Assessment of oral hygiene and quality of life of children with autism spectrum disorder and their caregivers: an observational clinical study.

OBJECTIVE: This study aimed to evaluate the degrees of dependence and presence of bacterial plaque in children with autism spectrum disorder (ASD) and the quality of life (QoL) of children and their caregivers. METHOD AND MATERIALS: This is a cross-sectional observational study. This study included one hundred and nineteen individuals with ASD and their caregivers. Data were collected through a sociodemographic questionnaire, WHOQOL-Bref, and Burden Interview to measure QoL and caregiver burden, respectively. The Autoquestionnaire Qualité de Vie Enfant Imagé questionnaire, adapted in game format, was applied to verify QoL in children with ASD. An oral clinical examination evaluated the visible plaque index. The collected data were tabulated and organized for statistical analysis with a significance level of 5%. RESULTS: It was observed that 52% of the children had a severity of ASD level 1, 70% were dependent on general activities, and 65% were dependent on oral hygiene. Of the 77 children who thoroughly answered the questionnaire about their QoL, 64.9% had good QoL, and 35.1% had scores below 48, that is, low QoL. In general, the caregivers generally presented QoL with a rate of 60.95 (good) points on the scale. It was observed that gingival bleeding greater than 30% is 2 (ASD 2 + ASD 3) to 3 (ASD 3) times more likely to occur in patients who have higher levels of ASD (p˂0.004). CONCLUSION: It was concluded that the QoL of individuals with ASD was good, that most children depend on their daily activities and oral hygiene, and that they showed reasonable plaque control. On the other hand, the caregivers presented low QoL and moderate burden.

The international platform of registered systematic review and meta-analysis protocols (INPLASY) at 3 years: an analysis of 4,658 registered protocols on inplasy.com, platform features, and website statistics.

Background: INPLASY® is an international platform for registering systematic reviews and meta-analysis protocols that was launched in March 2020. INPLASY® provides an online database in which the protocols are maintained as permanent public records and can be accessed on its website (www.inplasy.com). Methods: We described the database features and registered information of all records published since the launch of the registry on March 31, 2023. Additionally, we analyzed the website statistics dataset to explore user experience and promote data transparency. Results: Four thousand six hundred fifty-eight records were registered in INPLASY®, and more than 94% of the protocols were published within 24 h. Most of the submissions were from China, followed by Portugal, Taiwan, Malaysia, and Brazil. The INPLASY® website received 386,395 page views from 64,568 visitors during the first three years. The accesses were obtained from 170 countries. Most of the accesses were from China, followed by the US, the UK, and Portugal. The review status "completed and published" was observed in 898 protocols, and these studies were published in 372 different scientific peer-reviewed journals. The features of INPLASY® include the following: (i) INPLASY® identifier, a unique protocol number; (ii) the digital object identifier (DOI) number, the URL of the protocol linked to a specific DOI; (iii) ORCID update, INPLASY® automatically updates authors' ORCID page, including their protocol; and (iv) search tools, the protocols are freely accessible on www.inplasy.com. Conclusions: INPLASY® has several practical and useful features that should be considered when planning the registration of a systematic review protocol. Furthermore, the sharp increase in the number of protocols registered in INPLASY® in the first three years and the database statistics demonstrate that INPLASY® has become an important source of systematic review protocols. Therefore, authors should access INPLASY® before planning a future review study to avoid unintended duplication of efforts and to obtain timely registration.

The Resolution of Periodontal Inflammation Promotes Changes in Cytokine Expression in the Intestine and Gingival Tissues of Aged Rats with DSS-Induced Colitis.

Our research aimed to explore how resolving periodontal inflammation impacts cytokine expression in the colons of aged Wistar rats. Research studies involving animals have been conducted to investigate the two-way relationship between periodontitis and inflammatory bowel disease (IBD), where chronic inflammation in either the mouth or intestines can negatively affect the other. We allocated seventeen male Wistar rats aged between 8 and 11 months to one of four groups: (1) ligature-induced periodontitis (LIP) without the resolution of periodontal inflammation (RPI) (LIP; n = 4), (2) LIP + RPI (n = 4), (3) LIP + dextran-sulphate-sodium-induced colitis (DIC) without RPI (n = 4), and LIP + DIC + RPI (n = 5). We performed histopathological and immunological analyses on periodontal and intestinal tissues and analysed cytokine expressions using a Rat Cytokine 23-Plex Immunoassay. Our findings showed that animals with and without DIC who underwent RPI showed significantly lower levels of IL-2, IL-4, IL-5, IL-10, IL-13, IL-17, IL-18, and TNF-α in the intestine compared to those without treatment. The RPI effectively reduced the number of inflammatory cells in the lamina propria and restored the epithelial barrier in the intestine in animals with DIC. The resolution of periodontal inflammation significantly reduced the levels of pro-inflammatory cytokines and chemokines in the intestines of aged rats with and without DSS-induced colitis.

