Antimicrobial potential and gustatory perception of chlorhexidine gluconate mouthwashes with or without alcohol after a single rinse - a randomized controlled crossover clinical trial.

OBJECTIVE: The aim of this double-blind randomized clinical trial was to assess whether the presence of alcohol in chlorhexidine gluconate mouthwashes influences their antimicrobial potential against salivary bacteria in young adults. Additionally, the taste perception was assessed. MATERIALS AND METHODS: In a randomized crossover design, 20 participants (17 women and three men; aged 18-38 years old) rinsed with the 0.12% chlorhexidine gluconate with (CHX+) or without alcohol (CHX-) for 1 min. Sterile flavoured-mint physiological saline was used as control solution. All participants rinsed with the assigned products only once with a period of at least 7 days of washout in between. For antimicrobial potential assay, stimulated saliva samples were collected from participants and had their total viable bacteria determined before and after each rinse. For taste perception assay, a visual analogue scale (VAS) was used to evaluate the taste perception after each rinse. Friedman followed by Wilcoxon tests and Bonferroni correction were performed. A P-value <0.017 was considered as statistically significant. RESULTS: The median per cent reduction in groups CHX+ and CHX- was 16.07 and 12.87, respectively. No statistically significant difference was found between these groups (P = 0.09). Regarding the gustatory perception, the VAS median values in groups CHX+ and CHX- were 3.50 and 5.50. No statistically significant difference was found in this outcome (P = 0.052). CONCLUSIONS: The presence of the alcohol on the formulation of gluconate chlorhexidine mouthwashes does not seem to interfere with their antimicrobial potential and with their taste perception.

Periodontal disease, tooth loss and coronary heart disease assessed by coronary angiography: a cross-sectional observational study.

OBJECTIVE AND BACKGROUND: To evaluate the association between periodontal disease, tooth loss and coronary heart disease (CHD). There is still controversy about the relationship between periodontal disease and tooth loss with vessel obstruction assessed using coronary angiography. MATERIAL AND METHODS: This cross-sectional study included 195 patients that underwent coronary angiography and presented with at least six teeth. Patients were classified into three categories of coronary obstruction severity: absence; one or more vessels with ≤ 50% obstruction; and one or more vessels with ≥ 50% obstruction. The extent of coronary obstruction was dichotomized into 0 and ≥ 1 affected vessels. A periodontist blinded to patient CHD status conducted a full mouth examination to determine mean clinical attachment loss, mean periodontal probing depth and tooth loss. Multiple logistic regression models were applied adjusting for age, gender, hypertension, smoking, body mass index, low-density lipoprotein cholesterol and C-reactive protein. RESULTS: Most patients were males (62.1%) older than 60 years (50.8%), and 61% of them had CHD. Mean periodontal probing depth, clinical attachment loss and tooth loss were 2.64 ± 0.72 mm, 4.40 ± 1.31 mm and 12.50 ± 6.98 teeth respectively. In the multivariable models, tooth loss was significantly associated with a higher chance of having at least one obstructed vessel (odds ratio = 1.04; 95% confidence interval 1.01-1.09) and with vessel obstruction ≥ 50% (odds ratio = 1.06; 95% confidence interval 1.01-1.11). No significant associations were found between periodontal variables and vessel obstruction. CONCLUSION: Tooth loss was found to be a risk indicator for CHD.

Factors associated with self-reported use of mouthwashes in southern Brazil in 1996 and 2009.

OBJECTIVE: To evaluate the association between sociodemographic factors and self-reported use of mouthwashes in a city in the south of Brazil over a time span of 13 years. METHODS: The study involves a comparison of two household surveys conducted in 1996 and 2009. Respectively, 850 and 982 households were included in each year. The mother of the family answered to a structured questionnaire to provide sociodemographic data. Self-reported use of mouthwash was evaluated in a binary manner (yes/no). Multivariate Poisson regression models were used to estimate proportion ratios (PR) and 95% confidence intervals (95% CI). RESULTS: The proportion of mouthwash use increased significantly from 10.8% to 24.2% after 13 years. The probability of using mouthwashes increased more than two times from 1996 to 2009 (PR = 2.25 95% CI 1.80-2.82). Higher probabilities for using mouthwashes were observed in households with higher income (PR = 2.63 95% CI 1.97-3.51) and in those households where the mothers had higher educational levels (PR = 1.46 95% CI 1.05-2.03). CONCLUSION: Higher family income and higher maternal educational level were associated with self-reported use of mouthwashes in a higher proportion of households.

Dental care providers' decision making regarding maintenance of compromised teeth and implant therapy indication: an analysis of gender and enrollment in teaching positions.

