Halitosis: a conceptual, etiologic and therapeutic approach / Halitose: uma abordagem conceitual, etiológica e terapêutica

Objective: Halitosis is the offensive odor emanated by the oral and nasal cavities and perceived by the individual and/or by other people. Halitosis is a symptom that directly impacts on the social aspects of an individual's life and may be a sign for a systemic disorder in some cases. Material and Methods: A search was conducted on the literature in order to gather the main aspects about halitosis and make a review about the main features necessary to the clinical practice when a professional deals with a patient with halitosis. Results: The information was summarized and discussed with a focus on what clinicians should be aware of when dealing with a patient with halitosis. Conclusion: Halitosis is a prevalent symptom that affects approximately 25% of the individuals. Its classification takes into consideration the origin of the compounds producing the malodor. The diagnosis must take into consideration the various etiological possibilities before defining the treatment. The treatment must be focused on the cause and since there is a wide range of possible causes, halitosis needs a multidisciplinary approach (AU)

Objetivo: Halitose é um cheiro ofensivo expelido pela cavidade bucal e pela cavidade nasal e percebido pelo indivíduo e/ou pelas outras pessoas. A halitose é um sintoma que impacta diretamente aspectos sociais da vida de um indivíduo e pode ser um sinal de alguma desordem sistêmica em alguns casos. Material e Métodos: Uma busca foi feita na literatura para reunir os principais aspectos da halitose e conduzir uma revisão sobre as principais características necessárias à prática clínica quando um profissional lida com um paciente com a queixa de halitose. Resultados: A informação disponível foi sumarizada e discutida com foco naquilo que um clínico deve estar atento quando lida com um paciente com a queixa de halitose presente. Conclusão: A halitose é um sintoma prevalente que afeta aproximadamente 25% dos indivíduos. Sua classificação leva em consideração a origem dos compostos que produzem o mau hálito. O diagnóstico deve levar em conta as várias etiologias possíveis antes de definir um tratamento. O tratamento deve ser focado na causa e, como há uma ampla variedade de possíveis causas, a halitose é um sintoma que precisa de uma abordagem multidisciplina (AU)

Long-term impact of patients' compliance to peri-implant maintenance therapy on the incidence of peri-implant diseases: An 11-year prospective follow-up clinical study.

OBJECTIVE: To prospectively evaluate the incidence of peri-implant diseases and the associated risk factors during 11 years of peri-implant maintenance therapy (PIMT). MATERIAL AND METHODS: A sample of 80 partially edentulous individuals rehabilitated with dental implants was invited to participate in a PIMT program (T1-prior to entering the PIMT program). After 11 years, 51 individuals remained regularly or irregularly adherent to PIMT (T2-last recall after 11 years) and were classified as regular (RC; n = 27) or irregular (IC; n = 24) compliers. Data of interest were analyzed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of peri-implant mucositis and peri-implantitis observed at T2 in the IC group (70.8% and 37.5%, respectively) were significantly higher than those observed in the RC group (37.0% and 11.1%, respectively). The incidence of peri-implant diseases was mostly attributable to potentially modifiable risk factors, as such: RC group-PM (p = 0.013); IC group-high plaque index (p < 0.001), irregular compliance (p < 0.001), the presence of PM (p = 0.015) and periodontitis (p < 0.039). CONCLUSION: Regular compliance during PIMT had a strong effect in minimizing the incidence of peri-implant diseases. Increasing regular dental visits and improving oral hygiene would provide benefits for preventing peri-implant diseases.

Effect of supragingival plaque control on recurrent periodontitis and clinical stability among individuals under periodontal maintenance therapy: 10-year follow-up.

BACKGROUND: The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT). METHODS: The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses. RESULTS: Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively. CONCLUSIONS: After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study.

OBJECTIVES: To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis. METHODS: A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses. RESULTS: The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased. CONCLUSIONS: The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis. CLINICAL RELEVANCE: Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Depressive disorders associated with the recurrence of periodontitis in periodontal maintenance.

