Selective outcome reporting bias is highly prevalent in randomized clinical trials of nonsurgical periodontal therapy.

Selective outcome reporting (SOR) is a type of bias that can compromise the validity of results and affect evidence-based practice. SOR can overestimate the effect of an intervention and lead to conclusions that a treatment is effective when it is not. This study aimed to investigate the prevalence of SOR in publications of RCTs on nonsurgical periodontal therapy (NSPT) and to verify associated factors. The protocols were searched and selected on the www.clinicaltrials.gov platform up to January 16, 2022. Corresponding publications were identified, and data extraction and discrepancy analysis were performed. The risk of bias was assessed according to the RoB2 tool. One hundred forty-five studies (174 publications) were included. The prevalence of SOR was 49.7% and was unclear in nearly one third of studies (27.6%). Only 31.7% of the primary outcomes were completely described in the publications. The overall risk of bias was high in 60% of the included studies. SOR was associated with statistical significance (p < .001), and multiple publications of the same study (p = .005). Our study demonstrated the high prevalence of SOR, highlighting the need to improve the quality of reporting of RCTs on NSPT studies.

Effects of periodontitis and periodontal treatment on systemic inflammatory markers and metabolic profile in obese and non-obese rats.

BACKGROUND: Little is known about a synergistic effect of periodontitis and obesity on systemic biomarkers and a possible effect periodontal treatment may exert. This study aimed to evaluate the impact of periodontitis and periodontal treatment on systemic inflammation and metabolic profile in obese and non-obese rats. METHODS: Sixty male Wistar rats were randomly divided in six groups differentiated by diet and periodontal status: no periodontitis (G1 and G4), untreated ligature-induced periodontitis (G2 and G5), and treated ligature-induced periodontitis (G3 and G6). Groups G4, G5, and G6 were exposed to cafeteria diet to induce obesity. Periodontitis was induced by silk ligatures over 4 weeks (G2, G3, G5, and G6). Rats in G3 and G6 received scaling and root planing and were followed for additional 4 weeks. After sacrifice, serum levels of C-reactive protein (CRP), interleukin (IL)-1ß, IL-6, IL-10, IL-17a, tumor necrosis factor alfa (TNF-α), glucose, triglycerides, and total cholesterol (TC) were compared between groups. RESULTS: CRP was significantly higher in obese rats with than without periodontitis (G5 = 10.15 versus G4 = 4.47 µg/L, P = 0.01). No beneficial effects of periodontal treatment were observed for CRP levels, IL-6, IL-1ß, IL-17a, and TNF-α, glucose and triglycerides. Treated periodontitis (G6) exhibited significantly lower TC than the periodontitis group (G5) in obese rats. CONCLUSION: Periodontitis increased serum CRP in obese rats, indicating a synergistic role of periodontitis in the systemic inflammatory burden triggered by obesity. The treatment of induced periodontitis reduced TC levels in obese rats.

Sun protection as a protective factor for actinic cheilitis: Cross-sectional population-based study.

OBJECTIVE: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. MATERIALS AND METHODS: A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. RESULTS: Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. CONCLUSIONS: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.

Virucidal efficacy of chlorhexidine: a systematic review.

This study aimed to systematically review the literature about the virucidal efficacy of CHX in comparison to other substances used in the oral cavity. Electronic searches were performed in four databases (PubMed, Scopus, Embase, and Web of Science). Only studies that presented the following characteristics were included: (1) verified virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1), any Influenza, or any human coronavirus (HcoV); and (2) compared the virucidal efficacy of CHX with essential oils (Listerine®), quaternary ammonium compounds, povidone-iodine, hydrogen peroxide, negative control substance, and absence of therapy. Two researchers independently selected the studies, extracted data and evaluated the risk of bias. A narrative data synthesis was used. Twenty-five studies were included, of which 21 were in vitro and four were randomized clinical trials (RCT). Studies assessed the virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1) (10 studies), Influenza A (InfluA) (4 studies), human coronavirus (HCoV) (4 studies) and Severe Acute Respiratory Syndrome-Related Coronavirus (SARS-CoV-2) (11 studies). Most studies demonstrated that CHX has a positive virucidal efficacy against HSV-1 and InfluA strains. However, lower efficacy was shown to InfluA strain in comparison to povidone-iodine. Lower to none virucidal efficacy of CHX is expected for HCoV and SARS-CoV-2 strains for in vitro studies. Three RCT demonstrated that CHX was able to significantly reduce the viral load of SARS-CoV-2 for a short period. CHX may present an interesting virucidal efficacy against HSV-1 and InfluA viruses. CHX also presents transient efficacy against SARS-CoV-2 when used as a mouthwash.

