Obstetric outcomes in women with rheumatic disease and COVID-19 in the context of vaccination status.

OBJECTIVE: To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS: Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi-squared or Fisher's exact test. RESULTS: There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies, 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2% (n = 2). CONCLUSIONS: In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.

Características clínicas y evolución de la infección por SARS-CoV-2 en pacientes con lupus eritematoso sistémico en Argentina: datos del registro nacional SAR-COVID / Clinical characteristics and course of SARS-CoV-2 infection in patients with systemic lupus erythematosus in Argentina: data from the SAR-COVID national registry

Introducción: el lupus eritematoso sistémico (LES) es una enfermedad sistémica que se ha asociado a mayor severidad con la infección por SARS-CoV-2. Particularmente la alta actividad de la enfermedad y algunos inmunosupresores se han vinculado a peores desenlaces. Objetivos: describir las características por SARS-CoV-2 en pacientes con LES en Argentina del registro SAR-COVID y establecer los factores asociados a peor desenlace de la misma. Materiales y métodos: estudio observacional. Se incluyeron pacientes con diagnóstico de LES con infección confirmada por SARS-CoV-2 (RT-PCR y/o serología positiva) del registro SAR-COVID. Los datos se recolectaron desde agosto de 2020 hasta marzo de 2022. El desenlace de la infección se midió mediante la escala ordinal de la Organización Mundial de la Salud (EO-OMS). Se definió COVID-19 severo con un valor EO-OMS ≥5. Análisis descriptivo, test T de Student, test de Mann Whitney U, ANOVA, chi2 y Fisher. Regresión logística múltiple. Resultados: se incluyeron 399 pacientes, el 93% de sexo femenino, con una edad media de 40,9 años (DE 12,2). El 39,6% tenía al menos una comorbilidad. Al momento de la infección, el 54,9% recibía glucocorticoides, el 30,8% inmunosupresores y el 3,3% agentes biológicos. La infección por SARS-CoV-2 fue leve en la mayoría de los casos, mientras que un 4,6% tuvo curso severo y/o falleció. Estos últimos presentaban comorbilidades, usaban glucocorticoides y tenían síndrome antifosfolipídico (SAF) con mayor frecuencia y mayor actividad de la enfermedad al momento de la infección. En el análisis multivariado, la hipertensión arterial, el diagnóstico de SAF y el uso de glucocorticoides se asociaron a hospitalización severa y/o muerte por COVID-19 (EO-OMS ≥5). Conclusiones: en esta cohorte de pacientes con LES con infección por SARS-CoV-2 confirmada, la mayoría cursó de manera sintomática, un 22,1% fue hospitalizado y un 5% requirió ventilación mecánica. La mortalidad fue cercana al 3%. El diagnóstico de SAF, tener hipertensión arterial y el uso de glucocorticoides se asociaron significativamente con COVID-19 severo.

Introduction: systemic lupus erythematosus (SLE) is a systemic disease that has been associated with greater severity with SARS-CoV-2 infection. Particularly high disease activity and some immunosuppressants have been linked to worse outcomes. Objectives: to describe the characteristics due to SARS-CoV-2 in patients with SLE in Argentina from the SAR-COVID registry and to establish the factors associated with a worse outcome of the same. Materials and methods: observational study. Patients diagnosed with SLE with confirmed SARS-CoV-2 infection (RT-PCR and/or positive serology) from the SAR-COVID registry were included. Data was collected from August 2020 to March 2022. The outcome of the infection was measured using the World Health Organization - ordinal scale (WHO-OS). Severe COVID-19 was defined as an WHO-OS value ≥5. Descriptive analysis, Student's T test, Mann Whitney U, ANOVA, chi2 and Fisher. Multiple logistic regression. Results: a total of 399 patients were included, 93% female, with a mean age of 40.9 years (SD 12.2), 39.6% had at least one comorbidity. At the time of infection, 54.9% were receiving glucocorticoids, 30.8% immunosuppressants, and 3.3% biological agents. SARS-CoV-2 infection was mild in most cases, while 4.6% had a severe course and/or died. The latter had comorbidities, used glucocorticoids and had antiphospholipid syndrome (APS) more frequently and higher disease activity at the time of infection. In the multivariate analysis, high blood pressure, the diagnosis of APS, and the use of glucocorticoids were associated with severe hospitalization and/or death from COVID-19 (WHO-EO ≥5). Conclusions: in this cohort of SLE patients with confirmed SARS-CoV-2 infection, most had a symptomatic course, 22.1% were hospitalized, and 5% required mechanical ventilation. Mortality was close to 3%. The diagnosis of APS, having high blood pressure, and the use of glucocorticoids were significantly associated with severe COVID-19.