OBJECTIVE: The aim of this study was to evaluate the association between depressive disorders and periodontal condition and the recurrence of periodontitis, during periodontal maintenance therapy (PMT). METHODS: From a 6-year prospective cohort study with 268 individuals under PMT, 124 individuals had complete periodontal clinical data recorded between T1 (baseline) and T2 (final data at the last PMT appointment). Individuals were divided into two groups, being 35 individuals with depressive disorders (DD) and 89 individuals without DD (NDD). Full-mouth periodontal examination was evaluated at T1 and T2. RESULTS: The periodontal status of NDD was significantly better then DD at T2. In the NDD group, the recurrence of periodontitis was 50.6% whereas in the DD group was 62.8%. Moreover, the following variables were significantly associated with recurrence of periodontitis in final multivariate logistic regression model: DD, age, co-habitation status without companion, smoking and the interaction between DD and smoking. CONCLUSION: Individuals with DD undergoing PMT presented higher rates of recurrence of periodontitis and tooth loss when compared to individuals without DD. Additionally, the interaction between DD and smoking significantly increased the risk for the recurrence of periodontitis.

Periodontal condition and recurrence of periodontitis associated with alcohol consumption in periodontal maintenance therapy.

BACKGROUND: This study followed individuals in periodontal maintenance therapy (PMT) over 6 years and longitudinally evaluated the effects of the frequency of alcohol consumption on the recurrence of periodontitis (RP). MATERIAL AND METHODS: From a 6-year follow-up cohort study with 268 individuals under PMT, 142 patients who attended at least one PMT visit within 12 months were determined to be eligible. Based on their alcohol consumption, participants were categorized into 3 groups: none or occasional alcohol use (NA; n=88), moderate alcohol use (MA; n=26) and intense alcohol use (IA; n=24). Complete periodontal examination and alcohol consumption were evaluated at 2 times, T1 (after active periodontal therapy) and T2 (6 years). RESULTS: The frequencies of RP in the NA, MA and IA groups were 46.5%, 57.6%, and 79.1%, respectively. The following variables were significantly associated with RP in final multivariate logistic regression model: age >50 years old (OR = 1.79; 95%CI 1.42-2.91; p=0.002), current smoking (OR = 2.42; 95%CI 1.33-4.31; p=0.001), and intensive alcohol use (OR = 1.96; 95%CI: 1.37-2.64; p=0.024). Interaction between intensive alcohol use and smoking showed a high OR estimate of 3.15 (95%CI 1.29-6.32) for RP. CONCLUSIONS: IA individuals undergoing PMT presented worse periodontal condition, higher rates of RP and tooth loss when compared to NA individuals. Additionally, the interaction between intensive alcohol use and smoking significantly increased the risk for RP. Key words:Periodontitis, alcohol consumption, maintenance, epidemiology.

Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: A randomized, triple-blind controlled clinical trial.

BACKGROUND: Preemptive analgesia has as its basic principle the administration of analgesics before the onset of painful stimuli, in order to reduce or prevent postoperative pain, but this question is little explored in implantology. Thus, this study was conducted in order to evaluate the clinical efficacy of ibuprofen in pain prevention after unit implant surgery. MATERIAL AND METHODS: For this triple-blind, parallel, placebo-controlled and randomized clinical trial, 54 insertion surgeries of unitary implants were performed. Two groups have received two different protocols 1 hour before surgery: Ibuprofen group (IBU) 600 mg of ibuprofen; and (2) placebo group (maize starch). The intensity of the pain was evaluated through the visual analogue scale (VAS) in 6 times (1, 6, 12, 24, 48 and 72 hours after the surgery). Patients were instructed to take 750 mg of paracetamol as rescue medication, if necessary. The occurrence and the intensity of pain were analyzed by means of an analysis of variance ANOVA with repeated measurements using the general linear model procedure. RESULTS: The IBU group had significantly lower VAS scores overall (IBU = 0.30, ± 0.57; placebo = 1.14, ± 1.07; p<0.001) and at all times in the intra, intergroup comparisons and time/group interaction than the placebo group (p<0.001). The use of rescue medication was significantly lower and the postoperative time was longer in the IBU group compared to placebo (p = 0.002). CONCLUSIONS: The single use of ibuprofen was found to be significantly superior in reducing pain after unit implant surgery compared to placebo. Key words:Analgesia, dental implants, pain, surgery, oral.

Microbiological profile associated with peri-implant diseases in individuals with and without preventive maintenance therapy: a 5-year follow-up.

