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Aims and Objectives: The aim of this study was to evaluate whether periodontal disease (PD) moderates the association between complex multimorbidity (MM) and fair/poor general health in a US representative sample of older individuals. Materials and Methods: This study identified 937 participants who were at least 60 years of age from the 2013-2014 National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to estimate the association between complex MM (including chronic conditions, functional limitations, and geriatric syndromes) and self-reported fair/poor general health. Subsequently, we specified interactions between complex MM and PD to determine whether PD moderates the effect of complex MM on fair/poor general health. Results: Nineteen percent of participants reported fair/poor general health. Complex MM was associated with 2.2 times greater odds of self-reported fair/poor health. However, PD was neither independently associated with fair/poor health nor an effect modifier for the association between complex MM and fair/poor general health. Age, white race, those with at least a high-school education level, a family income-to-poverty ratio of at least 2, former smoking status, and being married were significantly associated with fair/poor general health. Conclusion: Complex MM, but not PD, was associated with greater odds to report fair/poor general health, and PD did not moderate the association between complex MM and fair/poor general health. People with complex MM are more likely to have worse general health; however, PD did not strengthen this association. Further studies are needed to evaluate whether treatment for PD for people vulnerable to the development of complex MM has a positive effect on their general health.
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BACKGROUND: Birt-Hogg-Dubé (BHD) syndrome is a rare genetic syndrome caused by pathogenic or likely pathogenic germline variants in the FLCN gene. Patients with BHD syndrome have an increased risk of fibrofolliculomas, pulmonary cysts, pneumothorax and renal cell carcinoma. There is debate regarding whether colonic polyps should be added to the criteria. Previous risk estimates have mostly been based on small clinical case series. METHODS: A comprehensive review was conducted to identify studies that had recruited families carrying pathogenic or likely pathogenic variants in FLCN. Pedigree data were requested from these studies and pooled. Segregation analysis was used to estimate the cumulative risk of each manifestation for carriers of FLCN pathogenic variants. RESULTS: Our final dataset contained 204 families that were informative for at least one manifestation of BHD (67 families informative for skin manifestations, 63 for lung, 88 for renal carcinoma and 29 for polyps). By age 70 years, male carriers of the FLCN variant have an estimated 19% (95% CI 12% to 31%) risk of renal tumours, 87% (95% CI 80% to 92%) of lung involvement and 87% (95% CI 78% to 93%) of skin lesions, while female carriers had an estimated 21% (95% CI 13% to 32%) risk of renal tumours, 82% (95% CI 73% to 88%) of lung involvement and 78% (95% CI 67% to 85%) of skin lesions. The cumulative risk of colonic polyps by age 70 years old was 21% (95% CI 8% to 45%) for male carriers and 32% (95% CI 16% to 53%) for female carriers. CONCLUSIONS: These updated penetrance estimates, based on a large number of families, are important for the genetic counselling and clinical management of BHD syndrome.
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Síndrome de Birt-Hogg-Dubé , Carcinoma de Células Renais , Pólipos do Colo , Neoplasias Renais , Humanos , Masculino , Feminino , Idoso , Síndrome de Birt-Hogg-Dubé/genética , Síndrome de Birt-Hogg-Dubé/patologia , Penetrância , Proteínas Proto-Oncogênicas/genética , Proteínas Supressoras de Tumor/genética , Neoplasias Renais/epidemiologia , Neoplasias Renais/genética , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/genéticaRESUMO
OBJECTIVE: To identify complex multimorbid conditions, including chronic conditions, functional limitations and geriatric syndromes, associated with the presence and severity of periodontal disease (PD), after accounting for a series of demographic and behavioural characteristics. DESIGN: This cross-sectional study used secondary data from a nationally representative sample, classification and regression tree analysis and random forest identified combinations of specific conditions constituting complex multimorbidity associated with the presence and severity of PD. SETTING: US National Health and Nutritional Examination Survey (2013-2014). PARTICIPANTS: Individuals 60 years of age or older who completed a periodontal examination. RESULTS: Among 937 participants aged 60 and over, the prevalence of PD was 72.6%. PD was associated with sociodemographic factors and limitations in instrumental activities of daily living. Male sex and non-white race were the two most critical predictors of stage III/IV PD. Other important factors included age, education level and the federal poverty level. CONCLUSIONS: Rather than chronic conditions or geriatric syndromes, PD was associated with sociodemographic factors and functional limitations. Accounting for the co-occurrence of sociodemographic and functional limitations will help recognise older adults who are at an increased vulnerability to the severity of PD.