Increased Levels of C5a in Gingival Crevicular Fluid and Saliva of Patients with Periodontal Disease.

C5a is a powerful complement effector molecule that is considered to be an important proinflammatory mediator in several systemic chronic inflammatory diseases. However, its levels in periodontal diseases are yet to be assessed. We aimed to analyse the secretion of C5a in gingival crevicular fluid (GCF) and saliva of patients with periodontal disease. Twenty-eight patients diagnosed with stage 3-4 periodontitis and 16 periodontally healthy subjects participated in this study. GCF was collected from sites with the deepest probing depth of each patient, and volume was measured using a Periotron 8000®. One mL of unstimulated saliva was also collected. Samples were analysed using a commercially available ELISA kit. The data were analysed using the Mann-Whitney U test, Pearson's bivariate testing, and receiver operating characteristic curve. C5a was present in GCF from patients with periodontitis (1.06 ± 0.25 ng/mL) whilst it was undetected in controls. Saliva concentration was also significantly higher in periodontitis (1.82 ± 2.31 ng/mL) than controls (0.60 ± 0.72 ng/mL, p = 0.006). C5a levels were more pronounced in periodontitis in both oral fluids assessed by the present pilot study. These results suggest that the more pronounced levels of C5a in oral fluids from periodontitis patients indicate a potential role of this molecule in this disease pathogenesis, deserving to be better explored in subsequent studies.

Higher Prevalence of Periodontitis and Decayed, Missing and Filled Teeth in Patients with Psoriasis.

OBJECTIVE: The aim of this study is to describe the prevalence and severity of periodontitis and decayed, missing and filled teeth (DMFT) index in patients with psoriasis. As a secondary aim, verify if periodontitis was a risk indicator for psoriasis. MATERIALS AND METHODS: A total of 69 patients diagnosed with psoriasis (48.7 ± 14.6 years) and 74 healthy controls (40.3 ± 12.9 years) participated in the study. Probing pocket depth, clinical attachment loss (CAL), bleeding on probing, plaque index, and DMFT index were measured in all subjects. Periodontitis was defined as the presence of at least three interproximal sites with CAL ≥3 mm in different teeth and severe periodontitis should involve at least two interproximal sites in different teeth with CAL ≥5 mm. STATISTICAL ANALYSIS: The Mann-Whitney test was used to analyze the demographics and the clinical data. The significance level was 5%. A multivariate logistic regression was conducted, and the odds ratio were calculated to express the risk to develop psoriasis. RESULTS: Patients with psoriasis had significantly more sites with CAL ≥3 mm (p < 0.03) and CAL ≥5 mm (p < 0.0001), less sites with plaque (p < 0.0001), fewer teeth (p < 0.0001), and a high DMFT index (p < 0.02) as compared with controls. Severe periodontitis was significantly more frequent (87.1% × 58.1%) and was a risk indicator for psoriasis after adjusting for sex, age, race, and smoking habits (odds ratio: 3.7, 95% confidence interval: 1.5-9.0, p < 0.003). CONCLUSION: Patients with psoriasis have higher prevalence of severe periodontitis and higher DMFT than control patients. Severe periodontitis may be a risk indicator for psoriasis.

Tomographic and histomorphometric evaluation of socket healing after tooth extraction using leukocyte- and platelet-rich fibrin: A randomized, single-blind, controlled clinical trial.

The use of platelet concentrate in alveolar ridge preservation has been broadly studied. However, no randomized clinical trials with histomorphometric analysis and low risk of bias are available in the literature. We conducted a prospective, single-blind, parallel, randomized, controlled clinical trial to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in socket preservation after tooth extraction. Additionally, the effect of L-PRF on bone formation was analyzed histologically using bone biopsy specimens obtained during implant placement. A total of 48 subjects who underwent a non-molar tooth extraction were randomly assigned to the L-PRF group (n = 24) or the control group (n = 24). Cone-beam computed tomographies were performed immediately after tooth extraction and at 3 months after tooth extraction, prior to implant surgery. A significant difference in bone resorption was registered 1 mm below the crest: 0.93 ± 0.9 mm for the L-PRF group and 2.27 ± 1.2 mm for the control group (p = 0.0001). Histomorphometric analysis showed a higher percentage of new bone formation in the L-PRF group compared with the control group. The values were 55.96 ± 11.97% and 39.69 ± 11.13%, respectively (p = 0.00001). These findings indicate that the administration of L-PRF should always be considered when socket preservation is planned (Clinicaltrials.gov NCT03408418).

