Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study.

BACKGROUND AND OBJECTIVE: The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. MATERIAL AND METHODS: This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. RESULTS: There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). CONCLUSION: Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.

Proteomic analysis of Porphyromonas gingivalis exposed to nicotine and cotinine.

BACKGROUND AND OBJECTIVE: Smokers are more predisposed than nonsmokers to infection with Porphyromonas gingivalis, one of the most important pathogens involved in the onset and development of periodontitis. It has also been observed that tobacco, and tobacco derivatives such as nicotine and cotinine, can induce modifications to P. gingivalis virulence. However, the effect of the major compounds derived from cigarettes on expression of protein by P. gingivalis is poorly understood. Therefore, this study aimed to evaluate and compare the effects of nicotine and cotinine on the P. gingivalis proteomic profile. MATERIAL AND METHODS: Total proteins of P. gingivalis exposed to nicotine and cotinine were extracted and separated by two-dimensional electrophoresis. Proteins differentially expressed were successfully identified through liquid chromatography-mass spectrometry and primary sequence databases using MASCOT search engine, and gene ontology was carried out using DAVID tools. RESULTS: Of the approximately 410 protein spots that were reproducibly detected on each gel, 23 were differentially expressed in at least one of the treatments. A particular increase was seen in proteins involved in metabolism, virulence and acquisition of peptides, protein synthesis and folding, transcription and oxidative stress. Few proteins showed significant decreases in expression; those that did are involved in cell envelope biosynthesis and proteolysis and also in metabolism. CONCLUSION: Our results characterized the changes in the proteome of P. gingivalis following exposure to nicotine and cotinine, suggesting that these substances may modulate, with minor changes, protein expression. The present study is, in part, a step toward understanding the potential smoke-pathogen interaction that may occur in smokers with periodontitis.

Association of polymorphisms in the carbonic anhydrase 6 gene with salivary buffer capacity, dental plaque pH, and caries index in children aged 7-9 years.

Carbonic anhydrase VI is a secreted enzyme that catalyzes the hydration of carbon hydroxide in saliva and other body fluids. This enzyme has been implicated in taste and gastrointestinal dysfunctions, tooth erosion, and caries. The purpose of this study was to analyze the allele and genotype distribution of three polymorphisms in the coding sequences of (CA6) gene and check for possible associations with salivary buffer capacity, number of decayed, missing, and filled teeth in deciduous and permanent teeth (dmft/DMFT, Decayed/Missing/Filled Teeth), plaque index (PI), and the plaque pH variation (DeltapH) in children aged 7-9 years. Two hundred and forty-five children from both genders, residents in area with fluoridated water (Piracicaba, São Paulo, Brazil) were divided into two groups: caries free and with caries. The clinical examinations were conducted by a single previously calibrated examiner (kappa=0.91) in an outdoor setting using a mirror and a probe, according to WHO criteria index (dmft/DMFT). Approximately 2 h after the first daily meal, the buffer capacity (BC) and the plaque pH were analyzed by means of a pH meter and an ion selective electrode. Plaque pH was measured immediately and 5 min after a mouth rinse with a 10% sucrose solution. The data were submitted to chi(2), Student's, and Mann-Whitney tests (alpha=0.05). The PI and DeltapH of the upper and lower teeth were significantly higher in the carious group than control (P<0.05). There was no difference between the groups in relation to BC. There was no association between the alleles and genotypes distributions for polymorphisms in the CA6 gene exons 2 and 3 and caries experience (P>0.05). There was a positive association between buffer capacity and the rs2274327 (C/T) polymorphism. The allele T and genotype TT were significantly less frequent in individuals with the highest buffer capacity (P=0.023 and 0.045, respectively). This finding encourages future studies relating CA6 gene polymorphisms and their association with malfunctions, such as taste and gastrointestinal alterations, or the differential effect of chemical modulators on the protein products originated from the distinct genotypes of the CA6 gene.

Comparison of the effects of pilocarpine and cevimeline on salivary flow.

OBJECTIVE: The aim of the present study was to compare the effect of low-dose pilocarpine and cevimeline as stimulants for salivary flow in healthy subjects. METHODS: In this cross-over clinical trial with a 1-week washout period, 40 male volunteers were submitted to an oral dose of pilocarpine 1% (Salagen) -60 microg kg(-1) body-weight (Group 1) or Cevimeline (Evoxac) -30 mg (Group 2). Saliva samples were collected and the salivary flow rate was measured (ml min(-1)) at baseline and 20, 40, 60, 80, 140 and 200 min after administration of drugs. In addition, salivary secretion was also measured under mechanical stimulation to observe salivary gland function. RESULTS: The data were analyzed by Friedman and Wilcoxon signed-rank tests (significance level = 5%). Pilocarpine and cevimeline significantly increased salivary flow 140 min after intake. There was a significant higher secretion with cevimeline 140 and 200 min after administration. There were no differences seen among subjects in the salivary glands function by mechanical stimulation. CONCLUSION: Both drugs showed efficacy in increasing the salivary flow in healthy volunteers, but cevimeline was more effective than pilocarpine.