Effects of stress hormones on the production of volatile sulfur compounds by periodontopathogenic bacteria.

Little is known about the effects of stress hormones on the etiologic agents of halitosis. Thus, the aim of this study was to evaluate in vitro the effects of adrenaline (ADR), noradrenaline (NA) and cortisol (CORT) on bacteria that produce volatile sulfur compounds (VSC), the major gases responsible for bad breath. Cultures of Fusobacterium nucleatum (Fn), Porphyromonas endodontalis (Pe), Prevotella intermedia (Pi) and Porphyromonas gingivalis (Pg) were exposed to 50 µM ADR, NA and CORT or equivalent volumes of sterile water as controls for 12 and 24 h. Growth was evaluated based on absorbance at 660 nm. Portable gas chromatography was used to measure VSC concentrations. Kruskal-Wallis and the Dunn post-hoc test were used to compare the groups. For Fn, ADR, NA and CORT significantly reduced bacterial growth after 12 h and 24 h (p<0.05). All the substances tested increased hydrogen sulfide (H2S) production (p<0.05). For Pe, all the substances tested reduced bacterial development after 24 h (p<0.05), and NA significantly increased the H2S concentration after 12 h (p<0.05). In the Pg and Pi cultures, no effects on bacterial growth were observed (p>0.05). In the Pi cultures, ADR, NA and CORT increased H2S (p<0.05). Catecholamines and cortisol can interfere with growth and H2S production of sub-gingival species in vitro. This process appears to be complex and supports the association between stress and the production of VSC.

Bioequivalence study of two commercial amoxicillin suspension formulations in healthy human volunteers.

PURPOSE: To compare the pharmacokinetic profiles and to evaluate the bioequivalence of two commercial amoxicillin suspension formulations (500 mg/5 mL AMOXIL®, reference formulation and AMOXI-PED®, test formulation) in healthy Brazilian volunteers. METHODS: Under fasting condition, 25 volunteers (13 males and 12 females) were included in this randomized, open-label, two-period crossover (1-week washout interval) bioequivalence study. Blood samples were collected at pre-dose (0 hour) and 0.5, 1, 1.33, 1.66, 2, 2.5, 3, 4, 6, 8, and 12 hours after drug ingestion. Pharmacokinetic parameters (Cmax, tmax, t1/2, AUC0-tlast, and AUC0-∞) were calculated from plasma concentrations for both formulations in each subject. RESULTS: Arithmetic mean values of the pharmacokinetic parameters were: Cmax = 12.004 (± 2.824) µg×mL-1; tmax = 1.118 (± 0.396) h; t1/2 = 1.226 (± 0.179) h; AUC0-tlast = 29.297 (± 6.007) µg×h×mL-1; and AUC0-∞ = 29.299 (± 6.007) µg×h×mL-1 for reference formulation and Cmax = 11.456 (± 2.825) µg×mL-1; tmax = 1.331 (± 0.509) h; t1/2 = 1.141 (± 0.133) h; AUC0-tlast = 28.672 (± 5.778) µg×h×mL-1; and AUC0-∞ = 28.693 (± 5.796) µg×h×mL-1 for test formulation. The confidence intervals (90% CI) for reference and test formulations were, respectively, 90.74 - 100.46% for Cmax and 93.62 - 103.61% for AUC0-t. CONCLUSION: Based on the results, both formulations of amoxicillin evaluated in this study were considered bioequivalent according to FDA and ANVISA/Brazil criteria.

Vellozia flavicans Mart. ex Schult. hydroalcoholic extract inhibits the neuromuscular blockade induced by Bothrops jararacussu venom.