Management of excessive gingival display using botulinum toxin type A: a descriptive study.

Botulinum toxin is a protease used by the bacterium Clostridium botulinum that causes chemical denervation of skeletal muscles, producing a temporary weakening of muscle activity. Despite having a transitory effect, the application of botulinum toxin has been identified as an alternative for correcting an excessive gingival display (EGD). However, studies evaluating the maintenance of long-term results of botulinum toxin remain scarce. This study aimed to evaluate the effectiveness and duration of botulinum toxin type A in the treatment of anterior EGD. Botulinum toxin Type A was applied to 15 patients with EGD. The measurement was performed in triplicate, using a Castro Viejo dry point compass, between the central cervical portion of the upper lateral incisors to the lower portion of the upper lip, bilaterally. The measurements were performed before the application of the toxin and repeated on days 7, 14, 90, 120, and 180 after the procedure. The data were analyzed using repeated-measures ANOVA, followed by a Bonferroni. There was a statistically significant reduction between the measurements performed on the Baseline and seven days after the application of the botulinum toxin. After 180 days, approximately one-quarter of the patients in the sample did not presented EGD. Mild adverse effects were reported by 46.7% of the patients. The use of botulinum toxin type A was effective to treat EGD. After 180 days, it was still possible to observe a significant effect compared to the initial gingival exposure.

Antiplaque and antigingivitis efficacy of cetylpyridinium chloride with zinc lactate compared with essential oil mouthrinses: Randomized clinical trial.

BACKGROUND: The authors of this study aimed to evaluate the clinical antiplaque and antigingivitis effects of 3 oral hygiene regimens: toothbrushing with standard fluoride toothpaste and manual toothbrush and using a mouthrinse containing cetylpyridinium chloride, zinc lactate, and fluoride (CPC + Zn + F) in an alcohol-free base; toothbrushing with standard fluoride toothpaste and manual toothbrush and using a mouthrinse containing essential oils (EO) in an alcohol-free base; and toothbrushing with manual toothbrush and standard fluoride toothpaste and manual toothbrush (control). METHODS: The participants (N = 120) were randomly assigned to study groups and followed the assigned regimens twice daily for 6 weeks. The participants were examined by a calibrated examiner for the Quigley-Hein plaque index (Turesky modification) and Löe-Silness gingival index at baseline, week 4, and week 6. Statistical analyses were performed separately for plaque and gingival indexes by means of analysis of variance, paired t test, and analysis of covariance (α = 0.05). RESULTS: At week 4, the CPC + Zn + F group presented additional reductions in dental plaque compared with EO and control groups of (21.4% [P < .001] and 31.4% [P < .001], respectively). After 6 weeks, these values were 26.7% (P < .001) and 44.8% (P < .001), respectively. For Löe-Silness gingival index, additional reduction in the CPC + Zn + F group compared with EO were 10.6% (P < .001) and 13.7% (P < .001) at 4 and 6 weeks, respectively. Compared with control, these reductions were 13.6% (P < .001) and 17.8% (P < .001), respectively. CONCLUSIONS: The regimen including a mouthrinse containing CPC + Zn + F presented higher antiplaque and antigingivitis effects than EO and control regimens. PRACTICAL IMPLICATIONS: A mouthrinse containing CPC + Zn + F is an effective protocol for the control of dental plaque and gingivitis.

Efficacy of ozonated water mouthwash on early plaque formation and gingival inflammation: a randomized controlled crossover clinical trial.

