Influence of gender on periodontal outcomes: A retrospective analysis of eight randomized clinical trials.

AIMS: To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany. METHODS: Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics. RESULTS: Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12). CONCLUSION: Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic.

Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.

AIM: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features. MATERIALS AND METHODS: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire. RESULTS: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p < .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events. CONCLUSIONS: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects.

Different antibiotic protocols in the treatment of severe chronic periodontitis: A 1-year randomized trial.

AIM: To evaluate the clinical effects of different dosages of metronidazole (MTZ) and durations of MTZ + amoxicillin (AMX) in the treatment of generalized chronic periodontitis (GChP). MATERIAL AND METHODS: Subjects with severe GChP were randomly assigned to receive scaling and root planing (SRP)-only, or combined with 250 or 400 mg of MTZ + AMX (500 mg) thrice a day (TID), for 7 or 14 days. Subjects were monitored for 1 year. RESULTS: One hundred and nine subjects were enrolled. At 1 year, 61.9% and 63.6% of the subjects receiving AMX + 250 or 400 mg of MTZ for 14 days, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth ≥5 mm), against 31.8% of those taking 250 or 400 mg of MTZ for 7 days (p < .05) and 13.6% of those receiving SRP-only (p < .05). Fourteen days of MTZ + AMX was the only significant predictor of subjects reaching the clinical endpoint at 1 year (OR, 5.26; 95% CI, 2.3-12.1, p = .0000). The frequency of adverse events did not differ among treatment groups (p > .05). CONCLUSION: The adjunctive use of 400 or 250 mg of MTZ plus 500 mg of AMX/TID/14 days offers statistically significant and clinically relevant benefits over those achieved with SRP alone in the treatment of severe GChP. The added benefits of the 7-days regimen in this population were less evident. (ClinicalTrials.gov NCT02735395).

Evaluación de la efectividad de un desinfectante mediante el método de placas de contacto / Evaluation of the effectiveness of a disinfectant through the contact plate method

Objetivo: evaluar la efectividad del desinfectante LopHene ST mediante el método de placas de contacto. Métodos: se tomó 1 mL de la suspensión de los microorganismos de referencia (bacterias, levadura y un hongo filamentoso) y se esparció sobre una superficie de material análogo al material donde se aplica el desinfectante. En posiciones aleatorias en réplicas de tres, se realizó el muestreo de superficie con placas de contacto que contenían agar triptona soya y sabouraud dextrosa agar, más neutralizante. Se incubaron a 32 ± 2 ºC de 3 a 5 días y 22 ± 2 ºC de 5 a 7 días, según tipo de microorganismo a ensayar. Se contaron las unidades formadoras de colonias en las placas (control positivo). Sobre una superficie de igual dimensión, se aplicó el desinfectante preparado (concentración: 4 %) con 10 min de exposición. Se procedió de igual manera que con el control positivo, se tomó como criterio de aceptación una reducción del número de microorganismos en al menos 3 logaritmos. Resultados: los tres lotes evaluados mostraron que el desinfectante redujo la concentración de las bacterias en un rango de 4,60 a 7,20 logaritmos. Para la levadura la reducción fue de 4,70 a 5,40 logaritmos y para el hongo filamentoso ensayado los valores estuvieron entre 4,10 y 5,50 logaritmos. Conclusiones: el desinfectante LopHene ST es eficaz frente a las cepas de microorganismos ensayadas en el tiempo evaluado y a la concentración probada; con esto se confirma su capacidad bactericida y fungicida bajo las condiciones estudiadas. Además se demuestra que el método empleado resulta válido para el análisis de la efectividad de los lotes de desinfectante evaluados, al mostrar la reducción de las colonias.

Objective: to evaluate the effectiveness of disinfectant LopHene ST by contact plates method. Methods: one ml of the suspension of reference microorganisms (bacteria, yeast and a filamentous fungus) was taken and spread over a surface made of a material similar to that in which the disinfectant was applied. At random positions and in three replications, the surface was sampled by the contact plates method containing Tryptone Soy Agar and Sabouraud Dextrose Agar plus neutralizing substance. Microorganisms were incubated at 32 ± 2 ºC for 3 to 5 days and at 22 ± 2 ºC for 5 to 7 days, depending on the type of microorganism to be tested. Colony-forming unit on the plates (positive control) were counted, then the prepared disinfectant (4 % concentration) was used over an equal sized area during 10 minutes. The procedure was exactly the same as in the positive control; a reduction of the number of microorganisms by at least 3 logarithms, was adopted as acceptance criteria. Results: the disinfectant reduced the bacterial concentration in a range from 4.60 to 7.20 logarithms for the three tested batches. In the case of yeast, reduction was 4.70 to 5.40 logarithms and for the filamentous fungus, the reduction ranged from 4.10 to 5.50 logarithms. Conclusions: LopHene ST disinfectant is effective for the tested microorganism strains in the evaluated time lapse and at the tested concentration. This confirms the bactericidal and fungicidal capacity of this product under the studied conditions. It was also shown that the method is valid for the analysis of effectiveness of the evaluated disinfectant batches since the colonies were reduced.

C-Reactive protein predicts acute myocardial infarction during high-risk noncardiac and vascular surgery.

BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged ≥ 50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.

C-Reactive protein predicts acute myocardial infarction during high-risk noncardiac and vascular surgery

BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged >50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.

Guided esthetic crown lengthening: case reports.

It is well-recognized that excessive gingival display can have a negative impact on a patient's smile. Excessive gingival display due to gingival enlargement or altered passive eruption (dentogingival cause) can be corrected effectively through periodontal surgeries. This article describes two successful esthetic crown-lengthening surgeries that were guided by an acetate template to better predict the outcomes of the surgical procedures in relation to the symmetry and harmony of the gingival contour. This article also highlights the importance of utilizing an interdisciplinary approach to obtain an optimum esthetic result for restorative treatments in the anterior maxilla.

Proinflammatory and oxidative stress markers in patients with periodontal disease.

OBJECTIVE: To evaluate the involvement of proinflammatory and oxidative stress markers in gingival tissue in individuals with chronic periodontitis. SUBJECT AND METHODS: Eighteen subjects were divided in two groups: experimental (age 52.9+/-5.0) and control (age 51.1+/-9.6). The activities of enzymatic antioxidants such as catalase, glutathione peroxidase (GPx), glutathione S-transferase (GST), glutathione reductase, nonenzymatic antioxidants: total glutathione and reduced glutathione, oxidized glutathione (GSSG), thiobarbituric acid reactive substances (TBARS), and myeloperoxidase activity (MPO) were evaluated in gingival tissues from interproximal sites. Statistical differences between groups were determined by independent Student t test and P<.05. RESULTS: Individuals with periodontal disease exhibited a significant increase in the activities of MPO, GPx, GST, and also in TBARS and GSSG levels in gingival tissue compared to the control group (P<.05). CONCLUSION: The results of the present work showed an important correlation between oxidative stress biomarkers and periodontal disease.