Which is the best choice after tooth extraction, immediate implant placement or delayed placement with alveolar ridge preservation? A systematic review and meta-analysis.

A comprehensive literature search on implant placement protocols after tooth extraction (immediate, early, delayed, or later) was performed up to 2018. The screening process selected only randomized clinical trials (RCTs) from PubMed, Embase, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature. A series of pairwise meta-analyses was carried out to evaluate implant performance in each protocol. The primary outcomes were implant survival and esthetic outcome, measured by pink esthetic score (PES), and the secondary outcomes were peri-implant bone resorption and implant complications. The outcomes were at least 1 year after implant surgery. A total of 5056 studies were found, of which 16 were included for qualitative analysis and 9 for quantitative analysis. The meta-analysis showed increased risk of implant failure by 3% in the immediate implant protocol. PES analysis showed no statistical significant difference between immediate or delayed protocols (p = 0.16). However, the subgroup analysis showed that the anterior region presented better results with immediate implants, while the molar region presented better results with delayed implants. The quantitative analysis showed no statistical difference in peri-implant bone resorption between the immediate and delayed implant protocols (p = 0.42). Due to the lack of studies with a low risk of bias, further RCTs are needed for definitive conclusions.

Infecção periodontal por porphyromonas gingivalis: de uma inflamação oral a um possível "gatilho" para a autoimunidade via citrulinação de proteínas / Periodontal infection by Porphyromonas gingivalis: from oral inflammation to a possible "trigger" for autoimmunity by protein citrulination

A infecção periodontal é causada por uma disbiose polimicrobiana sinérgica onde o Porphyromonas gingivalis pode ser considerado um microrganismo-chave. Recentemente, este microrganismo tem sido associado à produção de autoanticorpos comuns à autoimunidade, sendo assim, o objetivo deste estudo foi revisar a literatura sobre como a infecção periodontal por Porphyromonas gingivalis pode iniciar uma resposta autoimune. A citrulinação fisiológica pode não ser suficiente para gerar doenças autoimunes, porém fontes externas de citrulinação como traumas e infecções podem modificar quantitativa e qualitativamente os peptídeos citrulinados. Diversos estudos têm fornecido valiosas informações a respeito dos fatores de virulência do Porphyromonas gingivalis, e seus efeitos no sistema imunológico do indivíduo. A Porphyromonas gingivalis-peptidilarginina-deiminase (PPAD), expressa pelo Porphyromonas gingivalis, gera peptídeos citrulinados que podem levar a produção de autoanticorpos, e assim, induzir a iniciação de uma resposta autoimune, amplificada e perpetuada pela citrulinação fisiológica (AU)

Periodontal disease is caused by a synergistic polymicrobial dysbiosis where Porphyromonas gingivalis can be considered a keystone pathogen. Recently,this pathogen has been associated with production of autoantibodies common in autoimmunity, therefore the purpose of this study was to review the literature about how periodontal infection with Porphyromonasgin givaliscan initiate an immune response. Physiological citrulination can be not sufficient to induce autoimmune diseases, however external sources of citrullination like trauma and infections can modify the quantity and quality of citrullinated peptides. Several studies has provided valuable information regarding virulence factors of Porphyromonas gingivalis and its effects on the individual's immune system. Porphyromonas gingivalis-peptidylargininedeiminase (PPAD), expressed by Porphyromonas gingivalis, generates citrullinated peptides that can lead to production of autoantibodies and than induce the initiation of autoimmune response, amplified and perpetuated by physiological citrulination.(AU)

Expressão de citocinas relacionadas à resposta th17 nos tecidos gengival e intestinal de pacientes com periodontite e doença inflamatória intestinal / Expression of Th17 related cytokines response in the gingival and intestinal tissue from patients with periodontitis and inflammatory bowel disease

Aim: The aim of this study was to analyze the levels of IL1-ß, IL-4, IL-6, IL10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, TNF-α and sCD40L in the gingival tissue (G), and compare to the levels of the paired intestinal mucosa (MI)in patients having both chronic periodontitis and InflmmatoryBowel Disease (IBD). Material and methods: Twenty-two IBD patients with chronic periodontitis and IBD, mean age40.0 (±14.5),were enrolled in the study. Patients were assessed using anamnesis and periodontal examination. Gingival and intestinal biopsies were collected and homogenized using a cell disruptor. Cytokine's expression was evaluated through multiplex technology and then compensated by weight. Results: After statistical analysis, significant higher levels of gingival IL-23 (p=0.02) and IFN-γ (p=0.01), and significant lower levels of IL-31(p=0.02) and TNF-α (p=0.01) were found when compared to intestinal mucosa. Significant positive correlation between gingival and intestinal tissue were observedbetweenIL-6 (G) andIL-23 (MIand significant negative correlation between IL-23 (G) and IL-1ß (MI), IL-10 (MI), IL-17A (MI) and IFN-γ (MI). Conclusion: We conclude that IL-23 and IFN-γ are significantly increased in the gingival tissue, when compared to the intestinal tissue, suggesting an important role of these cytokines in the manifestation of periodontitis in patients with IBD.(AU)