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Atividades Cotidianas , Doenças Periodontais , Idoso , Doença Crônica , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Multimorbidade , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , SíndromeRESUMO
Objective: This study aimed to identify combinations of chronic conditions associated with the presence and severity of periodontal disease (PD) after accounting for a series of demographic and behavioral characteristics in a nationally representative sample of US adults. Materials and Methods: A cross-sectional study of the 2013-2014 National Health and Nutrition Examination Survey (n = 4555). Outcome measure: PD using clinical attachment loss (measured as none, mild, moderate, or severe). The main independent variables were self-reported chronic conditions, while other covariates included demographic and behavioral variables. Classification and regression tree analysis was used to identify combinations of specific chronic conditions associated with PD and PD with higher severity. Random forest was used to identify the most important variables associated with the presence and severity of PD. Results: The prevalence of PD was 77% among the study population. The percentage of those with PD was higher among younger and middle-aged (< 61 years old) than older (> 61 years old) adults. Age and education level were the two most important predictors for the presence and severity of PD. Other significant factors included alcohol use, type of medical insurance, sex, and non-white race. Accounting for only chronic conditions, hypertension and diabetes were the two chronic conditions associated with the presence and severity of PD. Conclusions: Sociodemographic and behavioral factors emerged as more strongly associated with the presence and severity of PD than chronic conditions. Accounting for the co-occurrence for sociodemographic and behavioral factors will be informative for identifying people vulnerable to the development of PD.
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Background Intraprostatic inflammation is frequently observed in the prostate and linked to prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and cancer. The etiology of prostate diseases is unclear. Periodontal diseases are associated with an increased risk of prostate diseases. In men, chronic prostatitis and moderate/severe periodontitis have significantly elevated serum prostate-specific antigen (PSA) levels. Treatment of periodontal disease reduced PSA levels in men. The presence of periodontal pathogens deoxyribonucleic acid (DNA) was identified in the prostate fluid of prostatitis patients. These pathogenic bacteria might have the potential to trigger prostatitis progressing to prostatic adenocarcinoma. The mechanism(s) explaining the etiology of association between periodontal disease and prostate cancer remains unclear. However, the presence of periodontal pathogens has not been analyzed in the prostate gland. Objective To identify and compare the presence of specific periodontal pathogens in the areas of BPH, inflammation, and cancer of the prostate glands diagnosed with malignancy. Materials and methods Whole-mount radical prostatectomy sections from men (n=30) were identified for BPH, inflammation, and cancer areas and marked for tissue procurement. The tissues were subjected to DNA isolation and analysis of microbial DNA and total bacterial load for the following pathogens, including Porphyromonas gingivalis strain ATCC 33277, Prevotella intermedia strain B422, Treponema denticola strain 35405, Fusobacterium nucleatum subsp. fusiform strain, Tannerella forsythia strain ATCC 43037, and Campylobacterâââââââ rectus strain ATCC 33238performed real-time PCR. The universal bacterial primer pairs were used to detect genomic DNA (gDNA) from the total bacteria present in the samples. All species-specific primers were designed to target the variable regions of the 16S ribosomal RNA (rRNA). Data were analyzed using the 2-ΔΔCT method, statistically validated using unpaired t-test and ANOVA test. Results A total of 90 samples of prostate tissue specimens were analyzed for periodontal pathogens; only one pathogen (F. nucleatum subsp. fusiform strain ATCC 51190) showed a significant difference compared to the expression of S. epidermidis (internal control). In particular, F. nucleatum expression was 9, 11.9, and 10.3-fold higher in BPH, inflammation, and cancer, respectively, at p-value <0.05. Moreover, the bacterial load abundance/expression was almost similar in BPH (46.8-fold), inflammation (40.9 fold), and cancer (41.5 fold) higher. There was no significant difference in bacterial load (folder change) among the three areas of BPH, inflammation, and cancer (p-valve>0.05). Similarly, there was no significant difference between F. nucleatum (folder change) among the three areas (p-valve>0.05). Conclusion Fusobacterium nucleatum is identified in the prostates that harbor cancer, chronic inflammation, and BPH.
