Microbiological analysis of oral biofilms in patients admitted to intensive care unit: Pilot study.

AIM: To identify Pseudomonas aeruginosa and Staphylococcus aureus in oral biofilms of intubated and non-intubated patients admitted to an Intensive Care Unit (ICU). METHODS: This was a cross-sectional study, with 30 biofilm sites sampled. S. aureus and P. aeruginosa were identified by conventional biochemical assays. Antimicrobial susceptibility was tested by disk-diffusion. RESULTS: Of 30 sites, 50% contained P. aeruginosa and 3.33% S. aureus. P. aeruginosa was detected in similar amounts in all 3 sample sites, with 5 colonized sites (50%). S. aureus colonized a single supragingival site (3.33%). There was resistance to multiple antimicrobial agents of P. aeruginosa in 7 sites (100%) and S. aureus in 1 (100%). CONCLUSIONS: This study revealed an important relationship between P. aeruginosa and S. aureus colonization at supragingival, subgingival and lingual sites and intubation, thus revealing antimicrobial resistant bacteria colonization of medical interest, which may contribute to the therapy choice directed to these microorganisms.

The Microbiome in Periodontitis and Diabetes.

Objectives: To perform a comprehensive and integrative review of the available literature on the potential changes in the microbiome of healthy and individuals with diabetes under periodontal health and disease. Materials and Methods: The review was conducted by two independent reviewers. Indexed electronic databases (PubMed/Medline, Cochrane Library, Web of Science and Scopus) were searched, including articles published in English and dated from 5 years ago until December 2021. A manual search also was performed to identify co-related articles. Following the removal of duplicates and eligibility criteria, the articles were included in tables for analysis and described in the manuscript. Results: According to this review, diabetes mellitus was associated with significant changes in the subgingival and salivary microbiome, either in its association with periodontitis or in cases of periodontal health. In addition to affecting microbial diversity in terms of taxonomy, metagenomic studies have shown that this endocrine disorder may also be directly related to increased pathogenicity in the oral microbiome. Conclusion: Although the reviewed studies demonstrate important differences in the subgingival and salivary microbiome composition because of diabetes mellitus, further studies are needed to clarify the real effects of hyperglycemia on oral microbial profiles and support new diagnostic approaches and innovative treatments.

Eficácia anti-Hipergliceminante, anti perda óssea e anti-inflamatória do probiótico Lactobacillus rhamnosus EM 1107 em modelo experimental de periodontite associada a diabetes / Anti-hyperglycaminant, anti-bone loss and anti-inflammatory efficacy of the probiotic Lactobacillus rhamnosus EM 1107 in an experimental model of periodontitis associated with diabetes

A doença periodontal (DP) e a diabetes mellitus (DM) possuem uma relação bidirecional bem estabelecida uma vez que compartilham mecanismos inflamatórios crônicos semelhantes. Por seus efeitos microbianos e imunológicos, os probióticos têm sido sugeridos como adjuvantes ao tratamento destas duas condições tanto de forma profilática (preventiva) como terapêutica (durante a doença). Sendo a metformina (MET) o fármaco padrão para o tratamento da diabetes, o objetivo deste estudo foi avaliar a eficácia anti-hiperglicemiante, anti perda óssea e anti-inflamatória do probiótico Lactobacillus rhamnosus EM1107 em modelo experimental de periodontite induzida por ligadura em ratos diabéticos tratados com metformina. Este ensaio pré-clínico, in vivo, randomizado, cego e controlado foi composto por 114 ratos Wistar machos divididos aleatoriamente em seis grupos com 19 animais cada: controle, ligadura, ligadura/DM, ligadura/Prob, ligadura/DM/Prob e ligadura/DM/Prob/Met. Durante 30 dias os animais receberam probiótico via gavagem oral. A DM foi induzida no 14º dia do experimento com injeção de Streptozotocin (STZ) na veia peniana, seguida pela colocação de ligadura para indução da DP e gavagem de MET no 19º dia, e eutanásia no 30º dia. Observou-se uma redução extremamente significativa da glicose sérica tanto nos grupos Prob quanto no grupo Metformina (p<0,001) pela análise bioquímica. A análise microtomográfica (µCT) do osso alveolar e da área de furca nas maxilas evidenciou que os animais diabéticos tratados com probiótico e com metformina tiveram perda óssea linear e volumétrica significativamente menor do que aqueles que não tiveram tratamento algum. Pela análise histomorfológica (HE), todos os grupos que receberam probiótico tiveram uma redução do infiltrado inflamatório, além de uma preservação de cemento e do osso alveolar. A análise pelo TRAP revelou que o grupo Ligadura/DM/Prob/Met apresentou a maior redução na contagem de osteoclastos ativos (p<0,01). Observou-se redução significativa de IL-1ß e TNF-α nos grupos Ligadura/Prob (p<0,05) e Ligadura/DM/Prob (p<0,01) por meio do ensaio ELISA em tecido gengival. Nossos achados sugerem eficácia anti-hiperglicemiante, anti perda óssea e anti-inflamatória do probiótico Lactobacillus rhamnosus EM1107 admnistrado tanto isoladamente quanto em associação com a Metformina na DM associada a DP (AU).