Objetivo: O objetivo do estudo foi avaliar a expressão das citocinas: IL1-ß, IL-4, IL-6, IL10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, TNF-α e do ligante solúvel do CD40 (sCD40L) no tecido gengival (G) e compará- la com a expressão na mucosa intestinal (MI) de forma pareada em pacientes com periodontite crônica e Doença Inflamatória Intestinal (DII). Material e métodos: Participaram do estudo 22 pacientes com DII, média de idade de 40 anos (DP ±14,5 anos). Foram registrados os parâmetros clínicos e periodontais, e foram coletadas biópsias gengivais e intestinais pareadas. As mesmas foram homogeneizadas usando um disruptor celular. Os níveis das citocinas foram analisados pelo método multiensaio multiplex e posteriormente compensados pelo peso das amostras. Resultados: Após análise estatística, observamos níveis significativamente maiores de IL-23 (p=0,02) e IFN-γ (p=0,01) e significantemente menores de IL-31 (p=0,02) e TNF-α (p=0,01) no tecido gengival quando comparamos com o intestinal. Correlações significantes ocorreram entre o tecido gengival e o intestinal de forma positiva para a IL-6 (G) com a IL-23(MI) e de forma negativa entre IL-23 (G) com IL-1ß (MI), IL-10(MI), IL-17A (MI) e IFN-γ (MI). Conclusão: Concluímos que a IL-23 e IFN-γ encontram-se significantemente aumentadas no tecido gengival, quando comparados à mucosa intestinal, sugerindo um papel importante destas citocinas na manifestação da periodontite em pacientes com DII.(AU)

Periodontitis and systemic lupus erythematosus.

A large number of studies have shown a potential association between periodontal and autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE). Similar mechanisms of tissue destruction concerning periodontitis and other autoimmune diseases have stimulated the study of a possible relationship between these conditions. This study aims to review the literature about this potential association and their different pathogenic mechanisms. Considering that periodontal disease is a disease characterized by inflammation influenced by infectious factors, such as SLE, it is plausible to suggest that SLE would influence periodontal disease and vice versa. However, this issue is not yet fully elucidated and several mechanisms have been proposed to explain this association, as deregulation mainly in innate immune system, with action of phagocytic cells and proinflammatory cytokines such as IL-1ß and IL-18 in both conditions' pathogenesis, leading to tissue destruction. However, studies assessing the relationship between these diseases are scarce, and more studies focused on common immunological mechanisms should be conducted to further understanding.

Association between Chronic Periodontitis and Oral/Oropharyngeal Cancer

Abstract The aim of this case control study was to assess the association between the extent and severity of chronic periodontitis and oral cavity and/or oropharyngeal cancer. The case group comprised 35 patients (mean age 56.1±8.4), diagnosed for oral and/or oropharyngeal cancer. The control group comprised 40 individuals (mean age 55.4±9.4) without diagnostic of cancer. All individuals were subjected to a periodontal examination, including bleeding on probing, plaque index, gingival index, probing pocket depth (PPD), clinical attachment loss (CAL), and decayed, extracted and filled teeth index (DMFT). The case group had significantly more sites with plaque. GI and BOP had similar values in both groups. The median PPD and CAL values were significantly higher for the case group. Chronic generalized periodontitis was predominant in 80% of patients with oral and/or oropharyngeal cancer. Eighty nine percent of the patients in the case group presented severe chronic periodontitis. There was no significant difference between groups for median values of DMFT. The extent and severity of chronic periodontitis remained as risk indicators for oral cavity and/or oropharyngeal cancer even after the adjustments for traditional confound factors, i.e. smoking and alcohol consumption.

Resumo O objetivo deste estudo caso controle foi determinar a associação entre extensão e severidade da periodontite crônica e câncer da cavidade oral e/ou orofaringe. O grupo caso consistiu de 35 pacientes (idade média 56,1±8,4), diagnosticados para câncer oral e/ou de orofaringe. O grupo controle foi composto por 40 pacientes (idade média 55,4±9,4) sem diagnóstico de câncer. Todos os pacientes foram submetidos a exame periodontal, incluindo sangramento à sondagem, índice de placa, índice gengival, profundidade de sondagem e nível de inserção clínica, além do índice de dentes cariados, perdidos e obturados (CPOD). O grupo caso tinha significativamente mais sítios com placa. Índice gengival e sangramento à sondagem mostraram valores similares em ambos os grupos. A mediana dos valores de profundidade de bolsa à sondagem e nível de inserção clínica foram significativamente maiores para o grupo caso. A prevalência de periodontite crônica generalizada foi de 80% em pacientes com câncer oral e/ou de orofaringe. Oitenta e nove por cento dos pacientes no grupo de caso apresentaram periodontite crônica severa. Não houve diferença significante entre os grupos para os valores medianos de CPOD. A extensão e severidade da periodontite crônica permaneceram como indicadores de risco para câncer oral e/ou de orofaringe mesmo após o ajuste para fatores de confundimento tradicional, isto é, fumo e consumo de álcool.