OBJECTIVES: Clinical and microbiological longitudinal changes in individuals with peri-implant mucositis (PM) with or without preventive maintenance therapy (PMT) have not been reported, especially in long periods of monitoring. This 5-year follow-up study aimed to assess the clinical and microbiological changes along time in individuals initially diagnosed with PM. MATERIALS AND METHODS: Eighty individuals diagnosed with PM (T1) and followed during 5 years (T2) were divided into one group with PMT during the study period (GTP; n = 39) and another group without PMT (GNTP; n = 41). Full-mouth periodontal/peri-implant examinations were performed. Peri-implant microbiological samples were collected and analyzed through qPCR for Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Actinomyces naeslundii at T1 and T2. RESULTS: GNTP presented higher incidence of peri-implantitis than GTP. Moreover, GNTP showed significantly higher total bacterial load and higher frequency of the evaluated orange complex bacteria than GTP. Individuals who progressed to peri-implantitis presented significantly higher total bacterial load and higher frequencies of P. gingivalis, T. denticola, and F. nucleatum. CONCLUSIONS: The absence of regular appointments for PMT was associated with a higher incidence of peri-implantitis and a significant increase in total bacterial load. CLINICAL RELEVANCE: Regular visits during PMT positively influenced subgingival microbiota and contributed to peri-implant homeostasis and clinical status stability during a 5-year monitoring period. Compliance with PMT programs should be reinforced among individuals rehabilitated with dental implants.

Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy.

OBJECTIVES: To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status. MATERIALS AND METHODS: Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Levels of IL-6, IL-10, IL-1ß, TNF-α, and MMP-8 were quantified through ELISA. RESULTS: RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1ß, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC. CONCLUSIONS: The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis. CLINICAL RELEVANCE: Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.

Effect of Periodontal Therapy on Serum Levels of IL-6 in Type 2 Diabetics: A Systematic Review.

The objective of this systematic review was to search for scientific evidence regarding the impact of periodontal therapy on serum levels of interleukin 6 (IL-6) in type 2 diabetics. A survey was conducted in five databases. Two researchers read titles and abstracts for initial selection and full text for inclusion. Data extraction and methodological quality assessment were performed. Four hundred and fifty-five studies were identified and 15 were included. Significant divergence on the effect of periodontal intervention on IL-6 levels in diabetics was observed among studies. The evaluation results of studies that controlled obesity indicate that periodontal therapy seems to have beneficial effects on IL-6 levels.

Lip repositioning for treatment of excessive gingival display: a case report / Reposicionamento labial para tratamento de exposição gengival excessiva: relato de caso

Introdução: a exposição gengival excessiva é uma condição frequente e que apresenta um significante impacto estético. Pode apresentar diversos fatores etiológicos, incluindo erupção passiva alterada e hipermobilidade do lábio superior. Objetivo: reportar um caso clínico de exposição gengival excessiva tratado pela combinação de cirurgia a retalho com ressecção óssea e cirurgia de reposicionamento labial. Relato de caso: uma paciente de 24 anos, sexo feminino, procurou atendimento com queixa de exposição gengival excessiva ao sorrir e dentes curtos. A avaliação extraoral demonstrou exposição gengival maxilar de aproximadamente 5mm no sorriso espontâneo. Os exames clínico extraoral, clínico periodontal e tomográfico confirmaram o diagnóstico de erupção passiva alterada e hipermobilidade labial. O tratamento incluiu cirurgia a retalho com ressecção óssea, inicialmente, e cirurgia de reposicionamento labial. Conclusão: os procedimentos realizados foram efetivos na redução da exposição gengival excessiva ao sorrir, com baixa morbidade e satisfação da paciente. (AU)

Introduction: Excessive gingival display is a frequent condition and presents a significant a esthetic impact. It can present several etiological factors, including altered passive eruption and hypermobility of the upper lip. Objective: Report a clinical case of excessive gingival display treated by the combination of the flap surgery with bone resection and labial repositioning surgery. Case report: A 24-year-old female patient sought care with complaints of excessive gingival exposure when smiling and short teeth. Extra-oral evaluation showed a maxillary gingival exposure of approximately 5mm in the spontaneous smile. Extra-oral clinical examination, periodontal clinical examination and tomographic examination confirmed the diagnosis of altered passive eruption and lip hypermobility.The treatment included flap surgery with bone resection, initially, and labial repositioning surgery. Conclusion: The procedures performed were effective in the reduction of excessive gingival display when smiling, with low morbidity and patient satisfaction.(AU)

Association between Periodontitis and Hyperglycemia / Associação entre Periodontite e Hiperglicemia

ABSTRACT Objective: The objective of this study was to analyze the prevalence of undiagnosed hyperglycemia in individuals with periodontitis. Methods: The sample was composed of randomly selected individuals that had signed-up for treatment at the Newton Paiva University dental clinic. The volunteers were divided in two groups, the first composed by individuals without periodontitis (n = 30) and the second by individuals with periodontitis (n = 20). All participants answered a questionnaire about habits and overall health condition. Salivary flow was quantified and periodontal examination evaluated bleeding when probed, probing depth and clinical attachment level. Through laboratory tests, the fasting glucose and the glycated hemoglobin levels were quantified. Results: In the sample studied a higher percentage of individuals with hyperglycemia among those with periodontitis than those without periodontitis was identified. Conclusion: It is suggested, therefore, that the request of laboratory tests to check glucose levels becomes a part of the dental treatment protocol of individuals with periodontitis.