OBJECTIVES: To evaluate the effect of ozonated water in early plaque formation and gingival inflammation. MATERIALS AND METHODS: This was a randomized, controlled, double-blind, crossover clinical trial with two experimental periods of 96 h each, with 10 washout days between them. The sample consisted of 42 dental students divided into Test Group, mouthwash of ozonated water, and Control Group, bidistilled water mouthwash. The participants were instructed not to perform oral hygiene and used the assigned mouthwash under supervision once a day. For the investigation of the initial subgingival biofilm formation, the Plaque Free Zone Index was used at 24, 48, 72, and 96 h. The volume of gingival crevicular fluid, a questionnaire for taste perception assessment, and analysis of the adverse effects were also carried out. RESULTS: The percentage of conversion scores 0 and 1 to 2 of PFZ Index, the main outcome, for all dental surfaces showed no statistical difference between Test and Control groups, with 19.07 and 19.79, respectively. Also, there was not a significant difference in the score frequencies at each time point. Evaluation of GCF demonstrated that both groups had an increase in volume during experimental periods and that there was no statistically significant difference among groups. Test group had worse evaluation of taste perception and more adverse effects. CONCLUSIONS: Ozonated water seems not to affect the formation of supra and subgingival biofilms, as well as gingival inflammation. CLINICAL SIGNIFICANCE: Mouthwash with ozonated water once a day do not affect supra and subgingival biofilm formation.

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial / Eficácia de duas escovas de cerdas macias na remoção de Placa. Um ensaio clínico randomizado

ABSTRACT The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, usingMann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gymline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

RESUMO O objetivo desse ensaio clínico, examinador-cego, randomizado e controle foi de comparadas a eficácia de duas escovas de cerdas macias em relagäo ao controle de placa. Setenta vo-luntários foram randomicamente alocados para Grupo A (es-cova com ponta cónica) ou Grupo B (escova com ponta arredondada). Na consulta inicial (dia 0), voluntarios receberam exame de placa utilizando o Índice de identificagäo de placa melhorado. Sob supervisäo, eles escovaram seus dentes por 1 minuto com as escovas designadas e o exame de placa foi repetido. Voluntarios continuaram seu regime de higiene oral (escova dental alocada e dentifrício comum fornecidos pelos pesquisadores) durante 7 dias. Os procedimentos da consulta inicial foram novamente repetidos. Análises estatísticas distintas foram realizadas para percentual de redugäo média de placa para os escores de boca toda, interproximal e linha gengi-val em ambos os momentos, utilizando teste de Mann-Whitney, p<0,05. Após único uso da escova, no dia 0, o percentual de redugäo média de placa foi significativamente reduzido em ambos os grupos (p<0,05), com reduções significativas para boca toda (21,39±12,44 vs. 11,40±11,17), linha gengival (6,32±7,37 vs. 2,89±4,57) e interproximal (10,82±10,49 vs. 5,21±7,68) no Grupo A quando comparada com o Grupo B. Entretanto, no dia 7, nenhuma diferenga significativa foi observada entre os grupos para boca toda (29,94±20,91 vs. 26,58±18,64), linha gengival (14,04±18,82 vs. 13,78±17,63) e interproximal (26,41±22,77 vs. 23,12±20,98) (p>0,05). Em conclusäo, no dia 0, a escova do Grupo A apresentou eficácia superior na remo-gäo de placa suprageng ival quando comparada com a escova do Grupo B, como demonstrado nos escores de placa de boca toda, linha gengival e interproximal.

A Systematic Review of the Effect of Oral Rinsing with H2O2 on Clinical and Microbiological Parameters Related to Plaque, Gingivitis, and Microbes.

BACKGROUND: Hydrogen peroxide (H2O2) has been used for more than a century clinically to control plaque and gingival inflammation, with unclear supporting evidence. AIM: The aim of the present systematic review of the literature is to assess the effect of mouth rinses with H2O2 on dental plaque, gingival inflammation, and oral microorganisms. METHODS: Five databases (PubMed, Scopus, Embase, Cochrane Library, and Web of Science) were searched with the following focused question: what is the effect of hydrogen peroxide, in comparison to chlorhexidine or to a placebo solution, in oral microbiota control, dental plaque, and gingival inflammatory outcomes? Two independent examiners retrieved the articles and evaluated the evidence. RESULTS: The majority of included studies were performed with 1.5% H2O2. Results related to plaque accumulation generally demonstrate a slightly better effect of H2O2 as compared to placebo mouth rinses, however with a lower performance as compared to chlorhexidine. In terms of gingival inflammation, H2O2 performs better than placebo and more clearly demonstrates an anti-inflammation effect. No studies evaluated the effect of H2O2 against viruses or fungi. In terms of bacteria, H2O2 demonstrates an antibacterial effect. CONCLUSION: Rinsing with H2O2 has the potential to affect plaque, gingivitis, and oral bacteria, as compared to placebo. However, the antibacterial results are not comparable to the performance of chlorhexidine.