BACKGROUND: Snakebite is a significant public health issue in tropical countries. In Brazil, some of the most common snake envenomations are from Bothrops. Bothrops bites trigger local and systemic effects including edema, pain, erythema, cyanosis, infections, and necrosis. Vellozia flavicans is a plant from the Brazilian "cerrado" (savanna) that is popularly used as an anti-inflammatory medicine. Since inflammation develops quickly after Bothrops bites, which can lead to infection, the aim of the present study was to observe possible anti-snake venom and antimicrobial activities of V. flavicans (Vf). METHODS: The chromatographic profile of the main constituents from the Vf leaf hydroalcoholic extract was obtained by thin-layer chromatography (TLC). The anti-snake venom activity was measured by Vf's ability to neutralize the in vitro neuromuscular blockade caused by Bothrops jararacussu venom (Bjssu) in a mouse phrenic nerve-diaphragm model (PND). After a 20 min incubation, preparations of PND were added to Tyrode's solution (control); Vf (0.2, 0.5, 1, and 2 mg/mL); 40 µg/mL Bjssu; pre-incubation for 30 min with Bjssu and 1 mg/mL Vf; and a Bjssu pretreated preparation (for 10 min) followed by 1 mg/mL Vf. Myographic recording was performed, and the contractile responses were recorded. The antimicrobial activity (minimum inhibitory concentration [MIC] and minimum bactericidal concentration [MBC]) was obtained for Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, using gentamicin and vancomycin as positive controls. RESULTS: TLC analysis yielded several compounds from Vf, such as flavonoids (quercetin) and phenolic acids (chlorogenic acid). Bjssu completely blocked the contractile responses of PND preparations, while Vf preserved 97% (±10%) of the contractile responses when incubated with Bjssu. In the PND pretreated with Bjssu, Vf was able to inhibit the neuromuscular blockade progress. MIC and MBC of Vf ranged from 2.5 to 5.0 mg/mL for P. aeruginosa and S. aureus strains, while no antimicrobial activity was observed for E. coli and E. faecalis. CONCLUSIONS: The hydroalcoholic extract from Vf leaves was able to neutralize and decrease the in vitro neuromuscular blockade caused by Bjssu. However, it did not show significant antimicrobial activity against the tested bacteria.

Concentrations of metronidazole in human plasma and saliva after tablet or gel administration.

OBJECTIVES: The aim of this study was to determine the pharmacokinetic profile of metronidazole (Mtz) tablet and to compare Mtz gel and tablet concentrations in both blood plasma and saliva. METHODS: In this randomized cross-over study with a 1-week washout period, 13 volunteers randomly received one (a single oral dose of 750 mg Mtz (Flagyl®--tablet) and 2) 3 g of 15% Mtz benzoate gel (applied by using a dental tray). The HPLC with ultraviolet detection was used to quantify plasma and saliva concentrations of Mtz. The pharmacokinetic parameters (PPs) areas under the curves from 0 to 48 h (AUC0-48) and from 0 to infinity (AUC0-∞), the maximum plasma concentration (C(max)), the time to C(max), volume of distribution and renal clearance were determined for Mtz tablet. KEY FINDINGS: Considering the Mtz tablet, plasma showed higher Mtz concentration from 6 to 24 h after drug administration and the highest values concerning AUC0-48 h and AUC0-∞ than those obtained in saliva (P < 0.05). No significant differences were observed between plasma and saliva concentrations for Mtz gel. CONCLUSIONS: The study showed that some PPs were higher in plasma (P < 0.05) than in saliva concerning Mtz tablet. Gel formulation had similar Mtz bioavailability in plasma and saliva resulting in systemic absorption.

Effect of articaine on mental nerve anterior portion: histological analysis in rats.