Association between Chronic Periodontitis and Oral/Oropharyngeal Cancer.

The aim of this case control study was to assess the association between the extent and severity of chronic periodontitis and oral cavity and/or oropharyngeal cancer. The case group comprised 35 patients (mean age 56.1±8.4), diagnosed for oral and/or oropharyngeal cancer. The control group comprised 40 individuals (mean age 55.4±9.4) without diagnostic of cancer. All individuals were subjected to a periodontal examination, including bleeding on probing, plaque index, gingival index, probing pocket depth (PPD), clinical attachment loss (CAL), and decayed, extracted and filled teeth index (DMFT). The case group had significantly more sites with plaque. GI and BOP had similar values in both groups. The median PPD and CAL values were significantly higher for the case group. Chronic generalized periodontitis was predominant in 80% of patients with oral and/or oropharyngeal cancer. Eighty nine percent of the patients in the case group presented severe chronic periodontitis. There was no significant difference between groups for median values of DMFT. The extent and severity of chronic periodontitis remained as risk indicators for oral cavity and/or oropharyngeal cancer even after the adjustments for traditional confound factors, i.e. smoking and alcohol consumption.

Periodontitis and systemic lupus erythematosus / Doença periodontal e lúpus eritematoso sistêmico

ABSTRACT A large number of studies have shown a potential association between periodontal and autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE). Similar mechanisms of tissue destruction concerning periodontitis and other autoimmune diseases have stimulated the study of a possible relationship between these conditions. This study aims to review the literature about this potential association and their different pathogenic mechanisms. Considering that periodontal disease is a disease characterized by inflammation influenced by infectious factors, such as SLE, it is plausible to suggest that SLE would influence periodontal disease and vice-versa. However, this issue is not yet fully elucidated and several mechanisms have been proposed to explain this association, as deregulation mainly in innate immune system, with action of phagocytic cells and proinflammatory cytokines such as IL-1β and IL-18 in both conditions’ pathogenesis, leading to tissue destruction. However, studies assessing the relationship between these diseases are scarce, and more studies focused on common immunological mechanisms should be conducted to further understanding.

RESUMO Um grande número de estudos tem mostrado uma potencial associação entre doenças periodontais e doenças autoimunes, como artrite reumatoide e lúpus eritematoso sistêmico (LES). Os mecanismos de destruição tecidual semelhantes entre a periodontite e as demais doenças autoimunes têm estimulado o estudo de possíveis relações entre essas condições. O presente estudo tem como objetivo revisar a literatura acerca dessa potencial associação e dos seus diferentes mecanismos patogênicos. Considerando-se a doença periodontal uma doença de caráter inflamatório que sofre influência de fatores infecciosos, assim como o LES, é plausível sugerir que o LES influenciaria sua progressão, assim como a periodontite influenciaria a progressão do LES. Entretanto, essa questão ainda não é totalmente elucidada e vários mecanismos têm sido propostos para explicar tal associação, como desregulações, principalmente no sistema imune inato, com ações de células fagocíticas e de citocinas pró-inflamatórias, como IL-1β e IL-18, na patogênese de ambas as condições, o que contribui para a destruição tecidual. Existem, contudo, poucos estudos na literatura que avaliam a relação entre essas doenças e mais trabalhos focados nos mecanismos imunológicos comuns a ambas as condições devem ser feitos para um maior entendimento.

Use of minimally invasive gingival biopsies in the study of inflammatory mediators expression and their correlation with gingival fluid in patients with chronic periodontitis.