Oral, dental, and craniofacial features in chronic acid sphingomyelinase deficiency.

The aim of this study was to evaluate the oral, dental, and craniofacial features of individuals affected by the chronic forms of acid sphingomyelinase deficiency (ASMD). This study comprised a sample of adult and pediatric patients (n = 8) with chronic ASMD. The individuals underwent oral examinations to evaluate the occurrence of caries, as well as full-mouth periodontal examinations, to assess the occurrence and severity of periodontal diseases. Panoramic and profile radiographs were obtained to analyze dental conditions and craniofacial parameters. Participants also answered questionnaires to identify systemic impairment, parafunctional habits, and bruxism. Dental anomalies of size, shape, and number were found, with agenesis and microdontia being the predominant findings. The average of caries experience was 11.75 (±8.1). Only one patient had periodontal health and all adult individuals had periodontitis at different stages and degrees. Bruxism was found in 87.5% of the sample. The convex profile and maxillary and mandibular retrusion were the most relevant findings in the cephalometric analysis. It is concluded that individuals with chronic ASMD, in addition to several systemic manifestations, present significant modifications in their oral health, from a greater occurrence of dental anomalies, caries, periodontal disease, in addition to skeletal changes.

Effect of Obesity and/or Ligature-induced Periodontitis on Aortic Wall Thickness in Wistar Rats.

The purpose of this study was to evaluate aortic wall thickness after periodontal disease and/or obesity induction in a Wistar rat model.Sixty male Wistar rats were randomly divided into four groups: control (CT), periodontal disease (PD), obesity (OB), and obesity plus periodontal disease (OB+PD). Groups OB and OB+PD received cafeteria diet for 17 weeks. After they had acquired obesity (week 12), periodontal disease was induced by placing a silk ligature on the maxillary right second molar of groups PD and OB+PD. During the experimental period, body weight and Lee index were assessed. Mean alveolar bone loss (ABL) was evaluated, and aortas were prepared for histometric analysis of the aortic wall by ImageJ software. Body weight and Lee index increased in rats exposed to cafeteria diet. Mean ABL was higher in Groups PD and OB+PD than in control and OB (p<0.05). ABL was 18% higher in Group OB+PD than in Group PD, with statistically significant difference (p<0.001). Aortas were thicker in Groups OB and OB+PD than in control and PD groups, respectively (2.31mm ± 0.28 and 2.33 ± 0.29 vs. 2.18 ± 0.26 and 2.14 ± 0.27). Group OB differed significantly from the control group (p=0.036), and OB+PD and OB differed significantly from PD (p=0.004 and p= 0.001, respectively). Obesity alters aortic wall thickness in Wistar rats. However, the presence of periodontal disease did not affect the aortic wall thickness under the conditions of the present study.

O objetivo deste estudo foi avaliar a espessura da parede da aorta após modelos de indução de doença periodontal e/ou obesidade em ratos Wistar. Sessenta ratos Wistar machos foram aleatoriamente divididos em quatro grupos: controle (CT), doença periodontal (DP), obesidade (OB), obesidade mais doença periodontal (OB+DP). Os grupos OB e OB+DP rece beram dieta de cafeteria por 17 semanas. Após de adquirirem obesidade, (semana 12), doença periodontal foi induzido pela colocação de ligaduras de seda no segundo molar superior direito dos grupos DP e OB+DP. Durante o período experi mental, o peso corporal e índice de Lee foram obtidos. Média de perda óssea alveolar (POA) foi avaliada e as aortas preparadas para análise histométrica da parede aórtica (em mm) pelo software ImageJ. Ratos expostos a dieta de cafeteria demonstraram um aumento do peso corporal e do índice de Lee. Uma POA media maior foi observada nos grupos DP e OB+DP comparado aos grupos controle e OB (p<0.05). O grupo OB+DP, quando comparado ao grupo DP, apresentou POA 18% maior e essa diferença foi estatisticamente significativa (p<0.001). Os grupos OB e OB+DP exibiram uma espessura de aorta maior comparado aos grupos DP e controle, respectivamente (2.31 ± 0.28 e 2.33 ± 0.29 vs. 2.18 ± 0.26 e 2.14 ± 0.27). Diferenças significativas foram observadas nas comparações dos grupos OB e controle (p=0,036), e OB+DP e OB comparado ao grupo DP (p=0.004 e p= 0.001, respectivamente). A obesidade parece afetar a espessura da parede da aorta em ratos Wistar. Entretanto, a presença de doença periodontal não afetou a espessura da parede da aorta sob as condições do presente estudo.