OBJECTIVES: The aim of this study was to evaluate the possible toxic effects of articaine and lidocaine on mental nerve, due to the increasing number of paresthesia cases after nerve blocks. MATERIALS AND METHODS: The drugs were injected in the anterior portion of mental nerve of 24 rats, divided into three groups: G1--4% articaine with 1:100,000 epinephrine; G2--2% lidocaine with 1:100,000 epinephrine and G3--plain 1:100,000 epinephrine solution. These solutions were injected in the right side of the rat's mandible and the left side was used as control (0.9% saline solution). Previously to the injections, the animals were anesthetized with thiopental and, 24 h after the injections, their jaws were removed and submitted to routine histological techniques. A histopathological analysis was performed by optical microscopy. RESULTS: An inflammatory infiltration was found around mental nerve, classified as intense for G3, moderate for G1 and light for both G2 and control groups. No injuries were found in nervous structure, despite the inflammatory reaction observed around it. CONCLUSION: The results suggest that articaine is not toxic to the nervous structure and further studies are necessary to explain the possible relation between articaine injection and paresthesia.

Reduction of salivary arginine catabolic activity through periodontal therapy.

OBJECTIVE: Salivary enzymes may be used to diagnose periodontal conditions. Salivary arginase activity (SAA) is related to susceptibility to bacterial infection. Therefore, the aim of this controlled interventional study was to determine the SAA before and after non-surgical periodontal therapy. METHOD AND MATERIALS: Eighty-nine subjects were selected: 31 periodontally healthy patients (controls), 27 gingivitis patients, and 31 chronic periodontitis patients. Plaque and Gingival Indices, probing depth, and clinical attachment level were monitored. The presence of Campylobacter rectus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia was evaluated by polymerase chain reaction. Salivary total protein level and SAA were also established by spectrophotometry. Clinical and arginase data were analyzed using the Wilcoxon, Mann-Withney, and Kruskal-Wallis tests (P < .05). For microbial data, the chi-square test was used. The Pearson correlation test was also used between each parameter evaluated. RESULTS: After therapy, due to a significant reduction in SAA, the values observed for the gingivitis and periodontitis groups were similar to those found in the healthy group. Interestingly, after therapy, SAA followed the same positive pattern showed by the overall improvement of clinical parameters (gingivitis and periodontitis groups mean values, pre- > posttherapy) and by the reduction of target pathogens (gingivitis group T forsythia, pre- > posttherapy; periodontitis group P. gingivalis, T. denticola, P. intermedia, and T. forsythia, pre- > posttherapy). CONCLUSION: Based on the reduction of SAA after therapy, in accordance with the expected reduction in clinical and microbiologic parameters, it was concluded that SAA has the potential to serve as a reliable method to access to the therapeutic response of chronic periodontitis subjects treated with nonsurgical periodontal therapy.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study.

This cross-over study was conducted to assess the germ-killing efficacy of an essential oil mouthrinse (EOM) by determining the blood levels of microorganisms associated with induced bacteremia and investigating the prevalence of this event in Brazilians with mild-to-moderate gingivitis. Thirty four (31.19%) subjects positive for bacteremia induced by chewing a ration of apple were enrolled out of 109 screened subjects (50 males and 59 females). A difference of at least 10 colony forming units between the pre- and post-insult blood samples was defined as a positive result. For the following two weeks patients underwent a toothbrush plus fluoride dentifrice normalization period, and were then scheduled for the Phase I protocol as follows. At baseline I, subjects were instructed to chew a new apple ration, had new blood samples taken before and after this oral stimulus, and were randomly assigned to an experimental essential oil (n = 17) or placebo (P) mouthrinse (n = 17) treatment for 2 weeks. These procedures were repeated at the end of Phase I and then followed by a two-week wash-out period (tooth brushing with fluoride dentifrice). Bacteremia was again induced at baseline and at the end of Phase II, when subjects were crossed-over to the other EOM or placebo groups. Bacterial count differences between baseline and 2-week post-treatment (EOM versus P) in the blood samples collected were assessed by analysis of covariance. Mean aerobic counts decreased by 45.8%, whereas mean anaerobic counts decreased by 63.3% after EOM treatment. After the P treatment, aerobic bacteria increased by 28.4% and anaerobic bacteria decreased by 18.5%. This study validated this novel methodology and showed that the germ-killing action of EOM significantly reduced bacteremia.

