, LDL-colesterol e HDL-colesterol, com ajustes para idade, índice de massa corporal, fumo, uso de hipoglicemiante oral e tempo de acompanhamento. Resultados: Durante um tempo médio de acompanhamento de 713 dias, não houve mudanças significativas nas concentrações de triglicerídeos, colesterol total e LDL-colesterol. Um aumento significativo de 31,6% nos níveis de HDL-colesterol foi observado entre 2009 e 2011. Observamos uma associação negativa e significativa entre a média individual de perda de inserção periodontal e nível de HDL-colesterol, indicando que quanto maior a perda de inserção, mais baixos os níveis de HDL-colesterol ao longo do tempo. Conclusão: A doença periodontal destrutiva pode estar relacionada com um pior controle lipídico, particularmente relacionado a níveis de HDL-colesterol, em pacientes cardiopatas crônicos

Background: Inflammation has been recognized as an important risk factor for cardiovascular diseases. Periodontal disease may alter some plasma markers involved in the atherogenic process. Objective: To assess the association between periodontal disease and lipid levels over time in patients with chronic coronary artery disease.Methods: This retrospective cohort study included a sample of patients with chronic heart disease receiving care in an outpatient tertiary care for ischemic heart disease. Of 239 patients eligible for the study, we included 80 patients who had available retrospective data of lipid profile between 2009 and 2011. We performed periodontal examinations of all teeth present in 2011. Multiple models of generalized estimating equations were applied to assess the association between periodontal parameters and changes over time in the following outcomes: triglycerides, total cholesterol, LDL-cholesterol, and HDL-cholesterol levels adjusted for age, body mass index, smoking, use of oral hypoglycemic, and follow-up duration. Results: During a mean follow-up time of 713 days, there were no significant changes in the concentrations of triglycerides, total cholesterol, and LDL-cholesterol. A significant 31.6% increase in HDL-cholesterol levels was observed between 2009 and 2011. We observed a significant negative association between mean individual periodontal attachment loss and HDL- cholesterol levels, indicating that the greater the attachment loss, the lower the HDL-cholesterol level over time. Conclusion: Destructive periodontal disease may be related to a worse lipid control, specifically regarding HDL-cholesterol levels, in chronic cardiac patients

Esthetic analysis of gingival components of smile and degree of satisfaction in individuals with cleft lip and palate.

OBJECTIVE: To evaluate soft tissue characteristics in individuals with cleft lip and palate and the degree of satisfaction of these individuals after rehabilitation. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. PATIENTS: Forty-five individuals with repaired complete unilateral cleft lip and palate, aged 15 to 30 years. INTERVENTIONS: One hundred thirty-five frontal facial photographs were obtained at rest and in natural and forced smile. Specialists in periodontics evaluated the soft tissue characteristics. Both patients and specialists evaluated the smiles and scored them as esthetically unpleasant, acceptable, or pleasant. MAIN OUTCOME MEASURES: Comparison of the cleft area with the contralateral region was performed for evaluation of soft tissue. The results of the degree of satisfaction with smile were expressed as percentages and means. The findings between patients and periodontists experienced or inexperienced with cleft care were compared. RESULTS: Statistically significant differences were observed for alveolar process deficiency and absence of papilla in the esthetic area between groups (p < .05). Results show 84.4% of individuals considered their smile as esthetically pleasant. Specialists in periodontics of both groups scored the natural smile and forced smile as esthetically acceptable. There was a statistically significant difference in the mean of patients compared with both groups of specialists in periodontics (p < .05). CONCLUSIONS: Evaluation and knowledge of the soft tissue characteristics is extremely important for successful rehabilitation. The esthetic values and degree of patient satisfaction are essential for treatment success, since smile reconstruction should be esthetically pleasant to the patient.

Utilization of low-intensity laser during healing of free gingival grafts.

OBJECTIVES: This study evaluates the action of a low-intensity diode laser with gallium-aluminum-arsenide (GaAlAs) active medium on the healing process and analgesia in individuals undergoing free gingival grafts. MATERIAL AND METHOD: Ten individuals needing bilateral gingival graft in the mandibular arch were enrolled in a double-blind study. Each individual had a 30-d interval between the two surgeries. The side receiving application of laser was defined as test side and was established upon surgery; laser application was simulated on the control side. The laser was applied in the immediate postoperative period and after 48 h, and patients rated pain on a scale of 0 to 10, representing minimal and maximal pain, respectively. Photographs were obtained at 7, 15, 30, and 60 d postoperatively and evaluated by five periodontists. RESULTS: No statistically significant difference was found at any postoperative period between control and test sides, even though greater clinical improvement associated with treatment was observed at 15 d postoperative. At 30 and 60 d, some examiners observed the same or greater clinical improvement for the control. Only one individual reported mild to moderate pain on the first postoperative day. CONCLUSIONS: Low-intensity laser therapy did not improve the healing of gingival grafts and did not influence analgesia.

Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing.

OBJECTIVE: To evaluate the auxiliary effect of the low-intensity laser in subgingival scaling and root planing by analysis of its clinical aspects, as well as its analgesic potential during the procedure. BACKGROUND DATA: Despite the large number of studies conducted on low-intensity laser energy, few clinical studies are available on periodontics. MATERIALS AND METHODS: Ten patients were selected and submitted to measurement of six sites per tooth, four teeth per hemiarch (960 sites in all). All patients then received subgingival scaling and root planing. Besides periodontal treatment, the test side was also submitted to laser application. The analysis comprised measurement of probing depth, clinical attachment level, and gingival index. Laser energy was applied at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec per site) for preoperative analgesia, and scaling and root planing were performed with application of laser energy at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec) for analgesia, and at a wavelength of 630 nm (8.8 J/cm(2), 35 mW, 10 sec) for healing. The patients filled out a visual analogue scale to assess the pain they felt during the procedure. After 24 and 48 h, the laser was again applied at the wavelength of 630 nm, and the patients were re-evaluated after 3 d. RESULTS: There was a reduction in gingival inflammation, yet without a statistically significant difference between the study and control sides, both in clinical aspects and evaluation of pain during the procedure. CONCLUSION: Utilization of the diode laser as an auxiliary in subgingival scaling and root planing did not provide any apparent clinical benefit for teeth with shallow to moderate pockets.