BACKGROUND: There are no studies comparing the gingival crevicular fluid (GCF) cytokines expression with its corresponding values from the same tissue's sites. Such comparison might be of great value since most of the cytokine function is related to cell and/or tissue receptors. AIMS: Our aim was to use minimally invasive biopsies to evaluate the expression of interferon-gamma, interleukin 1 (IL-1) ß, IL-6, IL-17A, IL-17F, and their correlation with the expression in gingival fluid in patients with chronic periodontitis. MATERIALS AND METHODS: The collection of gingival fluid comprised 22 samples from 11 patients (mean age 46.73 ± 10.16 standard deviation years) with chronic periodontitis. The collection of biopsies comprised 22 samples from the same patients. Gingival fluid and biopsy were taken from the same site in one shallow and one deep site per patient. Gingival fluid samples were collected with periopaper® and analyzed using Luminex®. Biopsies were taken with a 2 mm diameter punch and analyzed for the same mediators using immunohistochemistry. RESULTS: The gingival fluid showed higher amounts for IL-1-ß in deep sites. Immunohistochemical markers were observed in the analyzed cells groups, both in deep and shallow sites, without significant differences between them. In the comparative analysis between immunohistochemical markers and GCF, IL-1-ß showed high concordance in shallow and deep sites. CONCLUSIONS: The use of a standardized punch of 2 mm diameter for periodontal tissue biopsies seems to be suitable for immunohistochemistry analysis and showed that the GCF may not express all the markers in the same proportion at the corresponding tissue.

Serum adipokine levels and their relationship with fatty acids in patients with chronic periodontitis.

Adipokines are present in inflammatory processes and may be directly related to periodontal disease. Moreover, their activities may be regulated by fatty acids. The goal of this study was to quantify the concentrations of the main adipokines, leptin, adiponectin and resistin, and the docosahexaenoic (DHA), docosapentaenoic (DPA), eicosapentaenoic (EPA) and arachidonic (AA) fatty acids, in patients with generalized chronic periodontitis. As a secondary objective, the ratios of these substances in the blood of these patients were evaluated. The study included 15 systemically healthy patients with generalized chronic periodontitis (test group) and 15 patients with gingivitis (control group). Medical and periodontal parameters and blood samples were collected. Serum concentrations of fatty acids were analyzed by gas chromatography and adipokines by multiplex bead immunoassay. There was no significant difference in adipokines between groups. However, there was a tendency for lower values of adiponectin in periodontitis patients. Regarding the fatty acids, they were significantly higher in the test group compared with controls. The res/DHA, res/AA, adipon/DHA, adipon/AA and adipon/DPA ratios were significantly lower in the test group. There was no significant correlation between adipokines and clinical parameters and between adipokines and fatty acids levels. It was concluded that generalized chronic periodontitis patients showed significantly higher levels of fatty acids in comparison to gingivitis; adiponectin revealed a trend to lower values in the periodontitis group, even after Ancova correction. The ratios suggest a minor proportion of adiponectin and resistin in relation to the fatty acids in patients with generalized chronic periodontitis.

Serum Adipokine Levels and their Relationship with Fatty Acids in Patients with Chronic Periodontitis

Adipokines are present in inflammatory processes and may be directly related to periodontal disease. Moreover, their activities may be regulated by fatty acids. The goal of this study was to quantify the concentrations of the main adipokines, leptin, adiponectin and resistin, and the docosahexaenoic (DHA), docosapentaenoic (DPA), eicosapentaenoic (EPA) and arachidonic (AA) fatty acids, in patients with generalized chronic periodontitis. As a secondary objective, the ratios of these substances in the blood of these patients were evaluated. The study included 15 systemically healthy patients with generalized chronic periodontitis (test group) and 15 patients with gingivitis (control group). Medical and periodontal parameters and blood samples were collected. Serum concentrations of fatty acids were analyzed by gas chromatography and adipokines by multiplex bead immunoassay. There was no significant difference in adipokines between groups. However, there was a tendency for lower values of adiponectin in periodontitis patients. Regarding the fatty acids, they were significantly higher in the test group compared with controls. The res/DHA, res/AA, adipon/DHA, adipon/AA and adipon/DPA ratios were significantly lower in the test group. There was no significant correlation between adipokines and clinical parameters and between adipokines and fatty acids levels. It was concluded that generalized chronic periodontitis patients showed significantly higher levels of fatty acids in comparison to gingivitis; adiponectin revealed a trend to lower values in the periodontitis group, even after Ancova correction. The ratios suggest a minor proportion of adiponectin and resistin in relation to the fatty acids in patients with generalized chronic periodontitis.