Portadores do HIV apresentam pior condição clínica periodontal e maior prevalência de Porphyromonas gingivalis e Tannerella forsythia / Subjects harboring HIV show poor clinical periodontal condition and higher prevalence of Porphyromonas gingivalis and Tannerella forsythia

Objetivo: O presente estudo transversal objetivou entender se os aspectos clínicos periodontais e a frequência dos patógenos periodontais Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis e Tannerella forsythia diferem em pacientes periodontais infectados pelo HIV, comparativamente a indivíduos não infectados pelo vírus. Material e método: Foram selecionados para o estudo indivíduos com periodontite, sendo 35 HIV+ e 35 HIV-; ambos os grupos foram pareados quanto a idade, gênero e um critério sítio-dependente de determinação de doença periodontal. Em visita subsequente, o exame periodontal completo determinou a condição periodontal geral dos indivíduos pelas mensurações de Índice de Placa (IP), Índice Gengival (IG), Índice de Sangramento à Sondagem (ISS), Profundidade de Sondagem (PS) e Nível de Inserção Clínica (NIC). A frequência das espécies bacterianas foi avaliada por meio de reação de polimerase em cadeia (PCR), a partir de amostras obtidas da saliva não estimulada. A análise estatística foi realizada por meio dos testes Mann-Whitney, t de Student e Qui-quadrado (p < 0,05). Resultado: Apesar da triagem por meio de critério específico de seleção, indivíduos HIV+ apresentaram maior destruição periodontal, revelada pelas maiores médias de PS, NIC (p < 0,05, t de Student), IP, IG e ISS (p < 0,05, Mann Whitney). Além disso, um maior número de indivíduos HIV+ alocou duas das espécies pesquisadas: P. gingivalis (p = 0,0007, Qui-Quadrado) e T. forsythia (p = 0,0001, Qui-Quadrado). Conclusão: Indivíduos HIV+ apresentaram pior condição periodontal e frequência mais elevada de P. gingivalis e T. forsythia, espécies do complexo vermelho que estão claramente associadas a tecidos periodontais danificados.

Objective: This cross-sectional study aimed at understanding whether clinical features and frequency of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola differ in periodontitis subjects infected with HIV when compared to non-infected subjects. Material and method: 35 periodontitis subjects were selected for the HIV+ group and 35 for the HIV? group; both groups were matched according to age, gender and a site-based criterion to determine periodontal disease. In a second visit, clinical periodontal status of the whole mouth of each participant was determined by plaque index (PI), gingival index (GI) bleeding on probing index (BOP), probing depth (PD) and clinical attachment level (CAL) measurements. The frequency of P. gingivalis, A. actinomycetemcomitans, T. forsythia and T. denticola was assessed by polymerase chain reaction (PCR) from unstimulated saliva samples. Statistical analysis was performed using the Mann Whitney, Student-t and Chi-Square tests (p < 0.05). Result: Despite screening through a specific selection criterion, HIV+ subjects showed more periodontal breakdown, demonstrated by higher mean values of PD, CAL (p < 0.05, Student- t-test), PI, GI, BOP (p < 0.05, Mann Whitney test) in comparison to HIV? controls.Also, a higher number of HIV+ subjects harbored two of the searched species: P. gingivalis (p = 0.0007, chisquare) and T. forsythia (p = 0.0001, Chi-square). Conclusion: HIV+ patients had poorer periodontal status and a higher prevalence of P. gingivalis and T. forsythia, two red complex bacterial species, which are clearly associated with damaged periodontal tissues.

Atividade do óleo de melaleuca alternifólia sobre o crescimento e expressão gênica de Porphyromonas gingivalis / Evaluation of Melaleuca alternifolia activity on growth and gene expression of Porphyromonas gingivalis