OBJECTIVES: The aim of this study was to evaluate Brazilian dentists' decision making regarding periodontally involved teeth and implant therapy indications as well as possible modifying factors such as gender, enrollment in teaching positions, and area of specialization. MATERIAL AND METHODS: This cross-sectional questionnaire-based study was conducted among Brazilian dentists between June and November 2012. The questionnaire comprised 27 questions divided into four different sections: socio-demographic characteristics, questions about their clinical practice toward implant therapy, decision making in four clinical cases, and agreement with different statements regarding endodontic, periodontal, and implant therapy. RESULTS: A total of 155 dentists answered the questionnaire with an average age of 35.5 years. Fifty-one percent were male, and 44.5% were involved in teaching positions. One hundred and thirty-six (87.7%) respondents had already pursued a post-graduation program or were currently involved in one. 33.5% placed dental implants, 42% provided implant maintenance care to their patients, while 30% performed treatment of peri-implant diseases themselves. Dental faculty and dentists who had not followed any further training program, preferred the use of regenerative therapies more frequently. As opposed, dentists not involved in teaching positions, and periodontists were more prone to select resective therapies. CONCLUSION: Results suggest that dentists' decision making did not follow the latest external evidence, which might be related to factors as professional expertise and patients' preferences. Considering the difficulties faced by professionals when handling complex cases, there is an urgent need to establish international protocols and guidelines to help the clinician identify this particular treatment option, which corresponds with their internal evidence and is based on good external evidence.

Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case-control study.

UNLABELLED: This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women. The findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth, showing that osteoporosis/osteopenia has had an influence on the progression of periodontitis. INTRODUCTION: This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women and explored the effects of use of osteoporosis medication and tooth loss on this association. METHODS: This case-control study involved 521 postmenopausal women, with minimum age of 50 years, in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions/medications, and lifestyle habits were recorded. A complete periodontal examination was performed and periodontitis was diagnosed. Bone mineral density was evaluated through lumbar spine and femoral bone densitometry, obtained using dual-energy X-ray absorptiometry. Logistic regression was used to calculate the strength of association between the occurrences of osteoporosis/osteopenia and periodontitis. RESULTS: Women with osteoporosis/osteopenia were twice as likely to present periodontitis, as were those with normal bone mineral density, even after adjusting for smoking, age, family income, and last visit to dentist (odds ratios (OR)adjusted=2.24, 95% CI [1.24-4.06], p=0.008). Among nonusers of osteoporosis medication (ORadjusted=2.51, 95% CI [1.33-4.73], p=0.004) and women with at least 10 remaining teeth (ORadjusted=2.50 95% CI [1.18-5.27], p=0.02), the odds ratio was higher and statistically significant. CONCLUSIONS: These findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth.

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum.

BACKGROUND AND OBJECTIVE: A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS: A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1ß and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1ß in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Treatment of dentin hypersensitivity by Nd:YAG laser.

BACKGROUND, AIMS: Promising results using Nd:YAG laser against dentin hypersensitivity have been reported. The aim of this double-blind, controlled, split-mouth designed clinical trial was to assess the effect of a single Nd:YAG laser application on alleviating hypersensitivity. METHODS/RESULTS: Seventeen subjects participated in the study. Each of them had two teeth treated; one with the laser activated and one with nonactivated (placebo), for 2 min The assessment of pain was performed by a VAS, after an air blast at baseline immediately after treatment, at 1 week, 4 weeks and 16 weeks. Mean values of VAS for test and control teeth were compared by paired t-test (alpha = 0.05). The results showed mean baseline VAS values of 6.59 (+/- 1.65) and 6.14(+/- 1.95) for test and control teeth, respectively. Immediately after treatment, these values decreased to 4.09(+/- 2.28) and 3.89(+/- 2.11), respectively. After 1 week, 4 weeks and 16 weeks the mean values for test and control teeth were 3.85 +/- 2.36, 4.03 +/- 1.95, 3.60 +/- 2.66, and 4.44 +/- 2.56, 3.41 +/- 2.30, 3.42 +/- 2.30, respectively. There were no statistically significant differences between test and control at any time. However, both groups improved significantly (P < 0.05) from baseline to immediately after application, and at 1 week, 4 weeks and 16 weeks, respectively. The changes that occurred between immediately after application and 1 week, 4 weeks and 16 weeks, respectively, were not statistically significant. CONCLUSION: It is concluded that the effect of treatment of hypersensitive teeth with Nd:YAG laser is not different from placebo. The observed effects seem to last for at least 16 weeks.