As adipocinas estão presentes em processos inflamatórios e podem estar diretamente relacionadas à doença periodontal. Além disso, suas atividades podem ser reguladas pelos ácidos graxos. Este estudo teve como objetivo quantificar as concentrações das principais adipocinas, leptina, adiponectina e resistina, e dos ácidos graxos: ácido docosahexaenóico (DHA), ácido docosapentaenóico (DPA), ácido eicosapentaenóico (EPA) e ácido araquidônico (AA), em pacientes com periodontite crônica generalizada. Como objetivo secundário, avaliar as proporções destas substâncias no sangue desses pacientes. O estudo incluiu 15 pacientes sistemicamente saudáveis com periodontite crônica generalizada (grupo teste) e 15 com gengivite (grupo controle). Foram coletados parâmetros médicos e periodontais e amostras de sangue. As concentrações séricas dos ácidos graxos foram analisadas por cromatografia gasosa e as das adipocinas foram analisadas pelo método multiensaio multiplex. Não houve diferença significativa entre os níveis de adipocinas entre os grupos. No entanto, houve uma tendência para menores valores nos níveis da adiponectina nos pacientes com periodontite. Com relação aos ácidos graxos, os valores foram significativamente maiores no grupo teste em comparação com os controles. As razões entre res/DHA, res/AA, adipon/DHA, adipon/AA e adipon/DPA foram significativamente menores no grupo teste. Não houve correlação significativa entre as adipocinas e os parâmetros clínicos e entre os níveis de adipocinas e ácidos graxos. Conclui-se que pacientes com periodontite crônica generalizada apresentaram níveis significativamente maiores de ácidos graxos em relação à gengivite, adiponectina apresentou uma tendência a valores menores no grupo periodontite, mesmo após a correção de Ancova. Os resultados das razões sugerem uma menor proporção de adiponectina e resistina em relação aos ácidos graxos em pacientes com periodontite crônica generalizada.

Expressão do interferon-γ em biópsias gengivais de pacientes com periodontite crônica severa / Expression of interferon-γ in gingival biopsies from patients with severe chronic periodontitis

O objetivo desse estudo foi analisar a expressão do interferon gama (INF-γ) em biópsias gengivais de sítios rasos e profundos de pacientes com periodontite crônica severa, e correlacionar a expressão do INF- γ no fluido gengival. Foram coletadas biópsias de 22 sítios profundos, 18 sítios rasos e 14 sítios controles. O fluido gengival foi coletado de 12 sítios profundos e 8 sítios rasos. Profundidade de bolsa à sondagem (PB); nível de inserção clínica (NIC); índice de placa visível (IPV) e índice de sangramento gengival (ISG) foram avaliados. As análises morfológica e imuno-histoquímica dos tecidos removidos foram realizadas. A intensidade da marcação do INF- γ nos tecidos foi avaliada semiquantitativamente. Houve uma tendência a um padrão de marcação similar nos sítios rasos e profundos, com predomínio de marcação fraca nos sítios profundos. Não houve diferenças estatisticamente significantes entre os três grupos. Não houve correlação significante (Spearman) com a expressão do INF- γ nos tecidos epiteliais e conjuntivos com os dados clínicos e o fluido gengival. Concluímos que não foi possível observar diferenças na expressão do INF- γ em biópsias gengivais nos sítios rasos e profundos de pacientes com periodontite quando comparados à indivíduos saudáveis, o que pode ser atribuído ao caráter bifásico do INF- γ.

The aim of this study was to analyze the expression of interferon-gamma (INF-γ) in gingival biopsies from shallow and deep sites in patients with severe chronic periodontitis and correlate the expression of INF-γ in the gingival crevicular fluid (GCF). Biopsies were collected from 22 deep sites, 18 shallow sites and 14 control sites. The GCF samples were collected from 12 deep and 8 shallow sites. Probing pocket in the epithelial and connective tissues with the clinical data and with the GCF. We conclude that there were no differences in the expression of INF-γ in gingival biopsies in shallow and deep sites of pacients with periodontitis compared to healthy subjects, which may be attributed to the biphasic character of INF-γ.

Effects of nonsurgical periodontal treatment on the alveolar bone density.

The aim of this study was to evaluate the effects of nonsurgical periodontal treatment on alveolar bone density (ABD) and bone height (BH) using direct digital radiography. Nineteen patients (mean age: 36 ± 7.3 years) with generalized chronic periodontitis were examined at baseline, 90 (90 AT) and 180 (180 AT) days after nonsurgical periodontal therapy. Radiographs were taken from two sites with specific characteristics: 39 sites with probing pocket depth (PPD) ≤ 3 mm and clinical attachment level (CAL) ≤ 1 mm (shallow sites); and 62 sites with PPD ≥ 5 mm and CAL ≥ 3 mm (deep sites). The ABD was assessed considering the bone regions of interest at the alveolar bone crest (ROI I) and at the medullar bone (ROI II). The BH was assessed considering the distance from the alveolar bone crest to the cementoenamel junction. Mann-Whitney test was used for the overall demographic data, Wilcoxon test was used to compare the baseline, 90 AT and 180 AT data as well as to compare the groups and subgroups within the same evaluation period. The significance level was set at 5%. The deep sites showed a significant increase of ABD in ROI I at 90 AT (p<0.007) and at 180 AT (p<0.005). ABD decrease was seen in ROI II at 180 AT (p<0.04) while BH reduced only in shallow sites at 90 AT. In conclusion, an increase in ABD was observed in deep sites of patients with generalized chronic periodontitis. However, no significant change in alveolar BH was observed in these sites.