RESUMO Objetivo: O objetivo desse estudo foi analisar a prevalência de hiperglicemia não diagnosticada em indivíduos com periodontite. Métodos: A amostra foi composta por indivíduos selecionados aleatoriamente que se inscreveram para tratamento no Curso de Odontologia do Centro Universitário Newton Paiva, Belo Horizonte, Minas Gerais. A amostra foi dividida em dois grupos, o dos indivíduos sem periodontite (n=30) e o dos indivíduos com periodontite (n=20). Todos responderam a um questionário sobre hábitos e condição de saúde geral. Também tiveram o fluxo salivar quantificado e passaram por um exame periodontal para avaliação do sangramento gengival, da profundidade de sondagem e do nível de inserção clínica. Através de exames laboratoriais, quantificou-se a glicemia em jejum e os níveis de hemoglobina glicada. Resultados: Na amostra estudada foi identificado maior percentual de indivíduos com hiperglicemia no grupo com periodontite do que no grupo sem periodontite. Conclusão: Sugere-se, portanto, que a solicitação de exames laboratoriais para avaliação dos níveis glicêmicos faça parte do protocolo odontológico de atendimento dos indivíduos com periodontite.

Erupção passiva alterada: tratamento e diagnóstico com tomografia computadorizada feixe cônico / Altered passive eruption: treatment and diagnosis with cone-beam computed tomography

O plano de tratamento para a exposição gengival excessiva depende da determinação precisa de importantes estruturas anatômicas através do exame clínico periodontal. A tomografia computadorizada é um exame que produz uma série de radiografias transversais que, posteriormente, são processadas por um computador, melhorando a precisão diagnóstica. Este artigo apresenta um relato de caso clínico sobre o planejamento terapêutico de exposição gengival excessiva, decorrente da erupção passiva alterada, utilizando o exame tomográfico. O exame tomográfico foi realizado com a paciente utilizando um retrator labial de plástico. A análise desse exame complementar demonstrou que a coroa clínica real era maior que a coroa aparente. Adicionalmente, revelou que a distância entre a junção cemento esmalte e a crista óssea alveolar era de 1 mm em média, indicando a ressecção óssea. O exame tomográfico com o uso de retrator labial permitiu maior qualidade e precisão na análise das estruturas anatômicas, auxiliando no diagnóstico, na determinação do prognóstico e no planejamento do tratamento da exposição gengival excessiva.

The treatment plan for excessive gingival display depends on the precise determination of important anatomical structures through periodontal clinical examination. The computed tomography is an examination that produces a series of transverse radiographies that are later processed by a computer, improving diagnostic accuracy. This article presents a clinical case report on the therapeutic planning of excessive exposure, due to altered passive eruption, using tomographic examination. The tomography exam was performed with the patient using a plastic labial retractor. The analysis of this complementary exam showed that the actual clinical crown was larger than the apparent crown. Additionally, it was found that the distance between cemento-enamel junction and the alveolar bone crest was 1mm on average, indicating bone resection. The tomographic exam with the use of a labial retractor allowed greater quality and precision in the analysis of the anatomical structures, aiding diagnosis, in the determination of the prognosis and in the planning of the treatment of excessive gingival display.

Avaliação da qualidade de vida em indivíduos com periodontite crônica: um estudo piloto / Evaluation of quality of life in individuals with chronic periodontitis: a pilot study

Objetivo: avaliar a relação entre periodontite e qualidade de vida. Material e métodos: a amostra deste estudo piloto foi composta por 40 indivíduos selecionados aleatoriamente nas clínicas odontológicas do Centro Universitário Newton Paiva, sendo divididos em dois grupos: grupo sem periodontite (n=20) e grupo com periodontite (n=20). Foi realizado exame clínico periodontal para avaliação dos seguintes parâmetros: profundidade de sondagem (PS), nível de inserção clínica (NIC) e sangramento à sondagem (SS). Adicionalmente, foram aplicados os questionários Oral Health and Quality of Life (OHQoL) e Oral Impacts on Daily Performance (OIDP). A análise estatística entre os grupos para as variáveis de interesse foi realizada pelos testes Qui-quadrado e Mann-Whitney. Os valores foram considerados significativos para p < 0,05. Resultados: indivíduos com periodontite apresentaram idade mais elevada, menor renda familiar e menor grau de escolaridade. Diferenças significativas entre os grupos foram observadas nos questionários OHQoL e OIDP. Conclusão: indivíduos com periodontite crônica apresentaram pior qualidade de vida em relação aos indivíduos sem periodontite.