Effect of Obesity and/or Ligature-induced Periodontitis on Aortic Wall Thickness in Wistar Rats / Efeito da obesidade e/ou periodontite induzida por ligadura na espessura da parede da aorta em ratos wistar

ABSTRACT The purpose of this study was to evaluate aortic wall thickness after periodontal disease and/or obesity induction in a Wistar rat model. Sixty male Wistar rats were randomly divided into four groups: control (CT), periodontal disease (PD), obesity (OB), and obesity plus periodontal disease (OB+PD). Groups OB and OB+PD received cafeteria diet for 17 weeks. After they had acquired obesity (week 12), periodontal disease was induced by placing a silk ligature on the maxillary right second molar of groups PD and OB+PD. During the experimental period, body weight and Lee index were assessed. Mean alveolar bone loss (ABL) was evaluated, and aortas were prepared for histometric analysis of the aortic wall by ImageJ software. Body weight and Lee index increased in rats exposed to cafeteria diet. Mean ABL was higher in Groups PD and OB+PD than in control and OB (p<0.05). ABL was 18% higher in Group OB+PD than in Group PD, with statistically significant difference (p<0.001). Aortas were thicker in Groups OB and OB+PD than in control and PD groups, respectively (2.31mm ± 0.28 and 2.33 ± 0.29 vs. 2.18 ± 0.26 and 2.14 ± 0.27). Group OB differed significantly from the control group (p=0.036), and OB+PD and OB differed significantly from PD (p=0.004 and p= 0.001, respectively). Obesity alters aortic wall thickness in Wistar rats. However, the presence of periodontal disease did not affect the aortic wall thickness under the conditions of the present study.

RESUMO O objetivo deste estudo foi avaliar a espessura da parede da aorta após modelos de indução de doença periodontal e/ou obesidade em ratos Wistar. Sessenta ratos Wistar machos foram aleatoria mente divididos em quatro grupos: controle (CT), doença periodontal (DP), obesidade (OB), obesidade mais doença periodontal (OB+DP). Os grupos OB e OB+DP rece beram dieta de cafeteria por 17 semanas. Após de adquirirem obesidade, (semana 12), doença periodontal foi induzido pela colocação de ligaduras de seda no segundo molar superior direito dos grupos DP e OB+DP. Durante o período experi mental, o peso corporal e índice de Lee foram obtidos. Média de perda óssea alveolar (POA) foi avaliada e as aortas preparadas para análise histométrica da parede aórtica (em mm) pelo software ImageJ. Ratos expostos a dieta de cafeteria demonstraram um aumento do peso corporal e do índice de Lee. Uma POA media maior foi observada nos grupos DP e OB+DP comparado aos grupos controle e OB (p<0.05). O grupo OB+DP, quando comparado ao grupo DP, apresentou POA 18% maior e essa diferença foi estatisticamente significativa (p<0.001). Os grupos OB e OB+DP exibiram uma espessura de aorta maior comparado aos grupos DP e controle, respectivamente (2.31 ± 0.28 e 2.33 ± 0.29 vs. 2.18 ± 0.26 e 2.14 ± 0.27). Diferenças significativas foram observadas nas comparações dos grupos OB e controle (p=0,036), e OB+DP e OB comparado ao grupo DP (p=0.004 e p= 0.001, respectivamente). A obesidade parece afetar a espessura da parede da aorta em ratos Wistar. Entretanto, a presença de doença periodontal não afetou a espessura da parede da aorta sob as condições do presente estudo.

Dental care and the COVID-19 pandemic: the precautionary principle and the best available evidence

The precautionary principle is part of evidence-based healthcare. However, since it is not always based in the most qualified evidence, it is frequently questioned. The emergence of a highly contagious disease, with increased levels of morbimortality, an acute respiratory syndrome, the so called Coronavirus Disease 2019 (COVID-19), led health professionals to look for the best alternatives to save lives. In this sense, the precautionary principle was evocated. The precautionary principle is used both preventively and therapeutically when knowledge about how to manage problems/diseases/conditions that are especially life-threatening. The aim of this short communication is to make a reflection about the precautionary principle, the dental profession and COVID-19. It is important to have in mind that in such a disease, guidelines, protocols and approaches can change very fast, since a continuous evaluation of all policies is mandatory.