Effects of Nonsurgical Periodontal Treatment on the Alveolar Bone Density

The aim of this study was to evaluate the effects of nonsurgical periodontal treatment on alveolar bone density (ABD) and bone height (BH) using direct digital radiography. Nineteen patients (mean age: 36±7.3 years) with generalized chronic periodontitis were examined at baseline, 90 (90AT) and 180 (180AT) days after nonsurgical periodontal therapy. Radiographs were taken from two sites with specific characteristics: 39 sites with probing pocket depth (PPD)≤3 mm and clinical attachment level (CAL)≤1 mm (shallow sites); and 62 sites with PPD≥5 mm and CAL≥3 mm (deep sites). The ABD was assessed considering the bone regions of interest at the alveolar bone crest (ROI I) and at the medullar bone (ROI II). The BH was assessed considering the distance from the alveolar bone crest to the cementoenamel junction. Mann-Whitney test was used for the overall demographic data, Wilcoxon test was used to compare the baseline, 90AT and 180AT data as well as to compare the groups and subgroups within the same evaluation period. The significance level was set at 5%. The deep sites showed a significant increase of ABD in ROI I at 90AT (p<0.007) and at 180AT (p<0.005). ABD decrease was seen in ROI II at 180AT (p<0.04) while BH reduced only in shallow sites at 90AT. In conclusion, an increase in ABD was observed in deep sites of patients with generalized chronic periodontitis. However, no significant change in alveolar BH was observed in these sites.

O objetivo desse estudo foi avaliar os efeitos do tratamento periodontal não cirúrgico na densidade do osso alveolar e na altura óssea alveolar usando radiografias digitais diretas. Dezenove pacientes (média de idade 36±7,3 anos) com pacientes com periodontite crônica generalizada foram examinados no tempo 0 e aos 90 (90AT) e 180 (180AT) dias após o tratamento periodontal não cirúrgico. Dois grupos de sítios foram radiografados, 39 com profundidade de bolsa a sondagem (PBS)≤3 mm e nível de inserção clínica (NIC)≤1 mm (sítios rasos) e 62 com PBS≥5 mm and NIC≥3 mm (sítios profundos). A densidade foi avaliada considerando as regiões ósseas de interesse na crista óssea alveolar (ROI I) e no osso medular (ROI II). A altura óssea compreendia a distância entre a crista óssea alveolar e a junção cemento-esmalte. Os sítios profundos mostraram um significante aumento na densidade óssea na ROI I tendo p<0,007 em 90AT e p<0,005 em 180AT. Uma redução na densidade óssea foi vista na ROI II 180AT (p<0,04) enquanto a altura óssea reduziu somente nos sítios rasos 90 AT. Como conclusão, um aumento na densidade foi observado na crista óssea alveolar de sítios profundos em pacientes com periodontite. No entanto, nenhuma alteração significante na altura óssea alveolar foi observada nesses sítios.

Effects of non-surgical periodontal treatment on the L-arginine-nitric oxide pathway and oxidative status in platelets.

Several studies have suggested an increase of cardiovascular disease (CVD) risk on periodontitis patients. An enhancement has been demonstrated on both platelet activation and oxidative stress on periodontitis patients, which may contribute for this association. Therefore, the aim of this study was to evaluate the effects of non-surgical periodontal treatment on the l-arginine-nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway and oxidative status in platelets. A total of eight periodontitis patients and eight controls were included in this study. Clinical, laboratory and experimental evaluations were performed on baseline and 90 days after periodontal treatment (except for western blot analysis). The clinical periodontal evaluation included measurements of probing pocket depth (PPD), clinical attachment loss (CAL), % of sites with plaque and % of sites with bleeding on probing. We evaluated: l-[(3)H]arginine influx; nitric oxide synthase (NOS) and arginase enzymes activity and expression; expression of guanylate cyclase and phosphodiesterase-5 enzymes; cGMP levels; platelet aggregation; oxidative status through superoxide dismutase (SOD) and catalase activities, and measurement of reactive oxygen species (ROS) levels and C-reactive protein (CRP) levels. The initial results showed an activation of both l-arginine influx and via system y (+ )L associated with reduced intraplatelet cGMP levels in periodontitis patients and increased systemic levels of CRP. After periodontal treatment, there was a significant reduction of the % of sites with PPD 4-5mm, % of sites with CAL 4-5 mm, and an enhancement in cGMP levels and SOD activity. Moreover, CRP levels were reduced after treatment. Therefore, alterations in the intraplatelet l-arginine-NO-cGMP pathway and oxidant-antioxidant balance associated with a systemic inflammatory response may lead to platelet dysfunction, which may contribute to a higher risk of CVD in periodontitis.