Objectives: to evaluate the relationship between periodontitis and quality of life. Material and methods: the sample of the study was composed of 40 randomly selected individuals at the dental clinics from Centro Universitário Newton Paiva, been divided into 2 groups: group without periodontitis (n=20) and group with periodontitis (n=20). Periodontal clinical examination was performed to evaluate probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BP). In addition, the Oral Health and Quality of Life (OHQoL) and Oral Impacts on Daily Performance (OIDP) questionnaires were applied. The statistical analysis between the groups for the variables of interest was performed by the Chi-square and Mann-Whitney tests. The values were considered significant for p < 0.05. Results: individuals with periodontitis presented higher age, lower family income and lower educational level. Significant differences between the groups were observed in the OHQoL and OIDP questionnaires. Conclusion: individuals with chronic periodontitis presented worse quality of life than individuals without periodontitis.

Associação entre beta-defensinas e periodontite / Association between beta-defensins and periodontitis: literature review

Objetivo: as beta-defensinas humanas (hBDs) podem ter um papel-chave na susceptibilidade às doenças na cavidade bucal. Além do efeito antimicrobiano direto, as hBDs aumentam a imunidade adaptativa. O objetivo deste estudo foi realizar uma revisão de literatura científica sobre a relação entre beta-defensinas (hBD) e periodontite. Material e métodos: foi realizada uma pesquisa bibliográfica na base de dados PubMed sobre a expressão de hBDs em indivíduos com periodontite. Os termos beta defensins e periodontitis foram utilizados nessa busca. Resultados: foram selecionados, por um revisor, sete artigos para serem incluídos nessa revisão de literatura: dois estudos de intervenção e cinco estudos transversais. Conclusão: o número de estudos sobre a expressão de beta-defensinas em indivíduos com periodontite é reduzido. O conhecimento sobre o papel das beta-defensinas na periodontite pode trazer um maior entendimento de sua etiopatogenia, além de possibilitar novos indicadores de risco e terapias. Estudos adicionais são necessários para a elucidação da relação entre esses peptídeos antimicrobianos e a periodontite.

Objective: human beta-defensins (hBDs) may play a key role in the susceptibility to diseases in the oral cavity. In addition to the direct antimicrobial effect, hBDs enhance adaptive immunity. The objective of this study was to investigate the literature on the relationship between hBD and periodontitis. Material and methods: a literature review was conducted in the PubMed database on the expression of hBDs in subjects with periodontitis. The terms "beta-defensins" and "periodontitis" were used in this search. Results: seven articles were selected being: two intervention studies and fi ve cross-sectional studies. Conclusion: the number of studies on the expression of beta-defensins in individuals with periodontitis is reduced. Knowledge about the role of beta-defensins in periodontitis may lead to a better understanding of their etiopathogenesis, in addition to providing new risk indicators and therapies. Additional studies are needed to elucidate the relationship between these antimicrobial peptides and periodontitis.

Gengivectomia convencional e gengivectomia a laser ­ uma revisão crítica / Conventional gingivectomy and laser gingivectomy ­ a critical review

Objetivo: realizar uma avaliação crítica da literatura em relação à melhor técnica cirúrgica, convencional ou a laser, bem como suas indicações. Material e métodos: para síntese deste trabalho, foi realizada uma busca bibliográfica na base PubMed e incluídos estudos relevantes relacionados ao tema. Resultados: foram selecionados, por dois revisores, dez artigos para serem incluídos nessa revisão da literatura: um ensaio clínico, um estudo experimental e oito relatos de casos. Conclusão: a gengivectomia convencional continua sendo uma técnica de grande escolha, e a gengivectomia a laser é uma opção que traz resultados satisfatórios com tempo cirúrgico menor, hemostasia, conforto para o paciente e cicatrização mais rápida. Entretanto, é necessária a realização de ensaios clínicos controlados randomizados para afi rmar se esta tecnologia poderá tornar-se padrão-ouro na prática diária.