Periodontal disease (PD) and diabetes mellitus (DM) have a well-established bidirectional relationship in the literature as they share similar chronic inflammatory mechanisms. Due to its microbial and immunological effects, probiotic therapy has been suggested as an adjuvant to non-surgical periodontal treatment. Considering metformin (MET) as the standard drug for the treatment of diabetes, the aim of this study was to evaluate the antihyperglycemic, anti-bone loss and anti-inflammatory efficacy of the probiotic Lactobacillus rhamnosus EM1107 in an experimental model of ligature-induced periodontitis in diabetic rats treated with metformin. This pre-clinical, in vivo, randomized, blinded and controlled trial consisted of 114 male Wistar rats randomly divided into six groups of 19 animals each: control, ligation, ligation/DM, ligation/Prob, ligation/DM/Prob and ligation /DM/Prob/Met. For 30 days the animals received a probiotic via oral gavage. DM was induced on the 14th day of the experiment with injection of Streptozotocin (STZ) into the penile vein, followed by ligation for PD induction and MET gavage on the 19th day, and euthanasia on the 30th day. An extremely significant reduction in serum glucose was observed in both the Prob and Metformin groups (p<0.001) by biochemical analysis. Microtomographic analysis (µCT) in the maxilla showed that diabetic animals treated with probiotic and metformin had significantly lower linear and volumetric bone loss than those that had no treatment at all. By histomorphological analysis (HE), all groups that received probiotics had a reduction in inflammatory infiltrate, in addition to preservation of cementum and alveolar bone. The TRAP analysis revealed that the Ligature/DM/Prob/Met group had the greatest reduction in osteoclast count (p<0.01). There was a significant reduction in IL-1ß and TNF-α in the Ligature/Prob (p<0.05) and Ligature/DM/Prob (p<0.01) groups by means of the ELISA assay in gingival tissue. Our findings suggest the anti-hyperglycemic, antibone loss and anti-inflammatory efficacy of the probiotic Lactobacillus rhamnosus EM1107 administered either alone or in association with Metformin in DM with PD (AU).

The effectiveness of photodynamic therapy as a complementary therapy to mechanical instrumentation on residual periodontal pocket clinical parameters: A clinical split-mouth test.

The purpose of this study was to evaluate the effectiveness of photodynamic therapy as complementary therapy to mechanical instrumentation on periodontal residual pockets. This longitudinal, prospective, double-blind and controlled split-mouth clinical trial included one hundred and fourteen residual periodontal sites with probing depth ≥ 4 mm and bleeding on probing, which were distributed into two groups: 57 in the test group (SRP + aPDT) - using a low power laser application Therapy XT (DMC Equipamentos Ltda, São Carlos, São Paulo, Brazil) with operational parameters of 660 nm and 110 mW for 15s, and 57 in the control group (SRP). Oral hygiene conditions were evaluated, through the Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI), as well as periodontal clinical outcomes, comprising the Bleeding on Probing (BOP), Probing Depth (PD) and Clinical Attachment Level (CAL) at baseline and after 3 months. Decrease of 17.74% was observed for the VPI after 3 months of follow-up, while the GBI was reduced by 19.91%, thus indicating statistically significant decreases for both parameters (p < 0.001). Decreases in VPI per site, BOP and PD and CAL gain between T0 and T3 in both treatment groups (p < 0.001) were observed, but no statistically significant intergroup differences were found (p > 0.05). Within the parameters used in this study, adjuvant aPDT to SRP did not lead additional benefits regarding the assessed clinical parameters after three months.

Antimicrobial Photodynamic Therapy Using a Chloro-Aluminum Phthalocyanine Adjuvant to Nonsurgical Periodontal Treatment Does Not Improve Clinical Parameters in Patients with Chronic Periodontitis.