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INTRODUCTION: Glycogen storage diseases (GSD) are genetic metabolic disorders of glycogen metabolism. There are >15 types based on the enzyme deficiency and the affected organ. Glycogen storage disease Type Ib is the only type associated with neutropenia and periodontitis. This type is caused by a deficiency of glucose-6-phosphate (G6P) translocase which prevents the transport of G6P across the endoplasmic reticulum. As a result, glycogen cannot be metabolized into glucose with its subsequent accumulation in tissues. The affected organs involved in Type Ib are the liver, kidney, and intestine. CASE PRESENTATION: A 5-year-old Jordanian boy from a consanguineous family referred to the periodontal clinic in February 2014 with an established diagnosis of GSD-Ib. The systemic manifestations include hepatomegaly, hypoglycemia, hyperprolactenemia, inflammatory bowel disease, osteoporosis, and neutropenia. Oral manifestations include severe gingival inflammation and recurrent oral ulceration disease. CONCLUSIONS: The clinical signs and symptoms of periodontal disease in GSD Type Ib are similar to those found in patients diagnosed with neutropenia. Future studies are needed to clarify whether severe generalized inflammation of the gingiva in children is part of the GSD Type Ib or is a separate entity caused by neutrophil dysfunction.
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Doença de Depósito de Glicogênio Tipo I , Neutropenia , Doenças Periodontais , Criança , Pré-Escolar , Doença de Depósito de Glicogênio Tipo I/complicações , Doença de Depósito de Glicogênio Tipo I/diagnóstico , Humanos , Rim , Fígado , Masculino , Neutropenia/diagnóstico , Doenças Periodontais/complicações , Doenças Periodontais/diagnósticoRESUMO
PURPOSE: To assess the pattern of bone loss in peri-implantitis in partially edentulous patients and relate patient and implant/site characteristics that may influence such patterns. MATERIALS AND METHODS: In this retrospective study, the records of partially edentulous patients with dental implants were stratified according to sex, age, smoking, and diabetes. Implants were stratified according to site, number of years in function, presence of adjacent implants, diameter, bone-grafted site, and implant platform. All these variables were obtained from previous periodontal charts and radiographs. The implants were then classified into two main groups: (1) bone loss as defined by the presence of progressive marginal bone change found on radiographs at least 12 months following prosthesis placement compared to a baseline with a threshold ≥ 2 threads of bone loss; and (2) no bone loss as defined by no detected bone change or bone level change with a threshold < 2 threads. The bone loss group was further divided into three subgroups according to pattern: vertical, horizontal, and combined. Descriptive analyses were applied to assess the frequency of the pattern of bone loss (horizontal, vertical, and combined). A statistical regression model was used to find if there was a significant correlation between patient/implant characteristics and the pattern of bone loss. RESULTS: A total of 304 charts with 540 implants met the inclusion criteria. One randomly selected implant per patient through Microsoft Excel software was included in this study. Of these, 157 (51.6%) of examined charts were men and 147 (48.4%) were women. The patients' mean age was 63.9 ± 11.4 years (range: 27 to 85 years) at implant placement, and implants had been in function for 12 to 120 months (median: 37 months). The percentage of implants that had bone loss was 24.7% (75 out of 304). The pattern of bone loss was 65%, 22%, and 13% for vertical, horizontal, and combined, respectively. Implants that had been placed in surgically bone-grafted sites had increased odds of vertical bone loss with either narrow or wide implants (OR = 2.5 [P = .04] and 3.1 [P = .01], respectively). The presence of adjacent implants had significantly (P = .003) increased odds of horizontal bone loss (OR = 5.1). CONCLUSION: Approximately one-quarter of dental implants (24.7%) developed bone loss beyond normal physiologic remodeling. Vertical bone loss around single implants was the most common pattern (65%), particularly around implants placed in bone-grafted sites with odds ratio of 2.5 for narrow implants vs 3.1 for wide implants. In the presence of adjacent implants, the odds of horizontal bone loss was 5.1 (P = .003).
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Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: The impact of radical surgery for urothelial carcinoma is significant on patient's quality of life. Organ-sparing surgery (OSS) can provide comparable oncological outcomes and with improved quality of life. In this review, we summarize the indications, techniques and outcomes of OSS for these tumors. METHODS: PubMed® was searched for relevant articles. Keywords used were: for upper tract urothelial carcinoma (UTUC): endoscopic, ureteroscopic/percutaneous management, laser ablation; for urothelial bladder cancer: bladder preservation, trimodal therapy, muscle invasive bladder cancer (MIBC); for urethral cancer: urethra/penile-sparing, urethral carcinoma. RESULTS: Kidney-sparing surgery is an option in patients with low-risk UTUC with better renal function preservation and comparable oncological control to radical nephroureterectomy. In select patients with MIBC, trimodal therapy has better quality of life and comparable oncological control to radical cystectomy. In distal male urethral cancer, penile conserving surgery is feasible and offers acceptable survival outcomes. In female urethral cancer, organ preservation can be achieved, in addition to OSS, through radiation. CONCLUSIONS: In the appropriately selected patient, OSS in upper tract, bladder and urethral carcinoma has comparable oncological outcomes to radical surgery and with the additional benefit of improved quality of life.