Objective: to perform a critical literature review regarding the best surgical technique (conventional or laser) and its indications. Material and methods: an electronic search was made at the PubMed and relevant studies were included. Results: 10 articles were selected by two reviewers to be included as follows: 1 clinical trial, 1 experimental study, and 8 case reports. Conclusion: conventional gengivectomy continues to be the chosen technique, and laser gengivectomy is an option with satisfactory results with less surgical time, hemostasis, more patient comfort, and a fast healing. However, more randomized controlled clinical trials are needed to verify whether this technology will be the gold-standard in our daily practice.

Odontologia no esporte: conhecimento e hábitos de atletas do futebol e basquetebol sobre saúde bucal / Dentistry in sport: knowledge and habits of soccer and basketball athletes regarding oral health / Odontología en el deporte: conocimiento y hábitos de atletas del fútbol y baloncesto con respecto a la salud bucal

RESUMO Introdução: A saúde bucal é parte integrante da saúde sistêmica e é necessária para o bom rendimento físico. Objetivo: Este estudo teve como propósito avaliar e comparar o grau de conhecimento, atitudes e hábitos de atletas do gênero masculino, confederados do futebol e basquetebol, sobre a interrelação de saúde bucal e esporte. Métodos: Elaborou-se um questionário semiestruturado, composto por dezesseis questões objetivas e uma questão dissertativa, que foi respondido por 42 atletas do futebol e 40 atletas do basquetebol. Os esportistas foram questionados sobre seus conhecimentos a respeito do uso de protetores bucais na prática esportiva, interferências das alterações bucais no rendimento esportivo, utilização de medicamentos com finalidade odontológica e doping. Foram também questionados sobre o histórico de trauma durante a prática esportiva, uso de protetores bucais, suplementos, consumo de isotônicos ou energéticos, presença de alteração na articulação temporomandibular e participação em programa de saúde bucal no clube de origem. Resultados: Os resultados obtidos permitiram evidenciar que os atletas entrevistados não têm o conhecimento adequado sobre a influência da saúde bucal na prática esportiva, apesar de concordarem que os profissionais da odontologia contribuem para a manutenção da saúde bucal e a consequente melhoria do rendimento esportivo. Observou-se ainda, que os atletas do basquetebol relataram uma porcentagem maior de traumatismo com relação aos do futebol. A maioria dos atletas das duas modalidades relatou fazer uso de bebidas esportivas, não fazer uso de suplementos alimentares e não ser respirador bucal. Conclusão: Há necessidade de divulgação da importância da saúde bucal no meio esportivo para a manutenção da saúde sistêmica e melhora da prática esportiva.

ABSTRACT Introduction: Oral health is an integral part of systemic health and is necessary for good physical performance. Objective: This study aimed to evaluate and compare the knowledge, attitudes, and habits of male athletes, members of the Brazilian Football and Basketball Confederations, about the interrelationship between oral health and sport. Methods: A semi-structured questionnaire was developed, consisting of sixteen objective questions and one essay question, which were answered by 42 soccer athletes and 40 basketball athletes. The athletes were questioned on their knowledge about the use of mouthguards during sports practice, interferences of oral changes in sports performance, use of drugs for dental purposes and doping. They were also asked about the history of trauma during sports practice, use of mouthguards, supplements, isotonic or energy drinks intake, temporomandibular joint changes and participation in oral health program in the home club. Results: The results showed that the athletes interviewed do not have adequate knowledge about the influence of oral health on sports practice, although they agree that dental professionals contribute to the maintenance of oral health and the consequent improvement in sports performance. It was also observed that basketball athletes reported a higher percentage of trauma compared to soccer athletes. Most athletes of both modalities reported the use of sports drinks, but do not make use of dietary supplements and not being a mouth-breather. Conclusion: There is a need to disseminate the importance of oral health in sports to maintain systemic health and to improve sports practice.