As doenças periodontais são infecções causadas por microrganismos que colonizam a superfície dental na margem gengival ou abaixo dela. Entre eles estão os patógenos periodontais, como Porphyromonas gingivalis. Estudos demonstraram que o óleo essencial extraído de Melaleuca alternifolia tem atividade inibitória e bactericida contra microrganismos da cavidade oral. Este estudo teve como objetivo avaliar a interferência do óleo de Melaleuca (MO) sobre o crescimento e virulência de P. gingivalis, comparando com a atividade da clorexidina (CL). Culturas dessa bactéria foram expostas a diferentes concentrações de MO e CL a fim de avaliar a atividade antimicrobiana através dos testes de concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM). Foi realizada uma análise da expressão diferencial de genes relacionados ao estresse oxidativo e à virulência de P. gingivalis através da técnica de RT-PCR, utilizando concentrações sub-CIM de MO e CL. As CIM e CBM encontradas para MO foram de 0,007% e para CL 1,5 μg/mL. O óleo de melaleuca reduziu significativamente a expressão dos genes de virulência kgp e ragA, e do estresse oxidativo dps, oxyR e sodB, enquanto que a CL reduziu a expressão do gene tpx (ANOVA, Bonferroni, p<0,05). O presente estudo concluiu que o óleo de Melaleuca possui ótima atividade inibitória e bactericida contra a bactéria P. gingivalis, além de reduzir de forma significante a expressão dos genes relacionados à virulência e ao estresse oxidativo, podendo ter um valor terapêutico futuro, principalmente no tratamento das periodontites.

Periodontal diseases are infections caused by microorganisms that colonize the tooth surface at the gingival margin or beneath it. Porphyromonas gingivalis is considered an important pathogen for chronic periodontitis. Studies have shown that the essential oil extracted from Melaleuca alternifolia has inhibitory and bactericidal activity against microorganisms from the oral cavity. Therefore, this study aimed to evaluate the effects of Melaleuca essential oil (MO) on growth and virulence of P. gingivalis, comparing to the activity of chlorhexidine (CL). Cultures of P. gingivalis were exposed to different concentrations of CL and MO to evaluate the antimicrobial activity by testing the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). An analysis of differential expression of genes related to oxidative stress and virulence of P. gingivalis was carried out through RT-PCR method, using sub-MIC concentrations of MO and CL. The MIC and MBC were found to be 0.007% for MO and 1.5 μg/mL for CL. MO significantly reduced the expression of virulence genes kgp and ragA, and oxidative stress genes dps, oxyR and sodB, while CL reduced the expression of the tpx gene (ANOVA, Bonferroni, p<0.05). This study concluded that Melaleuca essential oil presents an excellent inhibitory and bactericidal activity against the bacterium P. gingivalis, and significantly reduces the expression of genes related to virulence and oxidative stress, so may have a therapeutic value, particularly for periodontitis.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy.

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

Psychological stress has no association with salivary levels of ß-defensin 2 and ß-defensin 3.

BACKGROUND: Recent studies suggest that stress can predispose an individual to the development of periodontal disease, but the exact biological mechanism is unknown. Considering that psychological stress can down-regulate the production of ß-defensins (antimicrobial peptides produced in the oral cavity), the aim of the present study was to evaluate the association between stress and salivary levels of ß-defensin 2 (HBD-2) and ß-defensin 3 (HBD-3). METHODS: For this purpose, seventy five volunteers, classified as periodontally healthy, were submitted to a psychological evaluation using a validated questionnaire (Questionnaire of Lipp-ISS). Following analysis of the questionnaires, the subjects were divided in two groups (Group A: Absence of stress and Group B: Presence of stress). Unstimulated saliva samples were collected and the concentration of total protein was determined using the BCA method, and the concentrations of HBD-2 and HBD-3 were determined by ELISA. RESULTS: The levels of total protein did not show a statistically significant difference between the groups. Analyses of HBD-2 and HBD-3 concentrations indicate that the stress condition was not associated with the levels of either peptide in saliva (P=0.3664 for HBD-2 and P=0.3608 for HBD-3). CONCLUSION: In periodontally healthy subjects, HBD-2 and HBD-3 levels are not influenced by stress.

Oral streptococci growth on aging and non-aging esthetic restorations after radiotherapy

The aim of this study was to examine Streptococcus mutans biofilm growth on both aged and non-aged restorative dental resins, which were submitted to therapeutic irradiation. Sixty-four disks of an esthetic restorative material (Filtek Supreme) were divided into 2 groups: aged group (AG) and a non-aged group (NAG). Each group was subdivided into 4 subgroups: non-irradiated and irradiated with 10Gy, 35Gy, and 70Gy. The biofilms were produced by Streptococcus mutans UA159 growing on both AG and NAG surfaces. The colony-forming units per mL (CFU/mL) were evaluated by the ANOVA and the Tukey LSD tests (α=0.05). AG presented smaller amounts of CFU/mL than the NAG before irradiation and after 10Gy of irradiation (p<0.05). AG irradiated with 35 and 70Gy showed increased amount of bacterial biofilm when compared to non-irradiated and 10Gy-irradiated disks (p<0.05). The exposure to ionizing radiation at therapeutic doses promoted changes in bacterial adherence of aged dental restorative material.