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Carcinoma de Células de Transição/terapia , Tratamentos com Preservação do Órgão/métodos , Neoplasias Ureterais/terapia , Neoplasias da Bexiga Urinária/terapia , Humanos , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVE: Salvage surgery (SS) for penile cancer (PC) is indicated in the management of local failure following radiation therapy (RT). Reports describing survival outcome are rare. This study aims to assess survival outcome of SS following RT failure in PC. MATERIALS AND METHODS: We used The Surveillance, Epidemiology, and End Results database to identify patients received SS on the penis following RT. Social, demographic and pathological criteria of the patients were gathered. The 1-, 3-, 5-, 10-year survival rates were assessed. RESULTS: Between 1976 and 2013, 17 patients received penile SS following RT. Median age was 65 years (range 47-91 years). The mean follow-up was 51 months (range 3-213 months). Sixteen (94.12%) patients received external beam radiation and 1 (5.88%) received combined external beam radiation with brachytherapy. Tumor histology was squamous cell carcinoma in 16 (94.12%) patients and mucinous adenocar-cinoma in 1 (5.88%). The 1-, 3-, 5- and 10-year overall survival rates were 68.8, 35.7, 35.7 and 10.7%, respectively. The 1-, 3-, 5- and 10-year cancer specific survival rate was 72.7, 48.4, 48.4, and 36.3% respectively. CONCLUSION: Our results demonstrate, the overall survival of PC patients underwent SS was poor with nearly one third of patients dying within the first year and only one third surviving up to 3 years from the SS.
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PURPOSE: Organ-sparing surgery (OSS) is recommended in selected patients with testicular tumors and penile cancer (PC). The functional and psychological impacts of organ excision for these genital tumors are profound. In this review, we summarize the indications, techniques and outcomes of OSS for these two tumors. METHODS: PubMed® was searched for relevant articles up to December 2018. For Testicular sparing surgery (TSS) search, keywords used were; testicular tumors alone and in combination with "testicular sparing surgery", "partial orchiectomy" and outcomes. For penile conserving surgery (PCS), keywords used were: penile cancer alone and in combination with "penile conserving surgery", "partial penectomy" and outcomes. Because of the low quality of available evidence, a narrative rather that systematic review has been performed. RESULTS: Indications of TSS are tumors ≤ 2 cm in solitary testis or bilateral tumors and no rete testis invasion. Prerequisites include normal testosterone and luteinizing hormone levels and patient compliance with follow-up. Indications for PCS are distal penile lesions with clinical stage ≤ T1. Adequate penile stump (3 cm) is required after surgery to maintain forward urine stream. Frozen section helps to reduce the risk of recurrence. Local recurrence after PCS is not associated with reduced survival and can be managed with another PCS in selected patients. The reported oncological and functional outcomes following TSS and PCS are adequate. CONCLUSIONS: In properly selected patient OSS in testicular and penile tumors has a comparable oncological outcome to total organ excision with added advantages of preserving organ function and psychological well-being.
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Tratamentos com Preservação do Órgão/métodos , Neoplasias Penianas/cirurgia , Neoplasias Testiculares/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Urológicos Masculinos/métodosRESUMO
PURPOSE: To study regional trends in average years of potential life lost (AYPLL) among Caucasians (CA) and African Americans (AA) with prostate cancer (Pca) who received radical prostatectomy or radiation therapy among four different regions in the US as well as across different tumor grades. Years of potential life lost is defined as the difference between a predetermined end-point age and the age at death for a death that occurred prior to that end age, hence the AYPLL is calculated by dividing the total YPLL by the total number of patients died. METHODS: The surveillance epidemiology and end results (SEER) database was used to identify Pca patients who were CA or AA and who have received radical prostatectomy or radiation therapy. Study duration was divided into four decades; 1973-1982 (D1), 1983-1992 (D2), 1993-2002 (D3), 2003-2012 (D4). Examined regions were; North East (NE), North central (NC), South and West. Tumor grade was classified into; well/moderately differentiated (WD/MD) and poorly/undifferentiated (PD/UD) groups. Differences in AYPLL among CA and AA in each of these variables were compared. RESULTS: Overall, compared to CA, AA were diagnosed and died earlier from Pca. AA had higher AYPLL to Pca than CA. In both tumor grade groups, progressive increase in AYPLL among AA compared to CA was noted over the last three decades. In the WD/MD group, except for the South region, the highest recorded difference in AYPLL between AA and CA was in D4. In the PD/UD group, a similar difference in AYPLL between AA and CA was noted in all regions. The difference in AYPLL was higher in the PD/UD group than the WD/MD group. CONCLUSIONS: Racial disparity between AA and CA existed across the examined regions. It is more pronounced in advanced tumor grades. The differences were more significant in the last decade.