RESUMEN Introducción: La salud bucal es parte integrante de la salud sistémica y es necesaria para el buen rendimiento físico. Objetivo: Este estudio tuvo como propósito evaluar y comparar el nivel de conocimiento, actitudes y hábitos de atletas masculinos, confederados del fútbol y baloncesto, sobre la interrelación de salud bucal y deporte. Métodos: Se elaboró un cuestionario semiestructurado, compuesto por dieciséis preguntas objetivas y una pregunta abierta que fue respondido por 42 atletas de fútbol y 40 de baloncesto. Los deportistas fueron cuestionados sobre sus conocimientos acerca del uso de protectores bucales en la práctica deportiva, interferencias de las alteraciones bucales en el rendimiento deportivo, utilización de medicamentos con finalidad odontológica y dopaje. También se les preguntó sobre el historial de trauma durante la práctica deportiva, uso de protectores bucales, suplementos, consumo de isotónicos o energéticos, presencia de alteraciones en la articulación temporomandibular y participación en programa de salud bucal en el club de origen. Resultados: Los resultados permitieron evidenciar que los atletas no tienen el conocimiento adecuado sobre la influencia de la salud bucal en la práctica deportiva, a pesar de que están de acuerdo que los profesionales de la odontología contribuyen al mantenimiento de la salud bucal y la consecuente mejora el rendimiento deportivo. Se observó también que los atletas de baloncesto relataron un porcentaje mayor de traumatismo con respecto a los del fútbol. La mayoría de los atletas de las dos modalidades relató hacer uso de bebidas deportivas, no hacer uso de suplementos alimenticios y no ser respirador bucal. Conclusión: Hay necesidad de divulgar la importancia de la salud bucal en el medio deportivo para el mantenimiento de la salud sistémica y mejora de la práctica deportiva.

Associação entre periodontite e pneumonia nosocomial / Association between periodontitis and nosocomial pneumonia ­ a literature review

Objetivo: o processo infeccioso e inflamatório decorrente da periodontite poderia contribuir para o desenvolvimento da pneumonia nosocomial. O objetivo deste estudo foi realizar uma revisão da literatura científica sobre a relação entre periodontite e pneumonia nosocomial. Material e métodos: foi realizada uma pesquisa bibliográfica, na base de dados PubMed, por trabalhos que avaliavam o impacto da condição bucal no desenvolvimento da pneumonia nosocomial. Os termos "nosocomial pneumonia" e "periodontitis" foram utilizados nessa busca. Resultados: quatro artigos foram selecionados por dois revisores, para serem incluídos nessa revisão da literatura: um transversal, um do tipo caso-controle, uma revisão sistemática e um ensaio clínico. Conclusão: o número de estudos sobre a associação entre essas duas doenças é extremamente reduzido. O aprimoramento do conhecimento sobre o potencial papel da infecção periodontal na instalação da pneumonia nosocomial é fundamental, pois essa infecção respiratória está associada à significativa morbidade e mortalidade. Estudos adicionais são necessários para elucidação da relação entre essas duas condições patológicas.

Objective: the infectious and inflammatory process in periodontitis could contribute to the development of nosocomial pneumonia. The aim of this study was to review the scientific literature on the relationship between periodontitis and nosocomial pneumonia. Material and methods: a literature search was performed in the PubMed database, for studies that evaluated the impact of oral health in the development of nosocomial pneumonia. The nosocomial pneumonia and periodontitis terms were used in this search. Results: we selected, by two reviewers, four articles to be included in this literature review: a cross-sectional, a case-control, a systematic review and a clinical trial. Conclusion: the number of studies on the association between these two diseases is extremely low. The improvement of knowledge about the potential role of periodontal infection in the nosocomial pneumonia installation is critical because this respiratory infection is associated with significant morbidity and mortality. Additional studies are needed to elucidate the relationship between these two pathological conditions.

Enfoque bidirecional na relação entre periodontite e diabetes mellitus / Bidirectional approach on the relationship between periodontitis and diabetes mellitus ­ a literature review

O diabetes mellitus (DM) é uma doença crônica caracterizada por deficiência parcial ou total da produção de insulina e/ou resistência à sua ação. A periodontite é a complicação bucal mais prevalente do DM, sendo considerada sua sexta complicação clássica. Tem sido sugerida uma relação bidirecional entre DM e periodontite, na qual o DM favorece o desenvolvimento da periodontite e esta, quando não tratada, piora o controle metabólico do DM. Este trabalho teve como objetivo realizar uma revisão da literatura buscando entender os mecanismos envolvidos nessa relação bidirecional. Os artigos científicos utilizados foram publicados nos últimos dez anos e obtidos nas bases de dados Pubmed, Scielo e Medline. A literatura científica propõe alguns mecanismos para explicar a relação entre DM e periodontite. Eles podem ser agrupados em mecanismos bioquímicos/imunológicos, teciduais, genéticos e ambientais. Alterações do DM, como hiperglicemia e anormalidades da resposta imune, frente às infecções bucais aumentam o risco de periodontite. Em contrapartida, a periodontite pode promover resistência insulínica devido à produção exacerbada de mediadores pró-inflamatórios que dificultam o controle glicêmico. No entanto, ainda não está bem estabelecido como a periodontite pode contribuir para o aparecimento do DM.