O objetivo deste estudo foi avaliar a formação do biofilme de Streptococcus mutans crescido em resina restauradora envelhecida e não-envelhecida, submetidas à radiação terapêutica. Sessenta e quatro discos do material restaurador Filtek Supreme foram divididos em 2 grupos: grupo envelhecido (AG) e grupo não-envelhecido (NAG) e cada grupo foi dividido em 4 sub-grupos: não-irradiado e irradiado com 10Gy, 35Gy e 70Gy. O biofilme de S. mutans UA159 foi produzido na superfície de ambos os discos AG e NAG. As unidades formadoras de colônia/mL (UFC/mL) foram avaliadas por ANOVA e teste de Tukey (α=0,05). O grupo AG demonstrou menores quantidades de UFC/mL que o grupo NAG antes da radiação e após a radiação de 10Gy (p<0,05). Os sub-grupos AG irradiados com 35 e 70Gy demonstraram aumento na quantidade de biofilme quando comparado aos não irradiados e irradiados com 10Gy (p<0,05). A exposição à radiação ionizante nas doses terapêuticas promoveu mudanças na aderência bacteriana no material restaurador.

The effects of nicotine and cotinine on Porphyromonas gingivalis colonisation of epithelial cells.

Smoking is a risk factor for development of periodontitis. Porphyromonas gingivalis is an important colonizer of the subgingival crevice and is a major pathogenic agent in the initiation and progression of severe forms of periodontal disease. However, the effect of major cigarette's derivatives on P. gingivalis is poorly understood. The purpose of this study was to determine the influence of nicotine and cotinine on bacterial colonisation to epithelial cells. KB cells monolayers and P. gingivalis ATCC 33277 were exposed to 0.1, 10 and 100 microg/mL of nicotine and cotinine concentrations. The epithelial cells were incubated for 24 h while P. gingivalis was exposed to these substances until reach early logarithmic phase. After the incubation period, P. gingivalis ability to colonize KB cells was assayed. The number of cell-associated/invasive bacteria was assessed by counting the colony-forming units. 100 microg/mL cotinine significantly increased P. gingivalis association and invasion of epithelial cells, when the bacteria was exposed to this substance (p<0.05; ANOVA-Tukey test). No other condition or drug altered the bacteria colonisation ability (p>0.05). These data indicated that cotinine may interfere with P. gingivalis ability to associate and invade the epithelial cells. Further studies are needed to investigate whether oral cells might be more susceptible to be colonized by P. gingivalis in smokers.

Prevalência de cárie, presença de biofilme e inflamação gengival em pacientes com síndrome de respiração bucal / Caries prevalence, presence of biofilm and gingival inflammation in Mouthbreathing Syndrome Patients

A respiração representa uma das principais funções no organismo e sua disfunção, como a respiração bucal, pode acarretar em alterações orgânicas gerais. Existe uma grande prevalência de casos de crianças respiradoras bucais, tanto em idade escolar, quanto em idade pré-escolar. No entanto, ainda não está totalmente esclarecido se existe uma relação entre esse padrão respiratório e as doenças bucais. Sendo assim, o objetivo desse estudo foi comparar o índice de placa, CPOD e presença de gengivite em pacientes respiradores bucais e nasais, em idade escolar, com dentição mista. Foram selecionados 63 estudantes de duas escolas públicas, com idades entre 10 e 12 anos, na cidade de Taubaté, São Paulo. Após avaliação do padrão de respiração pela fonoaudióloga, os estudantes foram divididos em dois grupos: (RB) Respirador bucal, n = 32 e (RN) Respirador nasal, n = 31. Em ambos os grupos foram feitas análise de CPOD, índice de placa e índice de sangramento gengival. A análise estatística foi feita utilizando o teste Mann Whitnney, considerando 5% de nível de significância. Não foram encontradas diferenças estatísticas entre os grupos RN e RB para os parâmetros CPOD, índice de sangramento e índice de placa total. No entanto, o grupo RN apresentou maior índice de placa na região anterior em comparação grupo RB (p < 0,05). Dessa forma, foi concluído que respiradores bucais com idade entre 10 e 12 anos podem apresentar maior acúmulo de placa na região anterior da arcada dentária e, portanto, podem desenvolver futuramente problemas como cárie e gengivite.