Background and objective: To evaluate the effects of antimicrobial photodynamic therapy (aPDT) with chloro-aluminum phthalocyanine (AlClFc) adjuvant to scaling and root planing (SRP) on periodontal clinical parameters of patients with chronic periodontitis. Materials and methods: Fifty-four periodontal sites were randomly distributed into two groups: 27 in the test group (SRP+aPDT)-using a low-power laser application Photon Lase III (DMC Equipamentos Ltda, São Carlos, São Paulo, Brazil) with operational parameters of 660 nm and 100 mW for 15 sec, and 27 in the control group (SRP). SRP was performed in a single session and the periodontal clinical parameters such as visible plaque index, bleeding on probing (BOP), probing depth (PD), and clinical attachment level were assessed at the baseline (T0) and 3 months after aPDT (T3). Results: Regarding BOP, a decrease in both treatment groups, the test group (p = 0.003) and control group (p = 0.001), was reported between T0 and T3. A reduction in PD and clinical insertion gain for both treatment groups (p < 0.05) after 3 months of therapy was observed, although nonsignificant (p > 0.05) in intergroup comparison. Conclusions: aPDT with AlClFc adjuvant to SRP did not provide additional benefits in reducing PD and clinical insertion gain.

Eficácia da terapia fotodinâmica antimicrobiana com cloroalumínio ftalocianina nos parâmetros clínicos periodontais e níveis salivares de GSH e MDA em pacientes com periodontite crônica / Efficacy of antimicrobial photodynamic therapy with chloroaluminum phthalocyanine on clinical periodontal parameters and salivary levels of GSH and MDA in patients with chronic periodontitis

A terapia fotodinâmica antimicrobiana (TFDA) com cloro-alumínio ftalocianina (AlClFc) tem sido sugerida como adjuvante à terapia periodontal de raspagem e alisamento corono radicular (RACR), mas carece ainda de mais estudos clínicos. Objetivo: Avaliar a eficácia da TFDA com AlClFc nos parâmetros clínicos periodontais e níveis salivares de marcadores do estresse oxidativo - Glutationa (GSH) e Malondialdeído (MDA) - em pacientes com periodontite crônica. Metodologia: Este ensaio clínico, randomizado, duplo cego, paralelo, longitudinal e prospectivo, avaliou 22 pacientes: 14 no grupo teste (RACR+TFDA) e 8 no grupo controle (somente RACR). Cada paciente possuía no mínimo 2 sítios periodontais doentes (PS≥5mm), totalizando 63 sítios. A TFDA foi aplicada uma única vez logo após a finalização das sessões de RACR. Os índices de higiene bucal ­ índice de placa visível [IPV], índice de sangramento gengival [ISG], e os parâmetros clínicos periodontais - sangramento à sondagem [SS], profundidade de sondagem [PS] e nível de inserção clínica [NIC] - foram avaliados antes do tratamento no T0, e após os tempos de 3 meses (T3) e 6 meses (T6). Amostras de saliva foram coletadas em cada tempo de estudo para dosagem de GSH e MDA. Os dados foram analisados estatisticamente através dos testes não-paramétricos de Wilcoxon e Mann-Whitney, sendo pré-estabelecido um nível de significância de 5%. Resultados: A análise intragrupo demostrou diferença estatisticamente significativa entre os tempos T0, T3 e T6 (p<0,05) para as variáveis ISG, NIC e GSH somente no grupo controle. Para a PS, observou-se uma diminuição significativa da mediana no grupo teste entre T0 (5,49) e T6 (4,33), (p 1=0,008). No grupo controle também houve diferença significativa entre os três tempos, mas não foi possível identificar entre quais deles havia essa diferença. Para as demais variáveis IPV, SS e MDA não houve diferença significativa entre os tempos nos dois grupos. Na análise intergrupo, houve diferença estatisticamente significativa para o ISG no T6 (p 2=0,041), e para o GSH no T3 (p 2=0,031), sendo ambos maiores no grupo teste. Já para as demais variáveis, não houve diferenças estatisticamente significativas entre os dois grupos. Conclusão: A TFDA com o fotossensibilizador AlClFc adjuvante à RACR não trouxe benefícios adicionais sobre os parâmetros clínicos periodontais e nem sobre as concentrações salivares de GSH e MDA após 06 meses de tratamento (AU).