Periodontal disease and its impact on general health in Latin America. Section IV: Diagnosis.

The art of diagnosis is of great importance in the management of any disease. This includes preventive and therapeutic strategies. To make an accurate and effective diagnosis, knowledge about the health-disease process is fundamental. This paper reviews the important aspects for periodontal diagnosis in a contemporary approach, and endeavors to establish challenges for improving periodontal diagnosis, especially in Latin America. Considering that contemporary periodontal diagnosis should be based on knowledge of the etiopathogenesis of periodontal diseases, this paper highlights that the recently proposed classification system for periodontal diseases and conditions was based on the best available evidence. This system was conceived for individual diagnosis, therefore, its use in research and epidemiological settings might be limited. The system leads to a practical implication that stresses the importance of interviewing the patient, thorough periodontal charting, and requesting any imaging and other complementary tests necessary. An important observation is that partial periodontal data recordings usable for screening are not diagnostic methods and might underestimate disease. The goals of utmost importance for Latin America are to increase the awareness of both the population and the profession and to prioritize correct periodontal diagnosis. In addition, learning how to use the new classification system will help with diagnosing periodontal diseases.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report.

Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial.

The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, using Mann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gumline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77 vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

O objetivo desse ensaio clínico, examinador-cego, randomizado e controle foi de comparadas a eficácia de duas escovas de cerdas macias em relação ao controle de placa. Setenta voluntários foram randomicamente alocados para Grupo A (escova com ponta cônica) ou Grupo B (escova com ponta arredondada). Na consulta inicial (dia 0), voluntários receberam exame de placa utilizando o Índice de identificação de placa melhorado. Sob supervisão, eles escovaram seus dentes por 1 minuto com as escovas designadas e o exame de placa foi repetido. Voluntários continuaram seu regime de higiene oral (escova dental alocada e dentifrício comum fornecidos pelos pesquisadores) durante 7 dias. Os procedimentos da consulta inicial foram novamente repetidos. Análises estatísticas distintas foram realizadas para percentual de redução média de placa para os escores de boca toda, interproximal e linha gengival em ambos os momentos, utilizando teste de Mann-Whitney, p<0,05. Após único uso da escova, no dia 0, o percentual de redução média de placa foi significativamente reduzido em ambos os grupos (p<0,05), com reduções significativas para boca toda (21,39±12,44 vs. 11,40±11,17), linha gengival (6,32±7,37 vs. 2,89±4,57) e interproximal (10,82±10,49 vs. 5,21±7,68) no Grupo A quando comparada com o Grupo B. Entretanto, no dia 7, nenhuma diferença significativa foi observada entre os grupos para boca toda (29,94±20,91 vs. 26,58±18,64), linha gengival (14,04±18,82 vs. 13,78±17,63) e interproximal (26,41±22,77 vs. 23,12±20,98) (p>0,05). Em conclusão, no dia 0, a escova do Grupo A apresentou eficácia superior na remoção de placa suprageng ival quando comparada com a escova do Grupo B, como demonstrado nos escores de placa de boca toda, linha gengival e interproximal.

Association between severe periodontitis and chronic kidney disease severity in predialytic patients: A cross-sectional study.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the association between periodontitis and different severities of chronic kidney disease (CKD) in predialytic patients. MATERIALS AND METHODS: Demographic, socioeconomic, and medical data of 139 patients from the nephrology service of one university hospital in Porto Alegre, Brazil, were obtained through interview and clinical records. Full-mouth six-sites per tooth periodontal examinations were performed. Associations between periodontitis, stages of CKD, and estimated glomerular filtration rate (eGFR) were estimated by multivariable models adjusted for sex, smoking, vitamin D supplementation, physical activity, and renal treatment duration. CKD was classified based on eGFR (<60 ml/min/1.73 m2 ) estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS: Patients with severe periodontitis, compared to those without severe periodontitis, had 2.8 (95% CI: 1.25-6.62) and 3.4 (95% CI: 1.27-9.09) times higher risk of being in stages 4 and 5 of CKD, respectively. Having ≥ 2 teeth with clinical attachment loss (CAL) ≥6 mm increased 3.9 times the risk of being in stage 5 of CKD. Patients with severe periodontitis and ≥2 teeth with CAL ≥ 6 mm had 4.4 ml/min/1.732 and 5.2 ml/min/1.732 lower eGFR (p-values < .05), respectively. CONCLUSION: Severe periodontitis was associated with poor renal conditions in predialytic CKD patients, strengthening the importance of periodontal evaluation in such patient population.