Breathing represents one of the vital functions of the organism, and its unbalance, as mouth breathing, may cause some series of general organic alterations. There is a high prevalence of mouth breathing cases in scholar and prescholar children. However, it is not clear if exist a relation between this dysfunction and the oral diseases. Then, the aim of this study was to compare the plaque index, DMTF index and gingival index in nasal and mouth breathing children, with mixed dentition. The sample consisted of 63 children attending 2 public schools, with ages ranging from10 to 12, from the city of Taubate, São Paulo. The patients were divided in 2 groups after clinical diagnosis regarding breathing pattern: nasal breather (NB), n=32, and mouth breather (MB), n=31. DMTF index, plaque index and gingival bleeding index analyses were performed in both groups. Statistics were carried out by means of the Mann Whitnney test and the significance level was set at 5%. Considering the results from total DMTF, total plaque and total gingival indexes, no significant differences were found between groups. However, the NB group showed a higher plaque index in the anterior region (p<0.05). In conclusion, mouth breathing patients aging from 10 to 12 may have a higher plaque index in the anterior region and may be more susceptible to develop caries and gingivitis.

Interações medicamentosas: analgésicos, antiinflamatórios e antibióticos (Parte II) / Drug Interactions: Analgesics, Antimicrobial and Anti-Inflammatory Agents

Esta revisão, a segunda da série, descreve as principais interações que podem ocorrer com os fármacos antimicrobianos e analgésicos prescritos na clínica odontológica. É responsabilidade do cirurgião-dentista conhecer as possíveis interações que podem ocorrer com os fármacos antimicrobianos e analgésicos e o potencial risco dessas associações, a fim de que possa evitá-las durante o tratamento odontológico. Os autores discutem se essas associações comprometem a eficácia dos medicamentos e em que situações essas interações devem ser evitadas. Recomendações e precauções são também fornecidas com o objetivo de prevenir estas complicações

In vitro evaluation of the effect of nicotine, cotinine, and caffeine on oral microorganisms.

The aim of this in vitro study was to evaluate the effects of nicotine, cotinine, and caffeine on the viability of some oral bacterial species. It also evaluated the ability of these bacteria to metabolize those substances. Single-species biofilms of Streptococcus gordonii, Porphyromonas gingivalis, or Fusobacterium nucleatum and dual-species biofilms of S. gordonii -- F. nucleatum and F. nucleatum -- P. gingivalis were grown on hydroxyapatite discs. Seven species were studied as planktonic cells, including Streptococcus oralis, Streptococcus mitis, Propionibacterium acnes, Actinomyces naeslundii, and the species mentioned above. The viability of planktonic cells and biofilms was analyzed by susceptibility tests and time-kill assays, respectively, against different concentrations of nicotine, cotinine, and caffeine. High-performance liquid chromatography was performed to quantify nicotine, cotinine, and caffeine concentrations in the culture media after the assays. Susceptibility tests and viability assays showed that nicotine, cotinine, and caffeine cannot reduce or stimulate bacterial growth. High-performance liquid chromatography results showed that nicotine, cotinine, and caffeine concentrations were not altered after bacteria exposure. These findings indicate that nicotine, cotinine, and caffeine, in the concentrations used, cannot affect significantly the growth of these oral bacterial strains. Moreover, these species do not seem to metabolize these substances.

Use of phytotherapy in dentistry.

Over the past decade, interest in drugs derived from medicinal plants has markedly increased. This study was aimed at a literature review focusing on studies investigating herbal drugs and other natural products, as well as their therapeutic application, side effects and possible drug interactions. Few studies were found to support their rational use in dentistry. Since there is an increasing use of phytotherapeutic agents in dentistry, further studies are needed to evaluate their safety and effectiveness for clinical use.