Antimicrobial photodynamic therapy (TFDA) with chloro-aluminum phthalocyanine (AlClFc) has been suggested as an adjunct to periodontal scaling and root coronal smoothing therapy (RACR), but it lacks further clinical studies. Objective: To evaluate the efficacy of AlClFc TFDA in periodontal clinical parameters and salivary levels of oxidative stress markers - Glutathione (GSH) and Malondialdehyde (MDA) - in patients with chronic periodontitis. Methods: This randomized, double-blind, parallel, longitudinal, and prospective trial evaluated 22 patients: 14 in the test group (RACR + TFDA) and 8 in the control group (RACR only). Each patient had at least 2 diseased periodontal sites (PS≥5mm), totaling 63 sites. The TFDA was applied once only after the completion of the RACR sessions. The indexes of oral hygiene - visible plaque index [IPV], gingival bleeding index [ISG], and periodontal clinical parameters - bleeding to probing [SS], depth of probing [PS] and level of clinical insertion [NIC] - were evaluated before treatment at T0, and after 3 months (T3) and 6 months (T6) times. Saliva samples were collected at each study time for GSH and MDA dosing. Data were statistically analyzed using non-parametric Wilcoxon and Mann-Whitney tests, with a significance level of 5% being pre-established. Results: The intragroup analysis showed statistically significant difference between the T0, T3 and T6 times (p <0.05) for the ISG, NIC and GSH variables only in the control group. For PS, there was a significant decrease in the median in the test group between T0 (5.49) and T6 (4.33), (p1 = 0.008). In the control group there was also a significant difference between the three times, but it was not possible to identify among which there was this difference. For the other IPV, SS and MDA variables there was no significant difference between the times in the two groups. In the intergroup analysis, there was a statistically significant difference for ISG in T6 (p2 = 0.041), and for GSH in T3 (p2 = 0.031), both of which were higher in the test group. For the other variables, there were no statistically significant differences between the two groups. Conclusion: TFAP with the adjuvant AlClFc photosensitizer to RACR did not confer additional benefits on periodontal clinical parameters nor on salivary concentrations of GSH and MDA after 6 months of treatment (AU).

Conhecimento de trabalhadores rurais de um município do nordeste brasileiro acerca da prevenção e diagnóstico precoce do câncer de boca / Rural workers's knowledge about early diagnosis and oral cancer prevention in a brazilian northeast municipality

Introdução: O câncer de boca está entre o sexto e o oitavo tipo de câncer mais comum em todo o mundo. Dentre os principais fatores de risco relacionados aos tumores malignos orais encontram-se o tabaco, álcool e a radiação solar ultravioleta. A prevenção destes fatores de risco está entre os mais importantes desafios de saúde pública da atualidade. Objetivo: Analisar o conhecimento dos trabalhadores rurais, grupo de risco para câncer de boca, acerca da prevenção e diagnóstico precoce da neoplasia. Métodos: A amostra contou com 100 participantes, sendo os dados coletados através de questionário estruturado com perguntas relativas ao conhecimento sobre o câncer de boca, fatores de risco, diagnóstico precoce e prevenção. Resultados: Os resultados evidenciaram prevalência de indivíduos do sexo feminino, residentes na zona rural, expostos ao sol de 5 a 8 horas por dia. Sobre o conhecimento de câncer de boca, 40% relacionou-o com algum tipo de doença, 54% que o principal fator de risco seria a falta de higiene, e 44% respondeu que a forma de prevenir seria com cuidados de higiene. 29% dos participantes fazem uso de bebida alcoólica e 14% de cigarro. Dos entrevistados que utilizam formas de proteção, 71,27% utilizam apenas chapéu ou boné. Entre os participantes da pesquisa, 91% nunca realizou o autoexame. Conclusão: Os trabalhadores apresentam desconhecimento a respeito do câncer de boca e fatores de risco associados ao desenvolvimento desta neoplasia. Torna-se indispensável instituir um programa de prevenção e diagnóstico precoce desta doença em populações de risco (AU).

Introduction: Mouth cancer is between the sixth and the eighth most common type of cancer worldwide. Among the main risk factors related to oral malignant tumors are tobacco, alcohol and ultraviolet solar radiation. Prevention of these risk factors is among the most important public health challenges nowadays. Objectives: Analyze the level of knowledge of rural workers, risk group for oral cancer, about prevention and early diagnosis of this neoplasm. Material and Methods: The sample consisted of 100 rural workers, and the data were collected through structured questionnaire with questions regarding knowledge about oral cancer, its risk factors, early diagnosis and prevention of malignancy. Results: The results showed prevalence of females (52%), living in rural areas (86%), 44% exposed to the sun 5-8 hours daily. With respect to knowledge to oral cancer, 40% associated with some kind of disease, 54% answered that the main risk factor was the lack of hygiene, and 44% responded that the way to prevent it would be with hygiene care. It was detected that 29% of participants consume alcohol and 14% tobacco. Of the 94% of participants who use some form of protection, 71.27% only use hat or cap to protect from the sun. 91% had never conducted selfexamination. Conclusion: The results showed that rural workers present no knowledge about oral cancer and the risk factors associated with the development of this malignancy. Thus, it becomes essential to establish a program of prevention and early diagnosis of this disease in the risk population (AU).