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Negro ou Afro-Americano/estatística & dados numéricos , Expectativa de Vida/tendências , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , População Branca/estatística & dados numéricos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prostatectomia , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/patologia , Radioterapia , Programa de SEER , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Chronic inflammation and infections are associated with increased risk of prostate cancer development. There is considerable evidence that proves the interrelationship between bacterial/viral infections and carcinogenesis. Periodontitis is a chronic inflammatory disease triggered by gram-negative anaerobic bacteria. In this narrative review, we investigate the relationship between periodontal disease and prostate cancer by reviewing previous studies of the association and possible mechanisms that may explain this link. METHODS: A comprehensive search for articles published was performed using the key words, "periodontal disease", "prostate disease", "prostate cancer", "prostatic inflammation". Thorough reviews of each study were conducted and assessed for eligibility, and data was summarized. RESULTS: The role of inflammatory responses in the prostate as drivers of malignancy appears to be predisposed by periodontal pathogens and/or periodontitis inflammatory mediators. CONCLUSION: Periodontal diseases might be associated with prostate cancer. However, the mechanism(s) explaining this relationship remains unclear and requires further elucidation.
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PURPOSE: Organ-sparing surgery (OSS) for the kidney and adrenals has emerged as the need for preservation of function is paramount in patients with poor functional reserve. As reports increasingly showed that oncological outcomes were equivalent to radical excision, elective OSS became a viable alternative in patients with otherwise normal reserve. In this review, we summarize the current knowledge of OSS for adrenal and renal tumors. MATERIALS AND METHODS: PubMed, Web of Science and Cochrane Library Central Search were searched for recently published articles up to December 2017. The following keywords were used; "partial adrenalectomy", "adrenal sparing", "partial nephrectomy", "nephron sparing", "kidney/renal cancer". RESULTS: Partial adrenalectomy became an attractive alternative to total adrenalectomy avoiding adrenal insufficiency. Both minimally invasive surgery and ablative techniques were increasingly reported for adrenal OSS with adequate residual adrenal function and excellent oncological outcome. Radical nephrectomy remained for many years as the gold standard of treatment for organ-confined renal cell carcinoma. As the need to reduce the impact on renal function, more conservative approaches were utilized. Soon, the non-inferiority of nephron-sparing surgery to that of radical excision became evident and elective partial nephrectomy was gaining ground as the standard of care for small renal masses in patients with normal contralateral kidneys. CONCLUSIONS: Herein, we present a comprehensive review of the current status of OSS in renal and adrenal tumors.
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Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Tratamentos com Preservação do Órgão , Técnicas de Ablação , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/fisiopatologia , Humanos , Rim/fisiopatologia , Neoplasias Renais/patologia , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do TratamentoRESUMO
BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Placa Dentária , Gengivite , Doenças Periodontais , Periodontite , Consenso , Estética Dentária , HumanosRESUMO
BACKGROUND: Mucogingival deformities, and gingival recession in particular, are a group of conditions that affect a large number of patients. Since life expectancy is rising and people are retaining more teeth both gingival recession and the related damages to the root surface are likely to become more frequent. It is therefore important to define anatomic/morphologic characteristics of mucogingival lesions and other predisposing conditions or treatments that are likely to be associated with occurrence of gingival recession. OBJECTIVES: Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene. The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions. The objectives of this review are as follows (1) to propose a clinically oriented classification of the main mucogingival conditions, recession in particular; (2) to define the impact of these conditions in the areas of esthetics, dentin hypersensitivity and root surface alterations at the cervical area; and (3) to discuss the impact of the clinical signs and symptoms associated with the development of gingival recessions on future periodontal health status. RESULTS: An extensive literature search revealed the following findings: 1) periodontal health can be maintained in most patients with optimal home care; 2) thin periodontal biotypes are at greater risk for developing gingival recession; 3) inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession; 4) in the absence of pathosis, monitoring specific sites seems to be the proper approach; 5) surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients. CONCLUSIONS: The clinical impact and the prevalence of conditions like root surface lesions, hypersensitivity, and patient esthetic concern associated with gingival recessions indicate the need to modify the 1999 classification. The new classification includes additional information, such as recession severity, dimension of the gingiva (gingival biotype), presence/absence of caries and non-carious cervical lesions, esthetic concern of the patient, and presence/absence of dentin hypersensitivity.