Diabetes mellitus (DM) is a chronic disease characterized by partial or complete defi ciency of insulin production and/or resistance to its action. Periodontitis is the most prevalent oral complication of DM, considered its sixth classic complication. It has been suggested a two-way relationship between diabetes and periodontitis in which the DM favors the development of periodontitis and that, left untreated, worsens the metabolic control of diabetes. This paper aims to conduct a literature review in order to understand the mechanisms involved in this bi-directional relationship. The papers used were published in the last 10 years and obtained in Pubmed, Scielo and Medline. The scientifi c literature proposes some mechanisms to explain the relationship between diabetes and periodontitis. They can be grouped into biochemical/immunological, tissue, genetic and environmental mechanisms. DM changes such as hyperglycemia and abnormalities of the immune response, compared to oral infections, increase the risk for periodontitis. By contrast, periodontitis may promote insulin resistance due to the overproduction of proinfl ammatory mediators that hinder glycemic control. However, it is not yet well established how periodontitis may contribute to the onset of DM.

Avaliação dos níveis séricos de proteína c-reativa em indivíduos com periodontite: um estudo piloto / Evaluation of the serum levels of c-reactive protein: a pilot study

A proteína C-reativa (PCR) é um marcador inflamatório de fase aguda, produzido pelo fígado frente a agressões provocadas por trauma e doenças infecciosas. A periodontite é uma doença inflamatória e imunomediada dos tecidos de suporte dental, de etiologia bacteriana e como desfecho final nos casos avançados pode evoluir para a perda do dente. A periodontite poderia contribuir para o aumento dos níveis séricos de PCR, que pode ter um importante papel no mecanismo de algumas alterações sistêmicas. O objetivo desse estudo foi avaliar os níveis séricos de PCR em pacientes com periodontite. A amostra foi composta por 20 indivíduos atendidos pelo curso de Odontologia do Centro Universitário Newton Paiva (CUNP), sendo 10 indivíduos diagnosticados com periodontite (grupo caso) e 10 indivíduos sem periodontite (grupo controle). A coleta de dados sobre variáveis de interesse foi realizada através de um questionário estruturado. Adicionalmente, foi feito um exame clínico periodontal para avaliação dos parâmetros sangramento à sondagem, profundidade de sondagem e perda de inserção. Também foi feita uma análise sanguínea de PCR ultrassensível. A análise estatística univariada foi realizada para se fazer uma comparação das variáveis de interesse entre indivíduos com periodontite e sem periodontite e indivíduos com PCR alterada e PCR normal. Os resultados desse estudo demonstraram que indivíduos com periodontite apresentaram maiores níveis sanguíneos de PCR que indivíduos sem periodontite. O índice de massa corporal (IMC) também apresentou diferença significativa entre indivíduos com periodontite e sem periodontite e entre indivíduos com PCR alterada e com PCR normal. A periodontite poderia ser um fator contribuinte para o aumento dos níveis séricos da PCR. Mais estudos são necessários para comprovar tal relação

C-reactive protein (CRP) is an acute phase inflammatory marker produced by the liver when it is induced by some aggressions such as trauma and infection diseases. The periodontitis is an immunomediated inflammatory disease of the dental supportive tissues and its etiology is bacterial. In advanced situations it can evolve to the tooth loss. The periodontitis may contribute to increase CRP blood levels and may have an important role in the mechanism of some systemic changes. The aim of this study was to evaluate CRP blood levels in patients with periodontitis. A cross-sectional study with 20 patients seen by the dentistry course of Newton Paiva University Center (NPUC) in the first half of 2015 was conducted. Among the patients, 10 had the diagnosis of periodontitis (case group) and 10 were considered without periodontitis (control group). A data collect on the variables of interest was released through a questionnaire. Additionally, clinical periodontal examination was performed for the evaluation of bleeding on probing, probing depth and clinical attachment loss. It was requested for each patient an ultra sensitive CRP blood test. Univariated statistical analysis was performed for comparison of variables between patients with periodontitis and without periodontitis and patients with normal levels of CRP and high levels of CRP. The results of this study showed that the subjects with periodontitis had higher CRP levels than those in the group without periodontitis. The body mass index showed a significant difference between the patients with periodontitis and patients without periodontitis and between patients with high CRP levels and patients with normal CRP levels. The periodontitis could contribute to elevate the serum levels of CRP. More studies are needed to confirm this association