Dental Care and the COVID-19 Pandemic: The Precautionary Principle and the Best Available Evidence

Abstract The precautionary principle is part of evidence-based healthcare and is used both preventively and therapeutically when there is no available evidence about how to manage problems/diseases/conditions that are especially life-threatening. However, since it is not always based in the most qualified evidence, it is frequently questioned. The emergence of a highly contagious disease, with increased levels of morbimortality, an acute respiratory syndrome, the so called Coronavirus Disease 2019 (COVID-19), led health professionals to look for the best alternatives to save lives. In this sense, the precautionary principle was evocated. The aim of this paper is to make a reflection about the precautionary principle, the dental profession and COVID-19. It is important to have in mind that in such a disease, guidelines, protocols and approaches can change very fast, since a continuous evaluation of all policies is mandatory. During the pandemic, elective procedures may be restricted, but international organizations removed the recommendation to postpone elective procedures. Clinicians are advised to be updated about their local current policies. On the other hand, there are cases in which in-office dental care is unavoidable, such as individuals with pain, spontaneous bleeding and dental trauma. Biosafety is upmost importance when seeking patients during pandemic. In this sense, it was concluded that precautionary principle should be, therefore, used. However, caution needs to be taken and continuous surveillance necessary.

Effect of red wine and its major components on periodontitis and systemic inflammation in rats.

OBJECTIVES: To evaluate the influence of red wine exposure, alcohol, grape juice and resveratrol in the occurrence of spontaneous and ligature induced periodontitis as well as CRP, TNFα and IL-6 levels in Wistar rats. METHODOLOGY: 50 male Wistar rats were randomly assigned to 5 groups (Control, Red Wine, Grape Juice, 12% Alcohol and 0.05mg/mL Resveratrol). All groups were fed with laboratory rat chow and liquid intake according to group allocation. After 8 weeks, ligatures were placed around the maxillary right second molars. The contra-lateral molars remained as intra-group controls. After 14 days, animals were killed, blood samples collected and specimens prepared for analysis. Group comparisons were performed by ANOVA. A cut-off point in the 75th percentile in the side without ligature was used for definition of spontaneous periodontitis. RESULTS: All animals completed the experiment. According to mean alveolar bone loss, no statistically significant differences were found. Animals exposed to red wine presented a lower occurrence of spontaneous periodontitis, lower levels of TNF-α (0.97 ng/mL) and CRP (0.29 mmol/µL) compared to controls (1.97 ng/mL, p = 0.008 and 0.45 mmol/ µL, p less than or equal to 0.05 respectively). CONCLUSION: Red wine exposure potentially affects the occurrence of spontaneous periodontitis, CRP and TNF-α levels in Wistar rats.

Effect of adjuvant use of metformin on periodontal treatment: a systematic review and meta-analysis.

OBJECTIVE: The aim of the study was to perform a systematic review of the literature regarding the adjuvant effects of metformin on the results of mechanical periodontal treatment. METHODS: First, a search on the PubMed, EMBASE, and Scopus databases was performed up to March 2018. Randomized clinical trials with at least 3 months of follow-up and using metformin associated with mechanical periodontal treatment were included in the review. As comparison group, mechanical or periodontal therapy alone or in combination with placebo. The studies should involve adults with at least 30 years of age diagnosed with chronic periodontitis. For the evaluation of the risk of bias of the articles, the Cochrane Collaboration tool was used. RESULTS: Studies (1912) were retrieved and 4 were included in the review. The articles are all from the same research center and used metformin in gel at concentrations of 0.5%, 1%, or 1.5%. The majority of included studies presented low risk of bias. A linear meta-analysis was conducted for probing depth and clinical attachment loss outcomes. The results showed a weighted mean difference of 2.12 mm (95% CI 1.83-2.42) and 2.29 mm (95% CI 1.72-2.86) for probing depth and clinical attachment level, respectively, favoring the group exposed to 1% adjunct metformin. CONCLUSION: The adjuvant use of metformin may promote an additional benefit to the results of mechanical periodontal therapy. CLINICAL SIGNIFICANCE: The metformin as an adjuvant on periodontal treatment shows potential to reduce needs of additional interventions and also reduces the inflammatory burden in patients.