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Dentição , Retração Gengival , Adulto , Estética Dentária , Gengiva , Humanos , Retalhos CirúrgicosRESUMO
BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Gengivite , Peri-Implantite , Doenças Periodontais , Periodontite , Consenso , Estética Dentária , HumanosRESUMO
BACKGROUND: Mucogingival deformities, and gingival recession in particular, are a group of conditions that affect a large number of patients. Since life expectancy is rising and people are retaining more teeth both gingival recession and the related damages to the root surface are likely to become more frequent. It is therefore important to define anatomic/morphologic characteristics of mucogingival lesions and other predisposing conditions or treatments that are likely to be associated with occurrence of gingival recession. OBJECTIVES: Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene. The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions. The objectives of this review are as follows (1) to propose a clinically oriented classification of the main mucogingival conditions, recession in particular; (2) to define the impact of these conditions in the areas of esthetics, dentin hypersensitivity and root surface alterations at the cervical area; and (3) to discuss the impact of the clinical signs and symptoms associated with the development of gingival recessions on future periodontal health status. RESULTS: An extensive literature search revealed the following findings: 1) periodontal health can be maintained in most patients with optimal home care; 2) thin periodontal biotypes are at greater risk for developing gingival recession; 3) inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession; 4) in the absence of pathosis, monitoring specific sites seems to be the proper approach; 5) surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients. CONCLUSIONS: The clinical impact and the prevalence of conditions like root surface lesions, hypersensitivity, and patient esthetic concern associated with gingival recessions indicate the need to modify the 1999 classification. The new classification includes additional information, such as recession severity, dimension of the gingiva (gingival biotype), presence/absence of caries and non-carious cervical lesions, esthetic concern of the patient, and presence/absence of dentin hypersensitivity.
Assuntos
Dentição , Retração Gengival , Adulto , Estética Dentária , Gengiva , Humanos , Retalhos CirúrgicosRESUMO
OBJECTIVE: To compare postoperative pain associated with palatal and tuberosity donor sites for soft tissue grafting, and to evaluate the outcomes in both the donor and recipient sites. METHOD AND MATERIALS: Twenty healthy nonsmokers requiring bilateral soft tissue grafts were recruited for the study. For the 10 patients who required free gingival graft (FGG), 10 epithelialized grafts were taken from the tuberosity and 10 from the palate. The other 10 patients who required coronally advanced flap (CAF) and connective tissue graft (CTG) received 10 de-epithelialized grafts from the tuberosity and 10 from the palate. A total of 20 receded areas were treated with CAF and CTG. A total of 20 mucogingival defects were treated by FGG. Pain level was reported by the patient using a subjective score on a scale of 0 to 10 (0 = no pain, 10 = very severe pain). The length, width, and thickness of the outcome was measured for the FGG group at 8 weeks. The percentage of root coverage along with the length, width, and thickness of the final outcome was measured for the FGG group as well as the CAF and CTG group. RESULTS: Pain level in the tuberosity donor site was significantly lower than in the palatal donor site during the first 2 postoperative weeks (2.6 ± 2.16 versus 5.9 ± 2.74 respectively, P < .001). Mean gingival thickness of the healed tuberosity donor graft was greater than of the palatal donor grafts in both groups; for CAF and CTG group 2.9 ± 0.5 versus 2.3 ± 0.6 mm, respectively (P = .016); for FGG group 2.7 ± 0.7 versus 2.1 ± 0.7, respectively (P = .026). No differences were observed in the length or width of both grafted sites at an 8-week follow-up. No significant difference in the mean percentage of root coverage resulting from tuberosity or palatal donor sites was noted (67 ± 12% versus 62 ± 13%, respectively, P = .102). CONCLUSION: Soft tissue grafts harvested from the tuberosity site might provide a better option than soft tissue donor grafts obtained from the palate in terms of function and less postoperative pain.